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Childhood Obesity and the Link to Diabetes

Anita Wheeler, RN, MSN

Department of State Health Services

Health Promotion and Chronic Disease Prevention Section

School Health Coordinator/School Nurse Consultant

anita.wheeler@dshs.state.tx.us

Learning Objectives

• Define the terms overweight and obesity.

• Describe three health consequences of childhood obesity.

• Identify at least two nursing interventions that can be implemented in schools to address obesity and prevent Type 2 diabetes.

• Develop an Individualized Health Care plan that includes nursing outcomes for weight management and physical fitness.

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Update on Change in Definition of Obesity and Overweight

• Texas has established a surveillance system, School Physical Activity and Nutrition (SPAN), to monitor the prevalence of overweight/obesity in school-aged children.

• The information below helps in understanding the next slides about SPAN data.

• There was a change in the definitions of overweight and obesity among children and adolescents (17 years and younger) since 2007.

• These changes were implemented in accordance with the 2007 recommendations from the Expert Committee on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity convened by the American Medical Association (AMA) and co-funded by AMA in collaboration with the Health Resources and Services Administration and the CDC.

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Definition As categorized before 2007 As categorized 2007 and later

BMI ≥ to 95th percentile for age and sex

Overweight Obese

BMI ≥ 85th percentile and < 95th percentile for age and sex

At risk for overweight Overweight

Percentage of U.S. Children and Adolescents Classified

as Obese, 1963–2008*

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•*>95th percentile for BMI by age and sex based on 2000 CDC BMI-for-age growth charts.

•**1963–1970 data are from 1963–1965 for children 6–11 years of age and from 1966–1970 for adolescents 12–17 years of age.

•Source: NCHS. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD. 2011

•4.6

•4.2

•19.6

•18.1

3

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0

5

10

15

20

25

1963–1965, 1966–1970

1971–1974 1976–1980 1988–1994 1999–1900 2001–2002 2003–2004 2005–2006 2007–2008

Per

cen

tag

e

Prevalence of obesity among U.S. children and adolescents aged 2–19, for selected years 1963–1965 through 2007–2008

Total

2–5

6–11

12–19

Data Source: NHES 1963-1965 and 1966-1970 and NHANES from 1971-2008.Data for 1963–1965 are for children aged 6–11; data for 1966–1970 are for adolescents aged 12–17, not 12–19 years. Children aged 2–5 were not included in the surveys undertaken in the 1960s.http://www.cdc.gov/nchs/data/hestat/obesity_child_07_08/obesity_child_07_08.pdf

11th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN,

2000-2002 to 2004-2005

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*Overweight is > 95th Percentile for BMI by Age/Sex

2000-2002 2004-2005

Note: As explained in the previous slide the definition of overweight before 2007 was ‘> 95th Percentile for BMI by Age/Sex’ which is now categorized as obese.

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Prevalence of Obesity among 11th Graders by Health Service Region, SPAN 2009-2011

8th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN,

2000-2002 to 2004-2005

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*Overweight is > 95th Percentile for BMI by Age/Sex

2000-2002 2004-2005

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Prevalence of Obesity among 8th Graders by Health Service Region, SPAN 2009-2011

4th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN,

2000-2002 to 2004-2005

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*Overweight is > 95th Percentile for BMI by Age/Sex

2000-2002 2004-2005

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Prevalence of Obesity among 4th Graders by Health Service Region, SPAN 2009-2011

Obesity In High School:Texas and the U.S., 2001-2009

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Prevalence of High School Students Who Were Obese (At or Above the 95th Percentile for BMI by Age and Sex)

2001, 2005, 2007, 2009 YRBSTexas vs. United States

14.2 13.9 15.9 13.610.5 13.1 13.0 12.00.0

2.0

4.0

6.0

8.0

10.0

12.0

14.0

16.0

18.0

20.0

2001 2005 2007 2009

Per

cent

age

Texas US

HP2010 Target

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Obesity In High School:Trend in Texas and the U.S., 1999-

2009

14.2% 13.9%

15.9%

13.6%

10.7% 10.5%

12.1%13.1% 13.0%

12.0%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

1999 2001 2003 2005 2007 2009

Pre

val

ence

Year

Obesity Prevalence Trend in Texas and US Adolescents, YRBS 1999 to 2009

Texas

US

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Obesity In High School:Trend in Texas and the U.S., 1999-2011

