JENNIFER PANZARELLA RN, BSNNURS 565: NURSE AS EDUCATOR

Childhood Obesity

Introduction

Click or copy and paste link into your browser:

https://www.youtube.com/watch?v=2Hd0qwxvgH4

Definition

• Weight gain is the imbalance between caloric intake and energy expenditure.

• When the child is above the normal healthy weight for his or her age and height.

• Obesity is determined using the Body Mass Index (BMI).

http://www.cdc.gov/healthyweight/physical_activity/index.html

Overweight or Obese

Overweight:Body Mass Index (BMI) at or above the 85th

percentile and below the 95th percentile

Obese:Body Mass Index (BMI) at or above the 95th percentile

http://www.cdc.gov/obesity/childhood/defining.html

Body Mass Index (BMI)

BMI Calculator:

https://nccd.cdc.gov/dnpabmi/

Calculator.aspx

How to calculate BMI: Weight in kilograms divided by a

weight in meters

Age specificSex specificInexpensiveNot invasiveEasy to performHigh BMI is an indicator of high

body fathttp://www.cdc.gov/healthyweight/physical_activity/index.html

QUESTIONHow many children and adolescents aged 2-19 are affected

by childhood obesity in America?

a. 6 Millionb. 25 millionc. 12.7 milliond. 2 million

Statistics• Tripled over the last 30 years

• One third (1 in 3) of children and adolescents are overweight or obese.

• Childhood obesity affects 12.7 million in the U.S.

• Higher prevalence in Hispanics (21.9%) and Non-Hispanic Blacks (19.5%)

• 17% of children and adolescents are overweight or obese*CDC statistics are based on children and adolescents aged 2-19 between 2011-2014

New York State Otsego County

17.6% children and adolescents are overweight or obese

16.4% children and adolescents are overweight or obese

Statistics

The Healthy People 202o program goals aim to reduce childhood obesity

prevalence to 14.5% by 2020.

QUESTIONChildhood obesity increases the risk for:

a. Asthmab. Diabetesc. Cardiovascular diseased. Depressione. All of the above

Acute Health ConcernsHigh Blood PressureHigh CholesterolDiabetesAsthmaSleep ApneaJoint discomfortLiver DiseaseGallstonesGastro-esophageal reflux (GERD)DepressionLow self-esteem

Chronic Health Concerns

Adult Obesity Cardiovascular Disease Diabetes High Blood pressure Stroke Cancer Osteoarthritis Reproductive Problems Gallstones Sleep disorders Depression

QUESTION

What are the 3 major contributing factors associated with Childhood Obesity?

a. Inactivityb. Increased consumption of high-caloric foods (Food choices)c. Geneticsd. Media use or Screen time

Contributing factors

Genetics (or other organic causes)

Behavioral Environmental

*Minor role

• Not the major contributor• Taken into consideration• Medical causes should be

ruled out

*Important role

• Physical Inactivity• Food choices• Media use or screen time• Eating patterns• Social norms• Cultural norms• Family norms• Parenting style• Parents overweight or

obese

*Influential role

• Daycare• School• After-school programs• Community• Home

5-2-1-0 Lets go!Nationally recognizedReinforce healthful habitshttp://www.letsgo.org

Goals: To increase physical activity and healthful

eating habits.

Lets Move!Launched in 2010 by First Lady Michelle Obama

Initiatives Promotes Healthy Futureshttp://www.letsmove.gov

Initiatives1. Creating a healthy start for children2. Empowering parents and caregivers3. Providing healthy food in schools4. Improving access to healthy, affordable foods5. Increasing physical activity

Benefits of Family-based Interventions

Research finds that parental involvement strongly influences a child’s behaviors.

Integral change agentParents are responsible for meal planning (Plan, Purchase, and

Prepare)Parents are responsible for activity planningParents are the primary role-models for their own children

Where do we start?

INCREASED SCREEN TIMEPHYSICAL INACTIVITYPOOR EATING HABITS

Contributing Factors Associated with Childhood Obesity:

QUESTION

How many hours does the average school-age child spend in front of a screen?

a. 2 hoursb. 7 hoursc. 4 hourd. 9 hours

Screen Time

29% of children under 1 years old watch TV about 90 minutes daily.

