Childhood Obesity and the Link to Diabetes Anita Wheeler, RN, MSN - - PDF document

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Childhood Obesity and the Link to Diabetes Anita Wheeler, RN, MSN - - PDF document

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


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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
  • besity.
  • 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.

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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.

Page 3 Definition As categorized before 2007 As categorized 2007 and later BMI ≥ to 95th percentile for age and sex Overweight Obese BMI ≥ 85th percentile and < 95th percentile for age and sex At risk for overweight Overweight

Percentage of U.S. Children and Adolescents Classified as Obese, 1963–2008*

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  • *>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.
  • Source: NCHS. Health, United States, 2010: With Special Feature on Death and Dying. Hyattsville, MD. 2011
  • 4.6
  • 4.2
  • 19.6
  • 18.1
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5 10 15 20 25 1963–1965, 1966–1970 1971–1974 1976–1980 1988–1994 1999–1900 2001–2002 2003–2004 2005–2006 2007–2008 Percentage

Prevalence of obesity among U.S. children and adolescents aged 2–19, for selected years 1963–1965 through 2007–2008

Total 2–5 6–11 12–19

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

11th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN, 2000-2002 to 2004-2005

Page 6 *Overweight is > 95th Percentile for BMI by Age/Sex

2000-2002 2004-2005

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.

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Prevalence of Obesity among 11th Graders by Health Service Region, SPAN 2009-2011 8th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN, 2000-2002 to 2004-2005

Page 8 *Overweight is > 95th Percentile for BMI by Age/Sex

2000-2002 2004-2005

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Prevalence of Obesity among 8th Graders by Health Service Region, SPAN 2009-2011 4th Grade Prevalence of Overweight* by Health Service Region in Texas, SPAN, 2000-2002 to 2004-2005

Page 10 *Overweight is > 95th Percentile for BMI by Age/Sex

2000-2002 2004-2005

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Prevalence of Obesity among 4th Graders by Health Service Region, SPAN 2009-2011

Obesity In High School: Texas and the U.S., 2001-2009

Page 12

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

14.2 13.9 15.9 13.6 10.5 13.1 13.0 12.0 0.0 2.0 4.0 6.0 8.0 10.0 12.0 14.0 16.0 18.0 20.0 2001 2005 2007 2009

Percentage

Texas US

HP2010 Target

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Obesity In High School: Trend in Texas and the U.S., 1999- 2009

14.2% 13.9% 15.9% 13.6% 10.7% 10.5% 12.1% 13.1% 13.0% 12.0% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 1999 2001 2003 2005 2007 2009 Prevalence Year

Obesity Prevalence Trend in Texas and US Adolescents, YRBS 1999 to 2009

Texas US

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Obesity In High School: Trend in Texas and the U.S., 1999-2011

14.2% 13.9% 15.9% 13.6% 15.6% 10.7% 10.5% 12.1% 13.1% 13.0% 12.0% 13.0% 0% 2% 4% 6% 8% 10% 12% 14% 16% 18% 1999 2001 2003 2005 2007 2009 2011 Prevalence Year

Obesity Prevalence Trend in Texas and US Adolescents, YRBS 1999 to 2011

Texas US

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Obesity In High School: U.S. 2005-2011

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2005 2007 2009 2011

Obesity in High School: By Race and Ethnicity

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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

10.9 10.2 13.8 10.0 17.3 18.0 14.6 16.7 17.6 16.9 19.2 16.5 8.0 7.5 15.2 7.6 0.0 5.0 10.0 15.0 20.0 25.0 30.0 2001 2005 2007 2009

Percentage White Black Hispanic Other HP2010 Target

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Obesity in High School: By Race and Ethnicity, Texas 2001-2011

10.9 10.2 13.8 10 10.2 17.3 18 14.6 16.7 16.4 17.6 16.9 19.2 16.5 19.2 8 7.5 15.2 7.6 14.1 5 10 15 20 25 30 2001 2005 2007 2009 2011 Percentage

Prevalence of Obesity among High School Students: By Race and Ethnicity, Texas 2001-2011

White Non-Hispanic African-American Non-Hispanic Hispanic Other

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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

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Obese children and adolescents are more likely to become

  • verweight or obese adults
  • Heart Disease
  • Cancer
  • Stroke
  • Type 2 Diabetes
  • Osteoarthritis
  • Physical Disability
  • High Blood Pressure
  • Sleep Apnea

Page 20

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Factors Contributing to Obesity

Genetics Environment Unhealthy Diet Sedentary Lifestyle Lack of Physical Activity

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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

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School Environments

School Physical Activity Environment

  • Daily physical education is

not provided in most schools.

  • Daily recess for elementary

school students is not

  • ffered at many schools.
  • Walking or biking to school

is less common.

Page 23

School Health Guidelines

  • 1. Policies and Practices
  • 2. School Environments
  • 3. Nutrition Services
  • 4. Physical Education and

Physical Activity

  • 5. Health Education
  • 6. School Health Services
  • 7. Family and Community
  • 8. School Employee Wellness
  • 9. Professional Development

Page 24

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Policies and Practices

School Health Council School Health Team School Health Coordinator

Assess* Develop and Implement Evaluate

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  • * Using the School Health Index (www.cdc.gov/HealthyYouth/SHI)

GUIDELINE 1

School Health Council Coordinated School Health Team School Health Coordinator

Family and Community

Promote Communication and Involvement

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Schools

  • Families
  • Community

Members

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School Health Services

ASSESS REFER ADVOCATE

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  • Health

Services

  • Mental Health
  • Services
  • Social
  • Services
  • STAFF

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

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Nursing Intervention Classifications (NIC)

