The Impact of Childhood

Obesity in America
Erin Rice, BSN, RN
Jacksonville State University
NU 527
Spring 2019
Statistics
• 13.7 Million children and adolescents affected
• 13.9% of 2-5 year olds
• 18.4% 6-11 year olds
• 20.6% 12-19 year olds
• Obesity is decreased with an increase in household education level
• Disproportionately affects low-income families
(Center for Disease Control and Prevention [CDC], 2018).
But they are just big boned!
Children are at risk for being overweight when they are between the 85th and
the 95th percentile; children are overweight when they are at or above the
95th percentile (Sahoo et al., 2015) Childhood obesity has a long term health
affect, leading to adult obesity; associated with type 2 diabetes and
hypertension (Seburg, Olson-Bullis, Bedeson, Hayes & Sherwood, 2015).
Childhood obesity can affect a child’s social and emotional well-being,
lowering their academic performance and a decrease in the quality of life
experiences (Sahoo et al., 2015). As the disease progresses they may
experience metabolic, orthopedic, renal, heart, pulmonary and even
neurological conditions (Sahoo et al., 2015). These chronic conditions may
not be diagnosed until they are an adult, but due the increased longevity of
the chronic disease, the severity of the disease is increased; resulting in a
shorter lifespan and increased short and long term complications (Pandita et
al., 2016).
Primary Prevention
• Primary: Evidence-based obesity prevention programs; reaching out
to local preschools, elementary schools, daycare settings, and
community and healthcare locations (Hoelscher et al., 2015).
• Advance Practice Nurse Role: Focused education with local schools
and community areas working with children on a daily basis.
Providing education and resources for nutritional
changes or options and assisting with plans for
increasing activity.
Secondary Prevention
• Secondary: Interventional programs, age based, involving the entire family, for
children who have been identified as overweight and obese (Hoelscher et at,
2015).
• Advance Practice Nurse Role: Identifying children who have recently been
diagnosed as overweight or obese and start the family and child in interventional
programs that are age focused. Educate local healthcare clinics on the importance
of early identification and how to
incorporate an interventional program at
their clinic or give resources to refer the
family.
• Imoisili et al (2019) recommend a weight
management program that is family
centered, lifestyle-based weight
management interventions.
Tertiary Prevention
• Tertiary: Intense multidisciplinary intervention that may include the
use of pharmacological or surgical interventions (Pandita et at., 2015).
• Advance Practice Nurse Role: Education with local healthcare clinics
on the need for intense intervention to prevent adult obesity,
resources on new pharmacological interventions and education with
family on surgical interventions, support family and educate on why
they need intense interventions for better quality of life. Peek (2016)
describes this stage as a multidisciplinary intervention that is most
likely out of the scope of the primary care provider and may include
pharmaceutical, highly restrictive diets and surgical interventions.
Screening
• USPSTF recommends screening for obesity in children 6 years of age and older
• Positive results require comprehensive, intensive behavioral interventions to
reduce BMI
• The purpose for screening is based on the association with morbidity
• Mental health
• Psychological issues
• Asthma
• Obstructive sleep apnea
• Orthopedic problems
• Cardiovascular issues
• Metabolic issues
• Screening: age and sex adjusted BMI
• Feasible in primary care
• Reliable
• Related to adult obesity

U.S. Preventive Services Task Force [USPSTF], 2017)

Screening
• BMI does not measure body fat directly
• BMI is correlated with a more direct measure of body fat than:
• Skinfold thickness measure
• Bioelectrical impendence
• Densitometry (underwater weighing)
• Dual energy x-ray absorptiometry (DXA scan)
(CDC, 2018)
 Data for screening BMI
• Assess at well child visits annually and plot on standardized growth
charts (Peek, 2016)
• Weight in kg/square of height in meters
• Age and sex specific percentile – NOT the same BMI categories for
adults (CDC, 2018)
• Overweight 85th percentile
• Obese 95th percentile
• Screen for weight related issues: sleep, respiratory, gastrointestinal, cardiovascular,
endocrine and nervous system
• Lab test when indicated by BMI percentile
• Identify non-fatty liver disease
• Cholesterol
• Type II diabetes (Peek, 2016)
• Screening and the use of intense behavioral interventions with
children 6 years of age and older will reduce BMI
• All children and adolescents are at risk for obesity
• Pharmaceutical interventions have not shown large improvements in weight
status and therefore not recommended (USPSTF, 2017)
• USPSTF have found No harms in screening and utilizing behavioral
interventions
• BMI screening tool us free from harm
• Behavioral interventions are not invasive (USPSTF, 2017)
 Resources
Centers for Disease Control and Prevention, (2018)., Prevalence of Childhood Obesity in the United States. Retrieved from:
https://www.cdc.gov/obesity/data/childhood.html

Hoelscher, D., Butte, N., Barlow, S., Vandewater, E., Sharma, S., Huang, T., Finklestien, E., Pont, S., Sacher, P., Byrd-Williams, C.,
Oluyomui, A., Durand, C., Li, L., & Kelder, S. (2015). Incorporating Primary and Secondary Prevention Approaches to Address Childhood
Obesity Prevention and Treatment in a Low-Income, Ethnically Diverse Population: Study Design and Demographic Data from the Texas
Childhood Obesity Research Demonstration (TX CORD) Study. Childhood Obesity. 11(1)

U.S. Preventive Services Task Force [USPSTF], (2017) Screening for obesity in children and adolescents: Recommendations statement.
American Family Physician 96(8)

Peek, L. (2016). Interventions in childhood obesity. Clinical Advisor.

Imoisili, O., Goodman, A., Dooyema, C., Harrison, M., Belay, B., & Park, S., (2019) Screening and referral for childhood obesity: Adherence
to the U.S. Preventive Services Task Force recommendation. American Journal of Preventive Medicine. 56(2): 179-186

Sahoo, K., Sahoo, B., Choudhury, A., Sofi, N., Kumar, R., & Bhadoria, A. (2015). Child Obesity: Causes and Consequences. Journal of
Family Medicine and Primary Care. 4(2): 187-192

Seburg, E., Olson-Bullis, B., Bredeson, D., Hayes, M., & Sherwood, N., (2015). A Review of Primary Care-Based Childhood Obesity
Prevention and Treatment Interventions. Current Obesity Reports. 4: 157-173

Pandita, A., Sharma, D., Pandita, D., Pawar, S., Tariq, M., & Kaul, A. (2016). Childhood Obesity: Prevention in Better than a Cure.
Diabetes, Metabolic Syndromw and Obesity: Targets and Therapy. 9: 83-89