64% of toddlers watch TV for about 2 hours daily.Preschoolers spend about 2.2 to 4.6 hours in front of a screen.School-age children spend about 7 hours daily in front of a

screen.

www.commercialfreechildhood.org

Screen TimeChildren are growing up connectedTechnology is everywhereInteractiveMobileThere are benefitsThere are challenges and health concerns

The American Academy of Pediatrics (AAP) released a statement in November 2016 discussing the impact of media on cognitive, language,

motor, social, and emotional skills of children.

www.healthychildren.org/MediaUsePlan

Screen time and Childhood Obesity

Increased screen use is associated with childhood obesityScreen time is linked to an elevated BMIScreen time is associated with consuming extra caloriesScreen time is associated with inactivityBedroom TV’s are associated with elevated BMI

www.commercialfreechildhood.org

Screen time and Other Concerns

Linked to irregular sleep patternsLinked to sleep disturbancesLinked to delayed language skillsLess time engaged in creative play to develop problem-

solving skillsDecreased interactions and decreased socializingAssociated lower academic achievements and poor gradesAssociated with inactivityAssociated with increased psychological difficulties

www.commercialfreechildhood.org

Screen Time and Media: AAP Recommendations

Avoid digital media in children 18-24 months of age. If you choose to introduce digital media, choose high quality programs and do it together!

Limit screen time for children 2-5 years to co-viewing 1 hour per day high quality programs. Help children understand and apply concepts to world around them!

Avoid fast-paced and violent content. Do not leave televisions on when not in use. Do not use media to calm child. Monitor media and downloaded content. Make mealtimes media and screen free. No screens 1 hour before bed. Create unplugged spaces Use new technology in social and creative ways Do not substitute sleep, activity, play, reading or social interactions with media or screen use.

AAP: Media and Young Minds (2016) http://pediatrics.aappublications.org/content/pediatrics/early/2016/10/19/peds.2016-2591.full.pdf

Pros Cons Prevent Childhood obesityTend to eat healthierMore activeEducational benefitsWhat else?

Developmental concernsHealth concerns (Obesity)Behavioral concerns

(Hyperactivity)What else?

Discussion: Media and Screen Use

What can you do to minimize media and screen use in your

family?

QUESTION

How many hours should a school-age child engage in aerobic physical activity?

a. 1 hourb. 2 hoursc. 30 minutesd. 1 or more hours

Physical ActivityAccording to the CDC children and adolescents should engage

in 60 minutes or more of physical activity daily.

• Aerobic Activity (moderate to vigorous)• Muscle Strengthening• Bone Strengthening

http://www.cdc.gov/physicalactivity/basics/children/what_counts.htm

Physical Activity Examples

What activities do YOU enjoy?

What activiites do your CHILDREN enjoy?

What activities will you enjoy as a FAMILY?

Aerobic Activity (moderate-vigorous)• Hiking• Running• Walking

• Bicycle riding• Jumping rope• Swimming• What else?

Muscle Strengthening• Resistance exercises

• Push-ups• Sit-ups

• Gymnastics• Rock Climbing

• Weights• What else?

Bone Strengthening• Hopping• Skipping• Running• Basketball• Volleyball• tennis

• What else?http://www.cdc.gov/physicalactivity/basics/children/what_counts.htm

Benefits Barriers Reduce risk for Childhood

obesityBuild strong bones and

musclesReduce depressive symptomsMay improve academic skillsIncreased quantity of lifeWhat else?

TimeMotivationFearSupportAccessWhat else?

Discussion: Physical Activity

How can you add physical activity to your family routine?

Active Learning: Calendar

Participates will break into 4 groups. Each group will fill in one week of physical activities on the

calendar. Each group will complete 7 days (Sunday-Saturday) We will share the suggestions with the entire groupUpon completion of the discussion the entire group will have

one month of physical activities that can be used at home. You got

this!You Got this!

Calendar Example

Sunday Monday Tuesday Wednesday

Thursday Friday Saturday

Bike ride in the park

Walk after dinner

Family Basketball game at

local community

center

Swimming at local

pool

Family exercise

night. Use a video or make your

own!

Rock climbing at

local community

center

Family football game

QUESTION

What is the major factor impacting food choices today?

a. Availabilityb. Colorc. Convenienced. Taste

Healthy Eating Habits

• Healthy eating habits start early in life• Advertising impacts the foods purchased• Limited access to healthy and affordable foods• Greater availability to high caloric foods• Increased portion sizes• Don’t skip breakfast• Foods are chosen often based on convenience

https://www.cdc.gov/obesity/childhood/causes.htmlhttp://www.cdc.gov/healthyschools/nutrition/facts.htm

Healthy EatingFruits Grains Dairy Vegetables Protein Limit

• Whole fruits(Meals, Snacks, Dessert)

