Nicholas Ruttan
Nursing Process IV
Childhood Obesity: Preventing the Global Epidemic
Childhood obesity is a growing problem throughout the nation. In the last 30 years, childhood obesity rates have more than doubled in the nation, from 16.0% in 2003-2004 among female children and from 14.0% to 18.2% in male children (Ogden et al. 2006). As nurses, this can be particularly a problem because obesity can lead to many issues later in life that is associated with increased morbidity, and reduced quality of life (Lenz 2009). Prevention would be the ideal fix because obese individuals do not have to suffer from any of the negative effects of the problem later on. Another reason for prevention is that it would be more cost effective, obesity in the United States is projected to increase by the year 2030, totaling up to $66 billion to treating obesity related disease, meaning prevention can be less expensive than treatment (Voelker 2012). Given the current trend obesity will increase 33% in the prevalence of obesity over the next 20 years (Finkelstein 2012), resulting in more money spent on treating obese related diseases. The third reason for prevention is that treatment is not always effective. Some individuals do not always over come obesity therefore programs of prevention of obesity in children were reviewed in order to see the effectiveness of each.
The Physical Activity Across the Curriculum or PAAC (Donnelly et al. 2009) and the Happy 10 program (Li et al. 2010) are two obesity prevention programs aimed both at enhancing physical activity in children. One common approach from these programs is the embodiment of physical education within their programs. PAAC’s goal consisted of incorporating approximately 90 min per week of physical activity to the children. While the Happy 10 programs goal was aimed at two 10 minute physical activity sessions a day, during class break. Teachers of both programs were trained to administer the program, they were provided information that explained how to properly teach the exercises.
At the end of each program both the PAAC and Happy 10 program showed similarities in their results. Lower incidence of overweight was seen in the PAAC group compared to control group. In children at risk for obesity, results from 21.8% moved to normal BMI in the PAAC group compared to 16.8% in the control group and 22.6% in the PAAC group compared to 31.1% in the control group moved to overweight. (Donnelly et al. 2009)
In the schools that had implemented the PAAC program for more than 75 minutes weekly showed smaller increases in BMI compared to schools that did the program for a shorter time period. (Donnelly et. al. 2009) Schools that implemented PAAC greater than 75 min a week showed significantly less increase in BMI at 3 years of the program compared to schools with less than 75 minutes of the PAAC program weekly. Children that had been selected to participate in the Happy 10 program showed a significant decrease in BMI when compared to the control group. Students in the intervention group had a lower BMI, and body fat percent when compared to the control group after a year follow up. (Donnelly et al. 2009; Li et al. 2010)
Other prevention programs such as Kaledo (Amaro et al., 2006) and the Christchurch obesity prevention program or CHOPPS (James, Thomas, Cavan, & Kerr, 2004) are two programs that also had goals at reducing childhood obesity. These programs showed similarities in that both programs have a common factor in promoting healthy eating habits among children. Kaledo is a prevention program that uses a board game called, “Kaledo” to promote diet and exercise. The goal game is to promote healthy diets through a selection of game cards. While the CHOPPS program is an educational program aimed at reducing the number of carbonated drinks children consume and limit weight gain through sessions.
Both programs contained intervention and non-intervention groups between class time of regular school. Children in the intervention group of the Kaledo program were provided time during the school day to play “Kaledo” once per week over the span of 24 weeks, while kids in the CHOPPS program were taught in sessions, that promoted good health and promotion of water drinking over one year. At the end of the CHOPPS program, children drinking carbonated drinks had a significant decrease in the intervention compared to the control group; however it showed no significant change in BMI between the groups. The results of the Kaledo program showed children reported a better understanding of nutrition and healthy foods. However the children in the Kaledo program did not show any significant differences between BMI as well. (Amaro et al., 2006; James, Thomas, Cavan, & Kerr, 2004)
The Active Generations program is a program recruits volunteers to implement nutrition education and physical activity classes in after school and summer programs. (Werner et al., 2012) The Active Generations class consisted of 90 minute sessions that educated children in hands-on activities and preparation of nutritional snacks as well as a 30 minute exercise session in the form of games.
