TEAM CHUBBY CHASERSChasing Away Childhood Obesity

Chasing the Chub-What is the Chub?

Overweight and obesity are the result of “caloric imbalance”—too few calories expended for the amount of calories consumed—and are affected by various genetic, behavioral, and environmental factors.

• The percentage of children aged 6–11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2010. Similarly, the percentage of adolescents aged 12–19 years who were obese increased from 5% to 18% over the same period.

(Centers for Disease Control and Prevention, 2012)

Percentage of youths in public schools who were obese in 2003

from Center for Disease Control

Percentage of youths in public schools who were obese in 2011 from Center for Disease Control

What qualifies a youth as “obese” in these demographic findings? According to Centers for Disease

Control: Youth with a BMI greater than or

equal to the 95th percentile for age an sex are considered overweight or obese.

Youths that are considered “at risk for overweight” have a BMI between the 85th and 95th percentile for their age and sex.

Demographic Facts & Statistics

Roughly 17%, or 12.5 million children and adolescents aging between 2-19 years old are considered obese (CDC, 2011).

Since 1980, obesity among children has almost tripled (CDC, 2011).

In 2007-08, Hispanic boys from 2 to 19 years old were more likely to be obese than non-Hispanic white boys, and non-Hispanic black girls were more likely to be obese than non-Hispanic white girls (CDC, 2011).

Cultural Descriptors racial/ethnic disparities in obesity prevalence are

already presentAfrican Americans and Hispanics higher intake of sugar-sweetened beverages higher intake of fast food lower rates of exclusive breastfeeding (Taveras and Gilman) On average ethnic minority women have a greater

acceptance of being overweight and higher rates of body satisfaction unrelated to weight

(Fitzgibbon and Beech)

80% of youth drink sugar drinks- Center for Disease Control and Prevention

What is Weight Bias/Stigma?

Bias and Stigma generally refer to negative attitudes that affect our interpersonal interactions and activities in a negative way.

Stigma may come in several forms, including:

1. Verbal types of bias (such as ridicule, teasing, insults, stereotypes, or derogatory names)

2. Physical stigma (such as touching, grabbing, or other aggressive behaviors)

How are children affected by Weight Bias/Stigma?

Children attribute multiple negative characteristics to overweight peers including being , “mean, stupid, ugly, unhappy, lazy, and having few friends”.

Peers are common perpetrators of weight-related teasing and derogatory names, and school is a frequent venue where stigma occurs.

Bias and stigma have negative implications for emotional well-being in children.

Research shows that children who are targets of weight stigma tend to engage in self-blame for the negative social experiences that they confront. 

Research on adolescents has documented that weight-based teasing is associated with low self-esteem and depression, and that overweight teens are more likely to be socially isolated.

Most alarming are recent studies demonstrating a positive association between obesity and suicidal attempts among youth.

How can Weight Bias/Stigma be reduced?

Professionals in the obesity field, both researchers and clinicians, can employ a variety of strategies to help reduce weight stigma and improve attitudes.

Health professionals can make a difference by becoming aware of their own biases, developing empathy, and working to address the needs and concerns of obese patients.

What can we do as nurses? Consider that this child may have

had negative experiences with other health professionals regarding their weight, and approach them with sensitivity.

Emphasize behavior changes rather than just the number on the scale

Offer concrete advice, e.g., join a sports team, start eating more fruits and veggies, etc., rather than simply saying, “You need to lose weight.”

Acknowledge the difficulty of lifestyle changes.

Recognize that small weight losses can result in significant health gains.

Environmental Factors In January 2012, the US Department of Agriculture passed

a series of regulations designed to improve the nutritional content of school lunches.

The field study was conducted in the cafeterias of Addison and Campbell-Savona Junior-Senior High Schools (grades 7-12) in western New York.