• Oatmeal• Popcorn• Brown Rice

• Fat-free milk

• Yogurt• Soy milk

• Fresh, frozen or canned

• Raw*• Salads• Sides• Main dishes

• Seafood• Beans• Unsalted

nuts and seeds

• Soy products

• Eggs• Lean meats• poultry

• Cake• Cookies• Pastries• Saturated

milk• Fats• Salt

• Half the plate should be fruits and vegetables (400g or 5 portions daily)

• Half your grains should be whole grains• Move to low fat dairy products• Vary your protein routine• Drink and eat less sodium, saturated fat, and added sugars

https://choosemyplate-prod.azureedge.net/sites/default/files/tentips/MyPlateMyWins.pdf

Healthful EatingMealtimes

Mealtime:https://choosemyplate-prod.azureedge.net/sites/default/files/printablematerials/DGTipsheet38BuildHealthyMealtimeHabits.pdf

Go food shopping togetherGet creative in the kitchenOffer the same foods for everyoneKids kid involved in the mealtime processDo not reward with foodEat at the table

Role model healthful eating habits!

Healthful EatingSnacks

Snacks:https://choosemyplate-prod.azureedge.net/sites/default/files/printablematerials/DGTipSheet24MyPlateSnackTipsforParents.pdf

• Prepare in advance (slice veggies and store them)

• Mix it up! • Snack on lean protein• Offer whole-wheat breads and cereals• Portion control• Fruits are quick and easy• Consider individually wrapped low fat

cheese• Drink low fat milk instead of sugary

alternatives• Drink water

Role model healthful eating habits!

Pros Cons (barriers)Prevent Childhood obesityPromote growth and

developmentIncreased energyHigher quality of lifeWhat else?

Overweight or obese Energy imbalance Decreased health Decreased cognitive development Cost Time What else?

Discussion: Health Eating

How can you promote healthy eating habits in your family?

Active Learning: Calendar

Participates will break into 4 groups. Each group will fill in one week of snacks on the calendar. Each group will complete 7 days (Sunday-Saturday) We will share the suggestions with the entire groupUpon completion of the discussion the entire group will have one month of

snacks that can be used at home.

You got

this!Eat Good

Feel good!

Calendar Example

Sunday Monday Tuesday Wednesday Thursday Friday Saturday

Carrots,Celery, and

Low-fat Ranch

dressing

Cheese,whole wheat

crackers, and

grapes

Apple slices, and trail mix

(dried fruit, whole grain cereal, and

nuts)

Cucumbers slices,

broccoli, and low-fat

ranch dressing

Cheese quesadilla's with salsa

Apple slices, celery sticks,

raisins, and peanut butter

Whole wheat

blueberry muffins and strawberrei

s

Parental Role

Create a healthy home environment

Engage children in physical activityMonitor media use and reduce screen timeMake available healthy foodsUse authority as a TOOL

Role-model healthful behaviors!

Click or copy and paste link into browser:https://www.youtube.com/watch?v=3bxGV2NBSy8 

Handout:https://choosemyplate-prod.azureedge.net/sites/default/files/tentips/

DGTipsheet12BeAHealthyRoleModel.pdf

*Based on LetsMove! initiatives

Benefits Barriers Decreased health risksIncreased quality of lifeIncreased quantity of lifeWhat else?

Access to healthy foodsCost of healthy foodsAccess to community activitiesCost of activitiesTimeWhat else?

Discussion: Adopting a Healthy Lifestyle

What are 3 ways you can incorporate healthy habits into the

family routine?

Behavior Change Change happens gradually

Will not happen Overnight

Use support and

resources

There will be set-backs

Pre-contemplation Stage: Consider the changeContemplation Stage: Consider pros and consPreparation Stage: Decide to make changeAction Stage: Take action!Maintenance: Sustained lifestyle change

When Set-Backs occurs… get back into action!

Make realistic mini-goals and focus on SUCCESS!

Setting Realistic GoalsMotivations Family

StrengthsBarriers Actions Realistic

Mini-GoalsSupport

Loose weight Enjoy outside

activities

Time

Energy

What else?

Plan and prepare healthy

meals and snacks

Plan time to exercise

Keep a calendar to

track progress

Physical Activity goal:Participate in pre-planned

activities for 30 minutes 3x

week.

Screen Goal:3 hours per day

Eating goal:Will eat 2

servings of fruits and vegetables daily 4x this

week

FAMILY

After school programs

Community based

programs

Preparation Stage Action Stage Maintenance Stage

SUCCESS

Track progressReward Success (NOT with food!)Be flexibleMake adjustmentsChange things upKeep it fresh

Have Fun!