  • Comprehensive
  • Research based
  • Reflects current

clinical practice

  • Easy to use

(Domains, Classes, Interventions, Activities all have definitions)

  • Uses language that

is clear and meaningful

  • Continually updated
  • Field tested

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Possible Nursing Interventions

  • Behavior

modification (4360)

  • Body image

enhancement (5220)

  • Emotional support

(5270)

  • Family involvement

promotion (7110)

  • Health education

(5510)

  • Journaling (4740)
  • Nutrition

management (1100)

  • Program

development (8700)

  • Teaching:

activity/exercise (5612)

Page 30

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Exercise Promotion (0200)

  • Appraise beliefs
  • Explore prior

experiences

  • Determine motivation
  • Explore barriers
  • Encourage verbalization
  • Encourage to begin or

continue exercise

  • Assist in finding positive

role model

  • Assist in setting short

and long term goals

  • Include family in

planning

  • Inform about health

benefits

  • Instruct on frequency,

duration, and intensity

  • Monitor adherence
  • Help in preparing

progress chart

  • Instruct on proper warm

up and cool down

  • Monitor response to

program

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Nursing Outcome Classifications

  • Developed inductively and deductively
  • Grounded in clinical practice and research
  • Uses clear, useful language
  • Helps in organizing outcome measures
  • Outcomes can be shared by all disciplines
  • Optimizes information for evaluation of

effectiveness.

  • Funded by the National Institute of Nursing

Research

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Nursing Outcome Measures

  • Knowledge-diet

(1802)

  • Compliance

Behavior: Prescribed diet (1622)

  • Knowledge-Weight

management (1841)

  • Physical Fitness

(2004)

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Nursing Outcome Classifications (NOC) Fourth Edition ISBN: 978-0-323-05408-9

Page 34

Knowledge: Diet- (1802)

Knowledge: Diet Overall Rating

No Knowledge 1 Limited Knowledge 2 Moderate Knowledge 3 Substantial Knowledge 4 Extensive Knowledge 5 Not Applicable N/A

Indicators: Recommended diet 1 2 3 4 5 Rationale for diet 1 2 3 4 5 Dietary goals 1 2 3 4 5 Relationship among diet, exercise and weight 1 2 3 4 5 Interpretation of food labels 1 2 3 4 5 Strategies to change dietary habits 1 2 3 4 5 Self-monitoring techniques 1 2 3 4 5

Outcome Target Range: Maintain at ______ Increase to _____

Nursing Outcome Classifications (NOC) Fourth Edition ISBN: 978-0-323-05408-9

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Individualized Healthcare Plan

Page 35

  • Nursing Assessment
  • Nursing Diagnosis
  • Planning Care Utilizing Nursing Interventions

and Outcome Classifications

  • Implementation
  • Evaluation

Constructing a Nursing Care Plan

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Assessment Nursing Diagnosis Planning (NIC and NOC) Implementation Evaluation (NOC Completed)

Height Weight Calculate BMI B/P Family History FitnessGram data Food diary Physical activity log Other Assessment Information 1) Altered nutrition: intake exceeds the body’s needs 2) Activity intolerance 3) Impaired physical mobility 4) Knowledge deficit/nutrition or physical activity 5) Activity intolerance

  • r high risk of

intolerance 6) Sleep pattern disturbance 7) Recreation deficit 8) Social isolation 1) Promotion of Behavior Change 2) Body Image Enhancement 3) Emotional Support 4) Exercise Promotion 5) Family Involvement Promotion 6) Health Education 7) Journaling 8) Nutrition Management 9) Nutritional Counseling 10) Program Development 11) Teaching: Prescribed Activity/Exercise

  • Should outline

who you will be collaborating with, if applicable.

  • Also should
  • utline specific

timeline for implementation.

  • Should outline the

steps of implementation. Example: Knowledge: Diet-1802 Rational 1 2 3 4 5 N/A Advantages 1 2 3 4 5 N/A Dietary Goals 1 2 3 4 5 N/A Interpretation Food Labels 1 2 3 4 5 N/A Strategies to Change 1 2 3 4 5 N/A Social Situations 1 2 3 4 5 N/A Self-monitoring Techniques 1 2 3 4 5 N/A

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Page 37 National Association of School Nurses (Online Courses) Childhood Overweight and Obesity: Overview 1.0 CNE Contact Hour Free to NASN Members! (Non-member price: $15.00) Evidence-based Practice 1.0 CNE Contact Hour Free to NASN Members! (Non-member price: $15.00) School Nurse Leadership: Advocating for Change 1.0 CNE Contact Hour Free to NASN Members! (Non-member price: $15.00) Height/Weight and BMI Screening, Resources and Interventions 1.0 CNE Contact Hour/module Free to NASN Members! (Non-member price: $15.00) Acanthosis Nigricans - School Nurse Educational Program 1.0 CNE contact hour Free for all audiences! Texas Health Step Modules (Free CEs) http://www.txhealthsteps.com/cms/ Obesity Exercise Induced Asthma Other Child Health Topics

Training and Resources

Resources

  • DSHS-Diabetes Council Algorithms

http://www.tdctoolkit.org/download_a_tool_kit.asp

  • DSHS-Diabetes Main Page

http://www.dshs.state.tx.us/diabetes/

  • DSHS-Obesity Prevention (Videos)

http://www.dshs.state.tx.us/obesity/GrowingCommunity.shtm

  • DSHS-Nutrition, Physical Activity and Obesity Home Page

http://www.dshs.state.tx.us/obesity/NPAOPprogrampage.shtm

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Contact Information

Anita Wheeler, RN, MSN

School Health Coordinator/School Nurse Consultant

512-776-2909 anita.wheeler@dshs.state.tx.us

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