Obesity Prevention and Education for School Nurses

Document Sample
Obesity Prevention and Education for School Nurses Powered By Docstoc
					Obesity Prevention and Education for
           School Nurses
   The planning committee &
 faculty attest that no relevant
    financial, professional or
   personal conflict of interest
exists, nor was sponsorship of
 commercial support obtained,
       in the preparation or
presentation of this educational
              activity.
                     Objectives
• Define obesity and relate current trends in Arkansas and in
  the US.
• Discuss risk factors for childhood obesity.
• Explain health consequences of obesity.
• Describe importance of health assessment especially blood
  pressure monitoring in regards to childhood obesity.
• Explain the relationship between Acanthosis nigricans and
  obesity.
• Describe the process for appropriate height and weight
  measurement for children.
• Review pertinent legislation.
• List resources available for schools and school nurses to
  combat childhood obesity.
Obesity Trends
      Definition of Obesity

Obesity is defined as an increased body
  weight in relation to height, when
    compared to some standard of
   acceptable or desirable weight.
   Obesity / Overweight in Children
• Obesity in children / youth refers to
  age and gender- specific BMI that is
  equal to or greater than the 95th
  percentile of the CDC BMI charts
• Overweight/at risk for obesity
  between 85th – 94th percentile
 (IOM, 2007)
    In the Past Three Decades…

Number of overweight:
  • 6-11 year olds tripled
  • Adolescents tripled (Gerberding & Marks, 2004)
  • Overweight adults tripled (>60%)
             Obesity in Children
16.3% of children and adolescents ages 2 -19 years are
  obese
   • 11% considered extremely obese
   • 12.4%        2 - 5 year old
   • 17.4%           6-11 year olds
   • 17.6%       12-19 year olds
31.9% are overweight / obese

(Ogden, JAMA, 2008)
Obesity in the United States




  http://www.cdc.gov/obesity/data/trends.html
2009
Trends in Obesity Among Boys
Trends on Obesity Among Girls
            The Epidemic of Childhood
             Overweight and Obesity
•  9 million children >6 yrs obese (IOM, 2005)
•  25 million children / adolescents are obese or
  overweight (NHANES, 2007)
            »Males 18.2%
            »Females 16.0 %
• HHS estimates that 20% of children / youth in the
  US will be obese by 2010.
 (GAO-07-260R Childhood Obesity and Physical Activity)
 http://www.gao.gov/new.items/d07260r.pdf
Risk Factors for Obesity
 Risk Factors for Obesity:
 Diet           Inactivity
– High-calorie foods     – Sedentary kids
                           more likely to
– High-fat foods dense     gain weight
  in calories
                         – Inactive leisure
– Soft drinks, candy,      activities
  desserts high in sugar
  / calories
        Risk Factors for Obesity:
               Genetics
• Overweight family and child may be
  genetically predisposed to gain excess
  weight
    • environment of high-calorie foods
    • physical activity may not be encouraged
                Heredity… / Genes
     •  80%
       of children with two overweight
       parents will become overweight
     •  40%
       of children with one overweight parent
       will become overweight
     •  7–9%
       of children with no overweight parents
       will become overweight
http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm
Percentage of Overweight Children and
Youth Who Become Overweight Adults

      80

      70

      60

      50
                                                          Preschool
      40                                                  School-age
      30                                                  Adolescent

      20

      10

      0
                        Percentage
       (National Institute for Health Care Management, Nov 2003)
       Risk Factors for Obesity:
        Psychological
• Some eat to cope with problems or deal
  with emotions; stress or boredom
  – Parents may have similar tendencies
    Environmental / Media
   Temptation at Every Turn
• Chips, cookies, and other less healthy
  food choices are marketed to children
  via media.
    Behavioral/Socio-cultural
• Sedentary lifestyles 
• Calorie-dense foods 
• Large portion sizes 
• Excessive television viewing / video
  games  low energy expenditure
• Parent modeling - eating and exercise
  behaviors
Consequences of Obesity
Health Consequences: Adult
     Premature Death

