Childhood Obesity

trends, complications, cost, and prevention

Definition, prevalence, and trends Causes and other contributing factors Risks psychological and physical Costs to individual, healthcare institutions, and society Obstacles to shifting the paradigm Recommendations for effecting change Motivational Interviewing

Overview

Definition, prevalence, and trends

a brief look at childhood obesity

Use of Body Mass Index (BMI) Overweight 85th percentile Obese 95th percentile

Definition of obesity

Increase in obesity from 1976-2000 No trend from 2000-2008 17% of children aged 2-19 were considered obese in 2008 5.5% were obese in 1976

Prevalence and trends

Causes & other contributing factors

multiple risk factors and reasons for childhood obesity

At the basic level, obesity occurs when more calories are consumed than are used Susceptibility to obesity Genetic characteristics havent changed in last 3 decades, but prevalence among school-aged children has tripled during that time

Genetics

Fast food, family restaurants, and portion sizes Less physically active than before More time in front of the TV or playing video games

Behavioral Patterns

Home, childcare, school, and community influence Childrens habits reflect parents habits Lack of playgrounds/parks, bike paths, sidewalks, pools

Environmental Factors

Risks and complications

psychological and physical

Still a negative stigma Targets of social discrimination Disrespected and bullied by peers Lead to low self-esteem and depression

Psychological risks

May be unable to perform simple tasks Glucose intolerance, fatty liver, hypertension, high blood pressure, asthma, sleep apnea, orthopedic complications, polycystic ovary syndrome Type 2 diabetes increasingly common

Physical risks

Costs
individual, healthcare institutions/insurance companies, society

$147 billion/year for obesity medical costs $1,400 higher each year for obese vs. healthy-weight individuals Immobile patients may spend up to $1,500 on a bariatric wheelchair (compared to $150-$330 for regular) Possible reduced lifespan

Individual costs

More diseases associated with obesity Insurance companies may raise premiums Retrofitting rooms for bariatric patients

Toilets Wider wheelchairs Bigger/adjustable beds Motors to assist nurses & prevent injury Larger waiting room chairs New MRI machines (70cm diameter vs. 60cm)

Healthcare institutional costs

Face complications of epidemic together May not feel need to change if everyone is obese Healthcare/insurance obstacles cost may be directed toward general public through increased taxes and higher insurance premiums

Societal costs

Obstacles to shifting the paradigm

why change isnt easy

Do not wish to/afraid of change Do not recognize need for change/cultural differences Bad habits are not easily broken Takes time & dedication to achieve results Fast food is easier and cheaper Limited access to healthful foods Making excusing is easier than taking action

Obstacles for change

Recommendations for effecting change

what we can do as a society or as individuals

Educate children about risk factors Focus on healthy lifestyle, not weight loss Limit TV and video games Limit fast food and sweetened beverages Encourage physical activity Have family dinners at the table, not in front of the TV

Parents

More time spent educating about wellness School nurses Gym & health classes

Schools and childcare

Use time to promote wellness and increase awareness Speak with parents about willingness/ability to change Motivational Interviewing

Pediatricians and nurses

Motivational Interviewing
and the transtheoretical model

Patient-centered interaction Explore and resolve ambivalence about change Build rapport with patient and family Collaborate with patient, empowerment Use empathy and encouragement Evoke intrinsic motivation, required for lasting change

MI technique

Six stages
Precontemplation Contemplation Preparation Action Maintenance Termination

Can move between stages Example: GiGi and dancing

Transtheoretical model

Used if providers have inadequate time Multifaceted approach Collaboration of healthcare team: primary care physicians, nurse practitioners, dieticians, exercise physiologists, psychologists, and social workers

Case Management

Conclusions
and future directions

Anderson, S. (2010, February 8). Childhood obesity: It's not the amount of TV, it's the number of junk food commercials. Retrieved December 3, 2010, from UCLA Newsroom: http://newsroom.ucla.edu/
Banerj, M. A. (2010, October 22). One-Third of U.S. Adults Could Have Diabetes by 2050: CDC. Retrieved December 2, 2010, from HealthDay News: http://www.healthfinder.gov Centers for Disease Control and Prevention. (2010, March 31). Childhood Overweight and Obesity. Retrieved December 2, 2010, from Centers for Disease Control and Prevention: http://www.cdc.gov/obesity/childhood/index.html Dehghan, M., Akhtar-Danesh, N., & Merchant, A. T. (2005). Childhood obesity, prevalence and prevention. Nutrition Journal , 4 (24). Ghose, T. (2010, July 17). Hospitals beef up equipment for obese. Milwaukee Journal Sentinal . Herzog, K. (2010, August 3). Nation's obesity rate skyrocketing, CDC reports. Milwaukee Journal Sentinal . Howard, K. R. (2007). Childhood Overweight: Parental Perceptions and Readiness for Change. The Journal of School Nursing , 23 (2), 73. Mason, H., Crabtree, V., Caudill, P., & Topp, R. (2008). Childhood Obesity: A Transtheoretical Case Management Approach. Journal of Pediatric Nursing , 23 (5), 337-344. Perrin, E. M., Finkle, J. P., & Benjamin, J. T. (2007). Obesity prevention and the primary care pediatricians office. Current Opinion in Pediatrics , 19 (3), 354-361. Resnicow, K., Davis, R., & Rollnick, S. (2006). Motivational Interviewing for Pediatric Obesity: Conceptual Issues and Evidence Review. Journal of the American Diatetic Association , 106 (12), 2024-2033. Schmid, J. (2009, April 24). GE Healthcare unveils new medical imaging equipment. Milwaukee Journal Sentinal . Waldrop, J. (2006). Behavior Change In Overweight Patients. Advance for Nurse Practitioners , 14 (8), 23. Warner, J. (2004, July 2). Video Games, TV Double Childhood Obesity Risk. Retrieved December 3, 2010, from WebMD: http://children.webmd.com

References