14.2% 13.9%

15.9%

13.6%

15.6%

10.7% 10.5%

12.1%13.1% 13.0%

12.0%13.0%

0%

2%

4%

6%

8%

10%

12%

14%

16%

18%

1999 2001 2003 2005 2007 2009 2011

Pre

val

ence

Year

Obesity Prevalence Trend in Texas and US Adolescents, YRBS 1999 to 2011

Texas

US

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Obesity In High School: U.S. 2005-2011

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2005 2007

2009 2011

Obesity in High School:By Race and Ethnicity

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Prevalence of High School Students Who Were Obese (At or Above the 95th Percentile for BMI by Age and Sex) by Race/Ethnicity

2001, 2005, 2007, 2009 Texas YRBS

10.9 10.2 13.8 10.017.3 18.0 14.6 16.717.6 16.9 19.2 16.58.0 7.5 15.2 7.60.0

5.0

10.0

15.0

20.0

25.0

30.0

2001 2005 2007 2009

Per

cen

tag

e

White Black Hispanic Other

HP2010 Target

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Obesity in High School:By Race and Ethnicity, Texas 2001-2011

10.9 10.2 13.8 10 10.217.3 18 14.6 16.7 16.417.6 16.9 19.2 16.5 19.28 7.5 15.2 7.6 14.10

5

10

15

20

25

30

2001 2005 2007 2009 2011

Per

cen

tag

e

Prevalence of Obesity among High School Students:By Race and Ethnicity, Texas 2001-2011

White Non-Hispanic African-American Non-Hispanic Hispanic Other

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ObesityNot just an adult concern anymore…

Conditions Seen in Children• High Cholesterol

• Type 2 Diabetes/Impaired Glucose Tolerance

• High Blood Pressure

• Social Problems andPoor Self-Esteem

• Sleep Disturbances

• Orthopedic Problems

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Obese children and adolescents are more likely to become overweight or obese adults

• Heart Disease• Cancer• Stroke• Type 2 Diabetes• Osteoarthritis• Physical Disability• High Blood Pressure• Sleep Apnea

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Factors Contributing to Obesity

Genetics

Environment

Unhealthy Diet

Sedentary Lifestyle

Lack of Physical Activity

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School Environments

School Food Environment

Low-nutrient, energy-dense foods and beverages are

• Served in vending machines, à la carte lines, school stores, fundraisers, and classroom parties.

• Marketed to students.

(cont.)Page 22

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School Environments

School Physical Activity Environment

• Daily physical education is not provided in most schools.

• Daily recess for elementary school students is not offered at many schools.

• Walking or biking to school is less common.

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SchoolHealth

Guidelines

1. Policies and Practices

2. School Environments

3. Nutrition Services

4. Physical Education andPhysical Activity

5. Health Education

6. School Health Services

7. Family and Community

8. School Employee Wellness

9. Professional Development

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Policies and Practices

School Health

Council

School Health Team

School Health

Coordinator

Assess*

Develop and Implement

Evaluate

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•* Using the School Health Index (www.cdc.gov/HealthyYouth/SHI)

GUIDELINE 1

School Health

Council

Coordinated School

Health Team

School Health

Coordinator

Family and Community

Promote Communication and Involvement

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Schools

• Families• Community

Members

14

School Health Services

ASSESS

REFER

ADVOCATE

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•Health Services

•Mental Health•Services

•Social•Services

•STAFF

NANDA Nursing Diagnosis(These are just the basic ones)

• Altered nutrition: intake exceeds the body’s needs

• Impaired physical mobility

• Deficit recreation

• Knowledge deficit related to (nutrition, physical activity)

• Chronic low self-esteem or Disorder of low self-esteem

• Social isolation

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Nursing Intervention Classifications (NIC)

• Comprehensive

• Research based

• Reflects current clinical practice

• Easy to use (Domains, Classes, Interventions, Activities all have definitions)

• Uses language that is clear and meaningful

• Continually updated

• Field tested

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Possible Nursing Interventions

• Behavior modification (4360)

• Body image enhancement (5220)

• Emotional support (5270)

• Family involvement promotion (7110)

• Health education (5510)

• Journaling (4740)

• Nutrition management (1100)

• Program development (8700)

• Teaching: activity/exercise (5612)

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Exercise Promotion (0200)

• Appraise beliefs

• Explore prior experiences

• Determine motivation

• Explore barriers

• Encourage verbalization

• Encourage to begin or continue exercise

• Assist in finding positive role model

• Assist in setting short and long term goals

• Include family in planning

• Inform about health benefits

• Instruct on frequency, duration, and intensity

• Monitor adherence

• Help in preparing progress chart

• Instruct on proper warm up and cool down

• Monitor response to program Page 31

Nursing Outcome Classifications

• Developed inductively and deductively

• Grounded in clinical practice and research

• Uses clear, useful language

• Helps in organizing outcome measures

• Outcomes can be shared by all disciplines

• Optimizes information for evaluation of effectiveness.