Lets Review!

1. Identify chronic health concerns related to childhood obesity.

2. Identify two ways to increase physical activity

3. Identify two ways to encourage healthy eating habits.

4. Identify two ways to role model healthful behaviors to their children.

We can do it Together!

References

Clarke, J., Fletcher, B., Lancashire, E., Pallan, M., & Adab, P. (2013). The views of stakeholders on the role of the primary school in preventing childhood obesity: a qualitative systematic review. Obesity Reviews, 14(12), 975-988. doi:10.1111/obr.12058

Davison, K, Jurkowski, J., Li, K., Kranz, S. and Lawson, H. (2013). A childhood obesity intervention developed by families for family: results from a pilot study. International Journal of Behavioral Nutrition and Physical Activity. 10;3. Pp. 2-11. DOI: 10.1186/1479-5868-10-3

Find Your Healthy Eating Style and Maintain it for a Lifetime. (2016). United States Department of Agriculture (USDA). Retrieved from:https://choosemyplate-prod.azureedge.net/sites/default/files/tentips/MyPlateMyWins.pdf

Healthy Diet. (2015). World Health Organization (WHO). Retrieved from: http://www.who.int/mediacentre/factsheets/fs394/en/

Healthy Weight. (2015). Centers for Disease Control and Prevention (CDC). Retrieved from: http://www.cdc.gov/healthyweight/physical_activity/index.html

Karnik, S., & Kanekar, A. (2012). Childhood Obesity: A Global Public Health Crisis. International Journal of Preventive Medicine. 3(1): 1–7.

Lindsay, A., Sussner, K., Kim, J., and Gortmaker, S. (2006). The Role of Parents in Preventing Childood Obesity. Future of Children. 16(1): 169- 186. Retrieved from: http://www.futureofchildren.org/publications/docs/16_01_08.pdf

Matthews, T. and Hamilton, B. (2016). Mean Age of Mothers is on the Rise: United States, 2000-2014. NCHS data brief, no. 232. Centers for Disease Control and Prevention (CDC). Retrieved from: http://www.cdc.gov/nchs/products/databriefs/db232.htm

Media and Young Minds (2016). Council On Communications and Media. Pediatrics. DOI: 10.1542/peds. 2016-2591. Retrieved from: http://pediatrics.aappublications.org/content/pediatrics/early/2016/10/19/peds.2016-2591.full.pdf

Nutrition, Physical Activity, and Obesity. (2014 May). Leading Health Indicators. Healthy People 2020. Retrieved from: https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Nutrition-Physical-Activity-and-Obesity

Ogdon, C., Carroll, M., Fryar, C., and Flegal, K. (2015). Prevalence of Obesity Among Adult and Youth: Untied States, 2011-2014. NCHS Data brief. US. Department of Health and Human Resources and Centers for Disease Control and Prevention and National Center for Health Statistics. Retrieved from: http://www.cdc.gov/nchs/data/databriefs/db219.pdf

Overweight and Obesity. (2015). Centers for Disease Control and Prevention (CDC). Retrieved from: http://www.cdc.gov/obesity/childhood/defining.html

Nutrition. (2016). Centers for Disease Control and Prevention (CDC). Retrieved from: https://www.cdc.gov/nutrition/index.html

Physical Activity. (2015). Centers for Disease Control and Prevention (CDC). Retrieved from: http://www.cdc.gov/physicalactivity/index.html

Prevalance. (2014). Childhood Overweight. Obesity Society. Retrieved from: http://www.obesity.org/resources/facts-about-obesity/childhood-overweight

Raychaudhuri, M., and Sanyal, D. (2012). Childhood obesity: Determinants, evaluation, and prevention. Indian Journal of Endocrinology and Metabolism. 16: 192-194. Retrieved from: https://dx.doi.org/10.4103%2F2230-8210.104037

Selected Research On Screen Time and Children. (n.d.). Campaign for a Commercial-Free Childhood. Retrieved from: http://www.screenfree.org/wp-content/uploads/2014/01/screentimefs.pdf

Sorg, M., Yehle, K., Coddington,J., and Ahmed,A. (2013). Implementing family-based childhood obesity interventions. The Nurse Practitioner. Vol. 38. No. 9. Pp. 14-21.

What Are the Health Risks of Overweight and Obesity? (2012). Explore Overweight and Obesity. National Heart, Lung, and Blood Institute (NIH)> Retrieved from: https://www.nhlbi.nih.gov/health/health-topics/topics/obe/risks