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Childhood Obesity: A School Nurses Intervention

Savannah Dillender
James Madison University
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Childhood Obesity

Obesity is an ongoing public health issue for adults and children. Children are rapidly

increasing in size and health risks are increasing as they grow. Stanhope and Lancaster (2014)

define obesity in children as, a BMI at or above the 95th percentile for children of the same age

and sex when plotted on the CDC growth charts (p. 348). It is hypothesized that factors

contribute to obesity in our youth today; including lifestyle, environmental concerns, dietary

choices, and genetics. In children ages 2 to 12; would an increase in activity and modified

nutritional intake decease BMI scores compared to children in the same age group who do not

have a change in lifestyle and dietary intake? This paper will examine some of the contributing

factors for childhood obesity and interventions needed to reduce the prevalence. Children need to

be guided into healthy lifestyles so they can develop into healthy adults. The school nurse is a

valuable resource to children and their parents.

Stanhope and Lancaster (2014) identify the approximate prevalence of obesity in children

as, 17% for ages 2-5 years, 34% for ages 6 to 11 years, and 31% for ages 12 to 19 years (p.

348). There are many health risks associated with childhood obesity. Hypertension, high

cholesterol, and diabetes are among these risks. In a research article by Brady (2015), there are

vast hemodynamic factors associated with childhood obesity. The cardiovascular system

attempts to adapt to the increase in adipose tissue and remodeling occurs. Left ventricular

hypertrophy (LVH) is noted to be a major risk in obese children with hypertension.

Echocardiography is indicated in children with hypertension to assess heart structure and

function. This research articles goes on to explain the negative effects on the heart due to LVH,

including volume overload and increased intravascular volume, which increase the negative

effects on the cardiovascular system. Hypertension can lead to other cardiovascular diseases and
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increase the risk of negative cardiovascular outcomes. Brady (2015) writes, Obese children also

have greater carotid intima media thickness, an ultrasound measurement associated with vascular

disease, when compared to normal weight children (p. 2). Families need to be educated in order

to understand the severity of the health risks related to childhood obesity. An article by Karnik

and Kanekar (2015), indicates that education should be provided at an appropriate level for the

population being addressed. Education level is an important factor when developing an

educational program for the public to understand.

Furthermore, a sedentary lifestyle and living environment may contribute to obesity in

children. A study conducted by Raistenskis, J., Sidlauskiene, A., Cerkauskiene, R., Burokiene,

S., Strukcinskiene, B., and Buckus, R. (2015) analyzes the relationship of environment on

childhood obesity. The participants were between the ages of 11 and 14 years old. The study

compares the amount of daily physical activity of children who live in a small town to children

who live in the city. There were 118 children from a small town and 414 children from the city

noted in the study. Anthropometric measurements, including body mass index (BMI) and body

fat percentage were included in the study. The World Health Organization (WHO) child growth

characteristics were used to determine categories of obesity, overweight, normal weight, or

underweight. Sedentary activities (screen time) were also compared with living environment by

providing a questionnaire with 47 activities to each participant. The study concluded that the city

children engaged in more daily physical activity than the small town children; with 25.5% of the

small town children being either overweight or obese compared to 18.6% of the city children

(Raistenskis et al., 2015). The children from both locations were noted to have high sedentary

time (screen time) periods and the data was not significant in that area of the study. The research

did indicate that youth physical activity programs in the small town area may need to be
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incorporated. The study lacked information regarding nutrition and socioeconomic factors.

Karnik and Kanekar (2015) write, sedentary lifestyle is an important factor for obesity, as many

children spend most of their time in front of television sets, play video games, and watch

computers (p. 5). Lifestyle modifications are another area of education for parents of obese

children or children at risk for becoming obese. Exercise programs can be implemented within

the home with no cost to the family. Family participation in exercise can also create a positive

bonding experience and provide support for the obese child.

In addition, other environmental factors may increase the risk for childhood obesity. A

history and intake should be documented by the school nurse. Families should be educated on the

risks of common environmental risk factors. Chemicals used in production of plastics may put

children at risk. In a study completed by Vafeiadi, M., Roumeliotaki, T., Myridakis, A.,

Chalkiadaki, G., Fthenou, E., Dermitzaki, E., and Chatzi, L. (2016), bisphenol A (BPA) is

associated with childhood obesity. The study includes 235 two and a half year olds and 500 four

year olds. The participants were measured for weight and length at birth, and again at ages 2 to 4

years old for weight and height. BMI was calculated at both birth and 2 to 4 years of age. Urine

concentrations of BPA were analyzed among both age groups. A population of pregnant women

were also included in the urine study. At the age of 4, participants underwent cardiometabolic

testing, including a 5 min. resting blood pressure measurement and non-fasting blood sampling.

Lipids and adiponectin were among the blood testing completed. Vafeiadi et al., (2016),

indicated that BPA had no effect on weight at birth or by the age of 2.5 years. However, there

was an increase in BMI among the 4 years old age group with exposure to BPA prenatally and in

early childhood. BPA is an endocrine-disrupting chemical (Vafeiadi et al., 2016). There was

no significant difference in blood pressure or lipids and adiponectin levels in the study groups.
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This study only included short term effects of BPA and socioeconomic status for the participants

was not indicated. Vafeiadi et al., (2016) also noted, BPA urine concentration varies throughout

the day and multiple daily samples were not collected. Education regarding environmental risks

should be provided at all well child visits and by the school nurse for all children regardless of

the risk for obesity. Low income families or families without health insurance may be directed to

their local health department for well child services.