The Active Generations program used a pre and post evaluation filled out by each of the children to record progress. The survey was used to show what the children’s gained and learned from the program. Results showed significant increase in the children’s reported fruit and vegetable eating consumption and also enhanced their ability in reading food labels as well as an increase in their confidence of performing physical activity. (Werner et al., 2012) The Active Generations is a promising program that shows that the combination of physical activity and promotion of healthy lifestyle make a significant difference in the fight against obesity. This has shown two reliable components when studying the prevention of childhood obesity (Amaro et al., 2006; Donnelly et al. 2009; James, Thomas, Cavan, & Kerr, 2004; Li et al. 2010; Werner et al., 2012).
Nurses can play a pivotal role when looking at the key issue of prevention. Most of the focus of care lies in problems that arise from obesity. School nurses can perform health screenings including screening for obesity, which includes the measurement of BMI. In addition, school nurses could be responsible for health promotion, local meetings and training staff members within the school when advocating for changes.
It can be difficult to draw conclusions in regards to choosing one prevention program geared towards children from these programs because, while most of the studies reported change in weight few of them were significant. Further information would need to be obtained over a longer period of time for programs to yield long term results. However, when looking at the PAAC and Happy 10 program, it does show that scheduled exercise is an essential component to prevention of childhood obesity, opposed to just knowledge of proper diet as seen in the CHOPPS and Kaledo programs. It would appear as the key to the prevention of childhood obesity lies between the two components of exercise and healthy eating habits as demonstrated the most through the Active Generations program.
References
Amaro, S., Viggiano, A., Di Costanzo, A., Madeo, I., Viggiano, A., Baccari, M. E. (2006). Kalèdo, a new educational board-game, gives nutritional rudiments and encourages healthy eating in children: A pilot cluster randomized trial. European Journal of Pediatrics, 165, 630–635. doi: 10.1007/s00431-006-0153-9
Donnelly, J. E., Greene, J. L., Gibson, C. A., Smith, B. K.,Washburn, R. A., Sullivan, D. K., et al. (2009). Physical activity across the curriculum (PAAC): A randomized controlled trial to promote physical activity and diminish overweight and obesity in elementary school children. Preventative Medicine, 49, 336–341. doi: http://www.elsevier.com
Finkelstein, Eric A. (2012). Obesity and Severe Obesity Forecasts Through 2030. American Journal of Preventive Medicine,42(6), 563-570 doi:10.1016/j.amepre.2011.10.026
James, J., Thomas, P., Cavan,D.,& Kerr, D. (2004). Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomized controlled trial. British Medical Journal, 328, 1237. doi:10.1136/bmj.38077.458438.EE
Lenz, M. The morbidity and mortality associated with overweight and obesity in adulthood: a systematic review. Dtsch Arztebl Int. 2009; 106(40): 641–648. doi: 10.3238/arztebl.2009.0641
Li, Y., Hu, X., Schouten, E.G., Liu, A., Du, S., Li, L., et al. (2010). Report on childhood obesity in China (8): Effects and sustainability of physical activity intervention on body composition of Chinese youth. Biomedical and Environmental Sciences, 23, 180–187.
doi: http://www.besjournal.com
Ogden, C. L., Carroll, M. D., Curtin, L. R., McDowell, M. A., Tabak, C. J., & Flegal, K. M. (2006). Prevalence of overweight and obesity in the United States, 1999–2004. Journal of the American Medical Association, 295, 1549–1555. doi:10.1001/jama.295.13.1549
Voelker, R. Escalating Obesity Rates Pose Health, Budget Threats. JAMA. 2012;308(15):1514. doi:10.1001/jama.2012.13712.
Werner, D., Teufel, J., Holtgrave, P. L., & Brown, S. L. (2012). Active Generations: An Intergenerational Approach to Preventing Childhood Obesity. Journal of School Health, 82(8), 380-386. doi: http://www.journalofschoolhealth.com