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. Page 2 1
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. Definition As categorized before 2007 As categorized 2007 and later BMI ≥ to 95th percentile for age Overweight Obese and sex BMI ≥ 85th percentile and < At risk for overweight Overweight 95th percentile for age and sex Page 3 Percentage of U.S. Children and Adolescents Classified as Obese, 1963–2008 * •19.6 •18.1 •4.6 •4.2 • *>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. Page 4 •Source: NCHS. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD. 2011 2
Prevalence of obesity among U.S. children and adolescents aged 2–19, for selected years 1963–1965 through 2007–2008 25 20 Percentage 15 10 Total 2–5 6–11 5 12–19 0 1963–1965, 1971–1974 1976–1980 1988–1994 1999–1900 2001–2002 2003–2004 2005–2006 2007–2008 1966–1970 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 Page 5 11 th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN, 2000-2002 to 2004-2005 2000-2002 2004-2005 *Overweight is > 95th Percentile for BMI by Age/Sex 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. Page 6 3
Prevalence of Obesity among 11 th Graders by Health Service Region, SPAN 2009-2011 8 th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN, 2000-2002 to 2004-2005 2000-2002 2004-2005 *Overweight is > 95th Percentile for BMI by Age/Sex Page 8 4
Prevalence of Obesity among 8 th Graders by Health Service Region, SPAN 2009-2011 4 th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN, 2000-2002 to 2004-2005 2000-2002 2004-2005 *Overweight is > 95th Percentile for BMI by Age/Sex Page 10 5
Prevalence of Obesity among 4 th Graders by Health Service Region, SPAN 2009-2011 Obesity In High School: Texas and the U.S., 2001-2009 Prevalence of High School Students Who Were Obese (At or Above the 95th Percentile for BMI by Age and Sex) 2001, 2005, 2007, 2009 YRBS Texas vs. United States 20.0 18.0 16.0 14.0 12.0 Percentage 10.0 8.0 6.0 HP2010 Target 4.0 2.0 14.2 10.5 13.9 13.1 15.9 13.0 13.6 12.0 0.0 2001 2005 2007 2009 Texas US Page 12 6
Obesity In High School: Trend in Texas and the U.S., 1999- 2009 Obesity Prevalence Trend in Texas and US Adolescents, YRBS 1999 to 2009 18% 15.9% 16% 14.2% 13.9% 13.6% 14% 12% 13.1% 13.0% 12.1% Prevalence 12.0% 10% 10.7% 10.5% Texas 8% US 6% 4% 2% 0% 1999 2001 2003 2005 2007 2009 Year Page 13 Obesity In High School: Trend in Texas and the U.S., 1999-2011 Obesity Prevalence Trend in Texas and US Adolescents, YRBS 1999 to 2011 18% 15.9% 15.6% 16% 14.2% 13.9% 13.6% 14% 13.1% 12% 13.0% 13.0% 12.1% 12.0% Prevalence 10% 10.5% 10.7% Texas 8% US 6% 4% 2% 0% 1999 2001 2003 2005 2007 2009 2011 Year 7
Obesity In High School: U.S. 2005-2011 2005 2007 2009 2011 Page 15 Obesity in High School: By Race and Ethnicity 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 30.0 25.0 20.0 Percentage 15.0 10.0 HP2010 5.0 Target 10.9 17.3 17.6 8.0 10.2 18.0 16.9 7.5 13.8 14.6 19.2 15.2 10.0 16.7 16.5 7.6 0.0 2001 2005 2007 2009 White Black Hispanic Other Page 16 8
Obesity in High School: By Race and Ethnicity, Texas 2001-2011 Prevalence of Obesity among High School Students: By Race and Ethnicity, Texas 2001-2011 30 25 20 Percentage 15 10 5 10.9 17.3 17.6 8 10.2 18 16.9 7.5 13.8 14.6 19.2 15.2 10 16.7 16.5 7.6 10.2 16.4 19.2 14.1 0 2001 2005 2007 2009 2011 White Non-Hispanic African-American Non-Hispanic Hispanic Other 9
Obesity Not just an adult concern anymore… Conditions Seen in Children • High Cholesterol • Type 2 Diabetes/ Impaired Glucose Tolerance • High Blood Pressure • Social Problems and Poor Self-Esteem • Sleep Disturbances • Orthopedic Problems Page 19 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 Page 20 10
Factors Contributing to Obesity Genetics Environment Unhealthy Diet Sedentary Lifestyle Lack of Physical Activity Page 21 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 11
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. Page 23 1. Policies and Practices 2. School Environments School 3. Nutrition Services Health 4. Physical Education and Guidelines Physical Activity 5. Health Education 6. School Health Services 7. Family and Community 8. School Employee Wellness 9. Professional Development Page 24 12
GUIDELINE 1 Policies and Practices School School Assess* Health Health Council Council Develop and Implement School Coordinated Health School Team Health Team Evaluate School School Health Health Coordinator Coordinator • * Using the School Health Index (www.cdc.gov/HealthyYouth/SHI) Page 25 Family and Community Schools Promote Communication and Involvement • Community • Families Members Page 26 13
School Health Services ASSESS • Health • Social Services • Services REFER • STAFF • Mental Health • Services ADVOCATE Page 27 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 Page 28 14
Nursing Intervention Classifications (NIC) • Comprehensive • Uses language that is clear and • Research based meaningful • Reflects current • Continually updated clinical practice • Field tested • Easy to use (Domains, Classes, Interventions, Activities all have definitions) Page 29 Possible Nursing Interventions • Behavior • Health education modification (4360) (5510) • Body image • Journaling (4740) enhancement • Nutrition (5220) management (1100) • Emotional support • Program (5270) development (8700) • Family involvement • Teaching: promotion (7110) activity/exercise (5612) Page 30 15
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