• 500,000 deaths per year –
  surpassing tobacco
• Risk increases with
  increased weight
              (USDHHS, 2001)
Health Consequence: Children
         Risk of CVD
• Hypertension
• Elevated insulin levels
• Dyslipidemia
   – Elevated low density
     lipoprotein (LDL)
   – Abnormal triglyceride levels
Other Health Consequences Children
• Sleep apnea       • Gastrointestinal
• Asthma              – fatty liver disease
                      – elevated liver
• Risk for Kidney
                        enzymes
  problems
                      – gallstones and
                        cholecystitis
                      – gastroesophageal
                        reflux
                      – constipation
Other Health Consequences Children
• Endocrine disorders    • Skin conditions
   – T2DM                     • AN – seen in:
   – Polycystic Ovary              10% of obese
     Syndrome                     white children
                                   50% of obese
   – Early sexual
                                  black children
     maturation
                              • Skin fungal
• Orthopedic disorders
                                infections
Health Consequences: Psychosocial !!!
             Children
 • Depression/Anxiety
 • Quality of Life
 • Negative self-esteem/Poor body image
 • Feelings of chronic rejection / Withdrawal from
   interaction with peers/Behavioral problems
 • Decreased endurance / involvement
 • Social, academic and job discrimination (Deckelbaum and
   Williams, 2001)
     Health Consequences for
     Children – Risk of T2DM
• Clearly, the growth in the treatment of type 2
  diabetes could signal the beginning of a multitude of
  long-term healthcare needs for many of these
  children.
           Economic Burden of Obesity
The Economic Estimates of the impact of obesity are
     astronomical:
      • 1995 - Approximately $52 billion was
        attributed to obesity
      • 2003 - This figure had increased to $75 billion
          (CDC, J. Gerberling, 2005)

According to one estimate total health care spending
  for children who receive a diagnosis of obesity is
  approximately $750 million a year

http://www.medstat.com/pdfs/childhood_obesity.pdf
    Economic Burden of Obesity

• Obesity is the No. 1 driver of increasing
  health care costs in the US today
• Diabetes contributes to health care
  disparities in the United States
Recap: Rising obesity rates - result of a
number of trends in the US
• Americans consume 300          • Parks & recreation spaces
  more calories/ day than they are not considered safe or
  did 25 years ago & eat less      well maintained in many
  nutritious foods                 communities
• Nutritious foods are…more • Many school lunches do
  expensive than calorie-          not meet nutrition
  dense, less nutritious foods     standards -children engage
• Americans walk less / drive      in less physical activity in
  more -- even for trips of less   school
  than one mile                  • ↑ screen time (TV, video
• Adults often work longer         games) contributes to ↓
  hours & commute farther          activity…for children
Assessing the Overweight/Obese Child
    Assessment of the Overweight and
       Obese Child and Adolescent
•   Hypertension
•   Acanthosis Nigricans
•   Nutrition and Physical Activity
•   Child and Family History
•   Height/Weight/BMI
     Definition of Hypertension

Average Systolic blood pressure (SBP)
 [higher number] and/or diastolic blood
 pressure (DBP) [lower number] that is ≥ to
 the 95th percentile for gender, age and
 height on 3 or more occasions
     Definition of Pre-Hypertension
    Average SBP or DBP levels that are greater
    than or equal to the 90th percentile, but
    less than the 95th percentile
    Adolescents with BP levels greater than or
    equal to 120/80 mmHg should be
    considered pre-hypertensive

http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm
   Assessing for Hypertension in
      Children & Adolescents
Approximately 9-13% of overweight children
have elevated blood pressure

Approximately 30% of obese children
(BMI >95th percentile) have hypertension
Blood Pressure in Children
  Lower than an Adult –
 Normal Blood Pressures
 •   4    91/52    •   12      104/62
 •   6    94/56    •   13      106/63
 •   7    96/57    •   14      107/64
 •   8    98/58
                   •   15      109/65
 •   9    100/59
 •   10   100/60   •   16      110/66
 •   11   102/61   •   17       110/66
                   (Selekman, 2006)
        Hypertension Overview