Moreover, nutrition plays a major role in childhood obesity. In a study by Koletzko,

Demmelmair, Grote, Prell, & Weber (2016), protein intake was examined in relation to

childhood obesity. The study was orchestrated with a population of 2,154 children. The

hypothesis by Koletzko et al., (2016) was named, The Early Protein Hypothesis and

hypothesized that early high protein intake caused increased plasma concentrations of insulin

releasing amino acids and therefore stimulated secretion of insulin-like growth factor (p. 303).

The study included self-reports from parents of 21 month olds and indicated that excessive

protein among the 21 month olds affected BMI scores for children into their 5th year of life. This

study lacked significant data regarding the sources of protein, other than noting that cows milk

was a common factor among the participants. Depending upon a childs growth curve, 2% or

skim milk may be indicated instead of Vitamin D milk. Healthy food choices and dietary intake

recommendations can be directed by the school nurse for students and their families. Education

and guidance from a pediatrician or dietician are also helpful. Healthy food choices implemented

at an early age reduce the risk for poor nutritional habits as children grow.

In contrast, childhood obesity may have a genetic component. Steinsbekk, Belsky,

Guzey, Wardle, & Wichstrm, (2016) conducted a study with 652 participants, ranging in age

from 4 to 8 years old. Children began the study at age 4 and were reassessed, including BMI
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scores; at age 6 and again at age 8. Genotype, adipose and appetite traits were analyzed. Salvia

samples were collected and analyzed for genetic loci. There were alleles across 32 single

nucleotide polymorphisms (SNPs) included in the study (Steinsbekk et al., 2016). The SNPs

were used to calculate genetic risk for developing obesity. When the participants were 6 years

old, their parents were given a 5 item Likert scale questionnaire. The Childrens Eating Behavior

Questionnaire (Steinsbekk et al., 2016) was used to analyze appetite. Although BMI was only

measured a total of three times throughout the study, Steinsbekk et al., (2016) concluded that

children with an increased genetic risk for obesity based on the SNPs, had a higher BMI and

percentage of body fat. The study noted that appetite had no influence on weight gain. The data

regarding the genetic variations with the 32 SNPs was also noted to be incomplete (Steinsbekk et

al., 2016). More research regarding genetic predisposition should be completed.

In conclusion, childhood obesity is an ongoing public health issue. The school nurse is a

major resource for children and their families. The school nurse can provide education regarding

prevention and management of obesity. The school nurse can also initiate information for health

management with primary care providers and additional community resources. Financial services

to purchase healthy foods are available to low-income families. The school nurse plays a vital

role in primary prevention of childhood obesity by influencing children and teaching healthy

food choices and the importance of daily exercise. Providing screenings and completing health

history intakes is a means of secondary prevention by the school nurse. The school nurse utilizes

tertiary prevention by providing care for the children who are already battling with childhood

obesity and by working with their families to promote continuity of care while collaborating with

other health care professionals (Stanhope and Lancaster, 2014).

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References

Brady, T. M. (2015). The role of obesity in the development of left ventricular hypertrophy

among children and adolescents. Current Hypertension Reports, 18(1).

doi:10.1007/s11906-015-0608-3

Karnik, S., & Kanekar, A. (2015). Childhood obesity: a global public health crisis. International

Journal of Preventive Medicine, 3(1), 1-17. doi:10.1201/b18227-3

Koletzko, B., Demmelmair, H., Grote, V., Prell, C., & Weber, M. (2016). High protein intake in

young children and increased weight gain and obesity risk. American Journal of Clinical

Nutrition, 103(2), 303-304. doi:10.3945/ajcn.115.128009

Raistenskis, J., Sidlauskiene, A., Cerkauskiene, R., Burokiene, S., Strukcinskiene, B., &

Buckus, R. (2015). Physical activity and sedentary screen time in obese and overweight

children living in different environments. Central European Journal of Public Health,

23(Supplement), S37-S43. doi:10.21101/cejph.a4184

Stanhope, M., & Lancaster, J. (2014). Foundations of nursing in the community: Community-

oriented practice (4th ed.). St. Louis, MO: Mosby Elsevier.

Steinsbekk, S., Belsky, D., Guzey, I. C., Wardle, J., & Wichstrm, L. (2016). Polygenic risk,

appetite traits, and weight gain in middle childhood. JAMA Pediatrics, 170(2), e154472.

doi:10.1001/jamapediatrics.2015.4472

Vafeiadi, M., Roumeliotaki, T., Myridakis, A., Chalkiadaki, G., Fthenou, E., Dermitzaki, E.,

Chatzi, L. (2016). Association of early life exposure to bisphenol A with obesity and

cardiometabolic traits in childhood. Environmental Research, 146, 379-387.

doi:10.1016/j.envres.2016.01.017