• Funded by the National Institute of Nursing Research

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Nursing Outcome Measures

• Knowledge-diet (1802)

• Compliance Behavior: Prescribed diet (1622)

• Knowledge-Weight management (1841)

• Physical Fitness (2004)

Page 33Nursing Outcome Classifications (NOC) Fourth Edition ISBN: 978-0-323-05408-9

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Knowledge: Diet- (1802)

Knowledge: Diet Overall Rating

No Knowledge1

Limited Knowledge

2

Moderate Knowledge

3

Substantial Knowledge

4

Extensive Knowledge

5

Not ApplicableN/A

Indicators:Recommended diet

1 2 3 4 5

Rationale for diet 1 2 3 4 5

Dietary goals 1 2 3 4 5

Relationship among diet, exercise and weight

1 2 3 4 5

Interpretation of food labels 1 2 3 4 5

Strategies to change dietary habits

1 2 3 4 5

Self-monitoring techniques 1 2 3 4 5

Outcome Target Range: Maintain at ______ Increase to _____

Nursing Outcome Classifications (NOC) Fourth Edition ISBN: 978-0-323-05408-9

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Individualized Healthcare Plan

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• Nursing Assessment• Nursing Diagnosis• Planning Care Utilizing Nursing Interventions

and Outcome Classifications• Implementation• Evaluation

Constructing a Nursing Care Plan

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Assessment Nursing Diagnosis Planning (NIC and NOC)

Implementation Evaluation (NOC Completed)

Height Weight Calculate BMIB/P

Family History FitnessGram dataFood diaryPhysical activity log

Other Assessment Information

1) Altered nutrition:intake exceeds thebody’s needs

2) Activity intolerance3) Impaired physical

mobility4) Knowledge

deficit/nutrition or physical activity

5) Activity intolerance or high risk of intolerance

6) Sleep pattern disturbance

7) Recreation deficit8) Social isolation

1) Promotion of Behavior Change

2) Body Image Enhancement

3) Emotional Support4) Exercise Promotion5) Family Involvement

Promotion6) Health Education7) Journaling8) Nutrition Management9) Nutritional Counseling10) Program

Development11) Teaching: Prescribed

Activity/Exercise

• Should outline who you will be collaborating with, if applicable.

• Also should outline specific timeline for implementation.

• Should outline the steps of implementation.

Example: Knowledge: Diet-1802

Rational 1 2 3 4 5 N/AAdvantages 1 2 3 4 5 N/ADietary Goals 1 2 3 4 5 N/AInterpretation

Food Labels 1 2 3 4 5 N/AStrategies to

Change 1 2 3 4 5 N/ASocial Situations 1 2 3 4 5 N/ASelf-monitoring

Techniques 1 2 3 4 5 N/A

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National Association of School Nurses (Online Courses)Childhood Overweight and Obesity: Overview

1.0 CNE Contact HourFree to NASN Members! (Non-member price: $15.00)

Evidence-based Practice1.0 CNE Contact HourFree to NASN Members! (Non-member price: $15.00)

School Nurse Leadership: Advocating for Change1.0 CNE Contact HourFree to NASN Members! (Non-member price: $15.00)

Height/Weight and BMI Screening, Resources and Interventions1.0 CNE Contact Hour/moduleFree to NASN Members! (Non-member price: $15.00)

Acanthosis Nigricans - School Nurse Educational Program1.0 CNE contact hourFree for all audiences!

Texas Health Step Modules (Free CEs) http://www.txhealthsteps.com/cms/ObesityExercise Induced AsthmaOther Child Health Topics

Training and Resources

Resources

• DSHS-Diabetes Council Algorithms

http://www.tdctoolkit.org/download_a_tool_kit.asp

• DSHS-Diabetes Main Page

http://www.dshs.state.tx.us/diabetes/

• DSHS-Obesity Prevention (Videos)

http://www.dshs.state.tx.us/obesity/GrowingCommunity.shtm

• DSHS-Nutrition, Physical Activity and Obesity Home Page

http://www.dshs.state.tx.us/obesity/NPAOPprogrampage.shtm

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Contact Information

Anita Wheeler, RN, MSNSchool Health Coordinator/School Nurse Consultant

512-776-2909

anita.wheeler@dshs.state.tx.us

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