New national data added to the childhood BP
database

Updated BP tables now include the 50th, 90th,
95th, and 99th percentiles by gender, age and
height

http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm
       Blood Pressure Levels for Boys
        by Age and Height Percentile

              SBP (mmHg)                                         DBP (mmHg)
Age    BP     Percentile of Height                               Percentile of Height

        %
Year   tile    5th    10th    25th   50th   75th   90th   95th    5th    10th    25th   50th   75th   90th   95th

12     50th   102     103     104    105    107    108    109     61      61     61     62     63     64     64

       90th   116     116     117    119    120    121    122     75      75     75     76     77     78     78

       95th   119     120     121    123    124    125    126     79      79     79     80     81     82     82

       99th   127     127     128    130    131    132    133     86      86     87     88     88     89     90




              http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm
              Blood Pressure Levels for Girls
              by Age and Height Percentile

              SBP (mmHg)                                         DBP (mmHg)
Age    BP     Percentile of Height                               Percentile of Height

        %
Year   tile    5th   10th   25th     50th   75th   90th   95th    5th   10th   25th     50th   75th   90th   95th

12     50th    101   102    104      106    108    109    110     59     60    61       62     63     63     64

       90th    115   116    118      120    121    123    123     74     75    75       76     77     78     79

       95th    119   120    122      123    125    127    127     78     79    80       81     82     82     83

       99th    126   127    129      131    133    134    135     86     87    88       89     90     90     91




              http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm
          How To Use The BP Tables
1. Use the standard height charts to determine the
   height percentile
2. Measure & record the child’s SBP and DBP
3. Use correct gender table for SBP and DBP
4. Find child’s age on the left side of the table
    Follow the age row horizontally across the table
    to the intersection of the line for the height
    percentile (vertical column)

     http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm
        How To Use The BP Tables
5. For SBP percentiles in the left columns and for
   DBP %tiles in the right columns:
   – Normal BP = < 90th percentile
   – Pre-hypertension = BP between the 90th- 94th
     percentile or > 120/80 mmHg in adolescents
   – Hypertension = BP  95th percentile on repeated
     measurement
     http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm
        How To Use The BP Tables
6. BP > 90th percentile should be repeated twice at
   the same office visit
7. BP > 95th percentile should be staged:
  – Stage 1 = the 95th percentile to the
    99th percentile plus 5 mmHg.
  – Stage 2 = >99th percentile plus 5
    mmHg.
    http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm
 Blood pressure in children - exercises
1.Boy - 10 y.o. 95th %tile for height – blood pressure
  100/60
• Blood pressure is 50th percentile = normal

               SBP (mmHg)                                         DBP (mmHg)
 Age    BP     Percentile of Height                               Percentile of Height
         %
 Year   tile    5th   10th    25th    50th   75th   90th   95th    5th   10th    25th    50th   75th   90th   95th
  10    50th    97     98     100     102    103    105    106     58     59     60      61     61     62     63
        90th   111    112     114     115    117    119    119     73     73     74      75     76     77     78
        95th   115    116     117     119    121    122    123     77     78     79      80     81     81     82
        99th   122    123     125     127    128    130    130     85     86     86      88     88     89     90
              Blood pressure in children -
                       exercises
2. Boy - 12 y.o. 50% %tile for height – blood
  pressure116/70
• Blood pressure is 90th percentile = normal

              SBP (mmHg)                                         DBP (mmHg)
Age    BP     Percentile of Height                               Percentile of Height
        %
Year   tile    5th   10th    25th    50th   75th   90th   95th    5th   10th    25th    50th   75th   90th   95th
 12    50th   101    102     104     105    108    109    110     59     60     61      62     63     63     64
       90th   115    116     118     119    121    123    123     74     75     75      76     77     78     79
       95th   119    120     122     123    125    127    127     78     79     80      81     82     82     83
       99th   126    127     129     131    133    134    135     86     87     88      89     90     90     91
              Blood pressure in children -
                       exercises
 3. Girl 9 y.o. 90th %tile for height – blood pressure
   118/76
 • Blood pressure >90th %tile = prehypertension
              SBP (mmHg)                                         DBP (mmHg)
Age    BP     Percentile of Height                               Percentile of Height

