Laura Rodriguez DNP APRN MCHCNS Reducing Childhood Obesity

Laura Rodriguez, DNP, APRN, MCH-CNS Reducing Childhood Obesity: Opportunities for Engaging Families in School Settings August 1, 2016 Excellence • Innovation • Diversity

Childhood Obesity

Childhood Obesity Statistics Definitions: o Overweight: BMI > 85 Percentile o Obese: BMI > 95 Percentile o Morbidly Obese: BMI > 40 for age group 2012 Overweight/Obesity Percentages § § Children: 30% Adolescence: 30% Obese: 17% = 12. 7 Million Children 2 -19 years 2014 survey: 26% Obesity & Morbid Obesity 2. 4%. Ogden CL, Carroll MD, Kit BK, Flegal KM. (2014). Skinner, A. (2014) 0. 9% to

Racial & Ethnicity Obesity Rates • Latino = 22. 5 % • Black = 20. 2 % • Non-Latino White 14. 1 % • Asian American 6. 8 % Low Income Indian/Native Alaskan Preschool = 21. 1% Latino = 18. 7% White = 12. 7% Blacks = 11. 8% Asian/Pacific Islander 11. 6 % Pan L, Mc. Guire LC, Blanck HM, May-Murriel AL, Grummer-Strawn LM. (2015).

PICOT Question • “In Male and Female Hispanic Children Ages 10 -11 & Their Parents’ Will Nutritional Education Increase Knowledge of Proper Portion Control With an Eventual Decrease in BMI and WC: HT?

Obesity Percentage of High School Students in Selected U. S. States Youth Risk Behavior Survey, CDC. (2013)

Obesity Percentage of High School Students in Selected U. S. States Youth Risk Behavior Survey, CDC. (2011)

Literature Review Multifactorial Causes • • • Family Breakdown Reduced Family Size Urban & Metropolitan Sprawl Greater Community Dissonance Astray Survival Advantage Low Family Income Pan L, Mc. Guire LC, Blanck HM, May-Murriel AL, Grummer-Strawn LM. (2015). Summerbell, et al. , (2009), Eckel, 2003).

Health Consequences of Childhood Obesity Short Term Effects: ü Cardiovascular Disease Risk Factors ü Pre-Diabetes ü Bone/Joint Problems ü Sleep Apnea ü Psychological Issues Freedman DS, Zuguo M, Srinivasan SR, Berenson GS, Dietz WH. (2007); Li C, Ford ES, Zhao G, Mokdad AH. (2009) CDC. National diabetes fact sheet: (2011) ; Daniels SR, Arnett DK, Eckel RH, et al. ( 2005) Office of the Surgeon General. (2010); Dietz WH. Overweight in childhood and adolescence. (2004)

Health Consequences of Childhood Obesity • Long Term Effects Ø Adult Obesity v. Heart Disease, Type 2 diabetes, Stroke, Osteoarthritis Ø Increased Cancer Risk v Breast, Colon, Endometrial, Esophageal, Kidney, Pancreatic, Gall Bladder, Thyroid, Ovarian, Cervical, Prostrate, Multiple Myeloma & Hodgkin’s Lymphoma Kushi LH, Byers T, Doyle C, Bandera EV, Mc. Cullough M, Gansler T, et al. (2006).

Health Care Costs Total Spent on Obesity • $150 Billion Annually – Estimated at $19, 000 per child – $12, 900 of Children at Risk – $4 Billion for all Obese 10 year Olds http: //globalhealth. duke. edu/media/news/over-lifetime-childhood-obesity-costs-19000 -child

Literature Review Proposed Solutions Comprehensive Approach Dietary Education Parental Involvement Physical Exercise Early Intervention Dennison, 2012; Oude Luttikhuis et al. , 2009; Summerbell et al. , 2009; & Waters et al. ; 2011.