        %                                                                                                    95
Year   tile    5th   10th   25th     50th   75th   90th   95th    5th   10th   25th     50th   75th   90th   th


 9     50th    96     97     98      100    101    102    103     58     58     58      59     60     61     61

       90th   110    110    112      113    114    116    116     72     72     72      73     74     75     75

       95th   114    114    115      117    118    119    120     76     76     76      77     78     79     79
       99th   121    121    123      124    125    127    127     83     83     84      84     85     86     87
 Blood pressure in children - exercises
4. Girl 16 y.o. 25th %tile for height – blood pressure
  126/80
• Blood pressure is >90th %tile = prehypertension
              SBP (mmHg)                                         DBP (mmHg)
Age    BP     Percentile of Height                               Percentile of Height

        %                                                                                                    95
Year   tile    5th   10th   25th     50th   75th   90th   95th    5th   10th   25th     50th   75th   90th   th


16     50th   108    108    110      111    112    114    114     64     64     65      66     66     67     68

       90th   121    122    123      124    126    127    128     78     78     79      80     81     81     82

       95th   125    126    127      128    130    131    139     82     82     83      84     85     85     86
       99th   132    133    134      135    137    138    139     90     90     90      91     92     93     93
         Classification of Hypertension
          in Children and Adolescents
                                 SBP or DBP Percentile

Normal                           < 90th percentile

Prehypertension                  90th percentile to < 95th percentile, or if BP exceeds
                                 120/80 even if below the 90th percentile up to < 95th
                                 percentile
Stage 1 hypertension             95th percentile to the 99th percentile plus 5 mmHg



Stage 2 hypertension             >99th percentile plus 5 mmHg

               http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm
       Classification of Hypertension
        in Children and Adolescents
                              Frequency of BP Measurement
Normal                        Recheck at next scheduled physical examination

Pre-hypertension              Recheck in 6 months

Stage 1 hypertension          Recheck in 1–2 weeks or sooner if the patient is
                              symptomatic; if BP is persistently elevated on two
                              additional occasions, evaluate or refer to source of care
                              within 1 month

Stage 2 hypertension          Evaluate or refer to source of care within 1 week or
                              immediately if the patient is symptomatic

             http://www.nhlbi.nih.gov/health/prof/heart/hbp/hbp_ped.htm
Assessing for Hypertension in Children
        & Adolescents - recap
1.   Choose appropriate cuff size
2.   Take in upper right arm
3.   Cuff should cover approx 2/3 of upper arm
4.   Cuff bladder should cover 80–100 % of the arm
     circumference
5.   Adolescent – adult cuff size
6.   Large adolescent - extra large cuff
7.   Student should sit for 3-5 minutes in a quiet
     environment before the BP is measured
    Refer for BP above the 95th percentile for either
     systolic or diastolic
    Therapeutic Lifestyle Changes
• Weight reduction - primary therapy for obesity-
  related hypertension. Prevention of excess weight
  gain can limit future increases in BP. Dietary
  modification strongly encouraged in children and
  adolescents with pre-hypertension and
  hypertension
• Physical activity can improve efforts at weight
  management and may prevent future increase in
  BP
• Family-based intervention improves success
        Acanthosis nigricans type III
      associated with obesity, insulin-
    resistant states and endocrinopathy
• Acanthosis nigricans is a disorder
  that may begin at any age
• Velvety thickening
• Gray to brown to black in body
  creases
   – Neck, armpits, groin
                                         http://www.aocd.org/skin/der
   – Darker skinned people have darker   matologic_diseases/acantho
     lesions                             sis_nigrica.html

                                         (James, et al 2005)
       Acanthosis Nigricans (AN)
• About 90% of children with type 2 have dark
  shiny patches on the skin, most often found on
  the back of the neck ("dirty neck") and in
  axillary creases http://www.childrenwithdiabetes.com

• Most commonly found in Hispanics, Native
  Americans, African Americans, Asian-
  American/Pacific Islanders
  (Jones and Ficca, 2007)
         Acanthosis Nigricans (AN)
• Most commonly associated with obesity or
  polycystic ovarian disease in women
• Can occasionally be found in people who have
  more serious underlying health problems or taking
  certain medications
• Treatment of the underlying medical condition
  usually resolves the skin lesions
    What can be done about AN?

• Acanthosis Nigricans is a marker that
  signals elevated insulin levels and a risk of
  developing type 2 diabetes and other
  conditions in the future

• Taking immediate action may help delay or
  prevent the health conditions associated
  with high insulin levels
AN / T2DM = further evaluation

• The current research does not support that AN
  will lead to type 2 diabetes
  (Jones and Ficca, 2007, CDC, 2005)


• Discuss findings with the student and family

• Refer the student to seek additional medical
  advice (Jones and Ficca, 2007)
Typical Acanthosis Nigricans
         of the Neck
Typical Acanthosis Nigricans
        of the Axillae
   Quick Weight, Activity, Variety, &
   Excess Survey (WAVE) for Children
Evaluate eating practices:
•    quantity
•     quality
•     timing of food intake
•     identify foods/patterns of eating that may lead to
      excessive calorie intake

  A means for a quick assessment of diet and activity and may
  be useful for some clinicians and children

  http://bms.brown.edu/nutrition/acrobat/wave.pdf
       Physical Activity Assessment
Assess daily activity levels
Include time spent on:
 exercise and activity
 sedentary behaviors, such as television, video
 viewing, and computer use
 Quick Activity, Variety, & Excess Survey (WAVE) For Kids



                               www.mypyramid.gov
               MyPyramid.gov
The Dietary Guidelines for Americans, 2005, gives
 science-based advice on food and physical activity
 choices for health

MyPyramid Worksheet
Check how you did yesterday and set a goal to aim for
   tomorrow
www.mypyramid.gov
                  Child History
 Increased thirst        Increased urination
 Snoring                 Fatigue
 Exercise intolerance    Blurred vision
 Increased hunger        Weight gain
 Acanthosis nigricans
                  Family History
Diabetes risk factors:
 Parent or sibling diagnosed with diabetes
 Grandparent or aunt/uncle diagnosed with diabetes
 Mother diagnosed with gestational diabetes
Higher-known risk groups:
 African American       Asian American
 Pacific Islander       Native American
 Hispanic/Latino
 < 60 minutes/day of physical play or activity
 > 2 hrs of TV/computer/video game use/day
                       Family History
Family history of obesity & medical problems
Several obesity-related medical conditions are familial
   Family history predicts type 2 diabetes mellitus or insulin resistance,
     and the prevalence of childhood diabetes.
   Cardiovascular disease and cardiovascular disease risk factors --
     (hyperlipidemia and hypertension) are also more common when
     family history is positive.
Consider history regarding first- and second-degree relatives
  (Barlow, 2007)
  Key Components of a Healthy Lifestyle -
         Education/Counseling
• 60 minutes of physical activity • Provide counseling / educate
  every day                          students, families / school staff
• Recommended # of cups of           on the key components of a
  fruits/vegetables per day          healthy lifestyle
  http://www.mypyramid.gov/        • Provide written diabetes
• Limit high-fat / high-sugar        prevention materials in
  food/drink                         appropriate language(s) from the
• Encourage water intake             National Diabetes Education
                                     Program (NDEP)
• Limit “screen time” to less than   http://ndep.nih.gov/index.htm
  2 hours per day

				
DOCUMENT INFO
Shared By:
Categories:
Tags:
Stats:
views:5
posted:11/22/2011
language:English
pages:66