Project Overview Priority Population 40 6 th Graders & at Least One Parent Setting Classroom Local Charter School Timeline Twelve Weeks

Prevalence of Overweight and Obesity Percent overweight/obese 45% 40% 35% 30% 23% 25% 20% 15% 10% 5% 0% Overweight or obese (≥ 85 th %ile) Obese (≥ 95 th %ile)

Percent overweight/obese Prevalence of Overweight and Obesity, by Sex 50% 43% 45% 40% 37% 35% 30% 25% 21% 24% 20% 15% 10% 5% 0% Overweight or obese (≥ 85 th %ile) Obese (≥ 95 th %ile) Boys (solid) Girls (hashed)

Theoretical Framework Nola Pender’s Health Promotion Model Individual Characteristics & Experiences Modeling Behavior Leads to Health Promotion Adaptable to the Community Setting

Project Components • Recruitment of Students & Parents • Debriefing Sessions • Post-Intervention Parental Survey

Project Components • Educational Sessions “Choose My Plate” USDA Initiative Portion Plate with Portion Size Education Placemat & Simulated Food Items Time Frame: Content: 30 Minutes Q&A: 10 minutes

Resources Placemats English & Spanish Portion Plates Bee Better The. Portion. Plate. com Simulated Food Items Nasco Company

Project Outcomes 30% Participation Rate 75% of Parents Answered Survey Items Correctly Parents Were Actively Engaged Sessions Lasted for ≈ 60 Minutes Open Discussion/ Serendipitous Events

Conclusion Objective Was Met Education on Portion Size & Portion Control Established Community Partnerships Parental Dietary Education Future Direction: Reducing Childhood Obesity Through Interdisciplinary Approach Publication of Findings

References CDC. National diabetes fact sheet: national estimates and general information on diabetes and prediabetes in the United States, 2011[PDF - 2. 7 MB]. Atlanta, GA: U. S. Department of Health and Human Services. Daniels SR, Arnett DK, Eckel RH, et al. Overweight in children and adolescents: pathophysiology, consequences, prevention, and treatment. Circulation 2005; 111; 1999– 2002. Dietz WH. Overweight in childhood and adolescence. New England Journal of Medicine 2004; 350: 855 -857. Dennison, B. (2012). Bright futures and NHLBI integrated pediatric cardiovascular health guidelines. Pediatric Annals, 41, 31 -35. doi: 10. 3928/0090448120111209 -10. Finkelstein, Malhorta & Graham. Duke Global Health Institute. http: //globalhealth. duke. edu/media/news/over-lifetime-childhood-obesity-costs-19000 -child Eckel, R. H. (2003). Obesity: a disease or a physiologic adaptation for survival? Obesity Williams & Wilkins. Mechanisms and Clinical Management. Philadelphia, Pa: Lippincott Freedman DS, Zuguo M, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. Journal of Pediatrics 2007; 150(1): 12– 17. Kushi LH, Byers T, Doyle C, Bandera EV, Mc. Cullough M, Gansler T, et al. American Cancer Society guidelines on nutrition and physical activity for cancer prevention: reducing the risk of cancer with healthy food choices and physical activity. CA: A Cancer Journal for Clinicians 2006; 56: 254– 281. Li C, Ford ES, Zhao G, Mokdad AH. Prevalence of pre-diabetes and its association with clustering of cardiometabolic risk factors and hyperinsulinemia among US adolescents: NHANES 2005– 2006. Diabetes Care 2009; 32: 342– 347. Office of the Surgeon General. The Surgeon General's Vision for a Healthy and Fit Nation. [PDF - 840 KB]. Rockville, MD, U. S. Department of Health and Human Services; 2010. Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011 -2012. Journal of the American Medical Association 2014; 311(8): 806 -814. Oude Luttikhuis, H. , Baur, L. , Jansen, H. , Shrewsbury, V. A. , O’Malley, C, Stolk, R. P. , & Summerbell, C. D. (2009). Interventions for treating obesity in children. Cochrane Database of Systematic Reviews, 1, 1 -143. doi: 10. 1002/14651858. CD 001872. pub 2. Pan L, Mc. Guire LC, Blanck HM, May-Murriel AL, Grummer-Strawn LM. Racial/Ethnic Differences in Obesity Trends Among Young Low-Income Children. Am J Prev Med, 48(5): 570 -574. 2015. Summerbell, C. D. , Waters, E. , Edmunds, L. , Kelly, S. A. M. , Brown, T. & Campbell, K. J. (2009). Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews. 3, 1 -48. doi: 10. 1002/14651858. CD 001871. pub 2. Waters, E. , de Silva-Sanigorski, A. , Hall, B. J. , Brown, T. , Campbell, K. J. , Gao, Y. , Armstrong, R. , Prosser, L. , & Summerbell, C. D. (2011). Interventions for preventing obesity in children. Cochrane Database of Systematic Reviews, 12, 1 -211.

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