Interventions in the smarter lunchroom makeover

Category of change Specific changesConvenience: Improving the convenience of fruits and vegetables

“Healthy convenience line” with only submarine sandwiches and healthier sides (ie, fruits andvegetables)Salad served in see-through to-go containersFresh fruit located next to the cash register100% fruit juice boxes kept in freezer next to ice cream

Attractiveness: Improving the attractiveness of fruits and vegetablesrelative to other options

Lunch menu posted with nice color photos of fruits and vegetables servedVegetables labeled with descriptive namesFresh fruit displayed in nice bowls or tiered stands

Normativeness: Making the selection of fruits and vegetablesseem normative

“Would you like to try.?” (verbal prompt by cafeteria staff)“No veggie? How about.?”“You can get another side with your meal. How about grabbing a piece of fruit by the register?”Last Chance for Fruit sign displayed next to fruit basket at the cash register

Results of the Smarter Lunchroom

This smarter lunchroom makeover was notably effective

This smarter lunchroom makeover increased actual fruit consumption by 18% vegetable consumption by 25% students were 16% more likely to eat an

entire serving of fruit 10% more likely to eat an entire serving of

vegetables

What does a community consist of?:

• Geographic location• Race• Ethnicity• Socioeconomic status

A community can either promote a healthy lifestyle for children or the opposite…

What can Communities do to help?

According to the US National Library of Medicine, communities can send out support by offering healthy messages or educating children the importance of adopting a healthy lifestyle.

Communities and parents can promote physical activity based programs for children, such as: Walking to school Bike paths Playgrounds Little league teams Supervised physical education Community Pools

Health Risk Factors

High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD). In one study, 70% of obese children had at least one CVD risk factor, and 39% had two or more.

Increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes.

Breathing problems, such as sleep apnea, and asthma.

Joint problems and musculoskeletal discomfort. Fatty liver disease, gallstones, and gastro-

esophageal reflux (i.e., heartburn). Obese children and adolescents have a greater

risk of social and psychological problems, such as discrimination and poor self-esteem, which can continue into adulthood.

Breathing problems such as sleep apnea and asthma

Obese children are more likely to become obese adults

health conditions including heart disease, diabetes, and some cancers.

If children are overweight, obesity in adulthood is likely to be more severe.

Now Later

Center for Disease Control and Prevention

approximately 17% (or 12.5 million) of children and adolescents aged 2—19 years are obese.

Adaptation Theory “Adaptation [theory]… is the process of

changing behavior in response to external or internal stimuli or surroundings” (Maiville & Huerta, 2013, p. 29).

Goals of Healthy People 2020

Goal Promote health and reduce chronic

disease risk through the consumption of healthful diets and achievement and maintenance of healthy body weights.

Overview The Nutrition and Weight Status

objectives for Healthy People 2020 reflect strong science supporting the health benefits of eating a healthful diet and maintaining a healthy body weight.

The objectives also emphasize that efforts to change diet and weight should address individual behaviors, as well as the policies and environments that support these behaviors in settings such as schools, worksites, health care organizations, and communities.

Why are Nutrition and Weight Status Important?

Diet and body weight are related to health status. Good nutrition is important to the growth and development of children. A healthful diet also helps Americans reduce their risks for many health conditions, including:

Overweight and obesity Malnutrition Iron-deficiency anemia Heart disease High blood pressure Dyslipidemia (poor lipid profiles) Type 2 diabetes Osteoporosis Oral disease Constipation Diverticular disease Some cancers

Understanding Nutrition and Weight Status

Diet Diet reflects the variety of

foods and beverages consumed over time and in settings such as, schools, restaurants, and the home. Interventions to support a healthier diet can help ensure that:

Individuals have the knowledge and skills to make healthier choices.

Healthier options are available and affordable.

Social and Physical Determinates to the Child’s Diet.

Conclusion Obesity is an epidemic Little changes could make a big

difference

References CDC – Obesity – Over Time – Adolescent and School Health.

(2011). Centers for Disease Control and Prevention. Retrieved April 14, 2013, from http://www.cdc.gov/healthyyouth/obesity/youth.htm

Childhood Obesity: A Global Public Health Crisis. (2012). National Center for Biotechnology Information. Retreived April 14, 2013, from http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3278864

Fitzgibbon, M., & Beech, B. (2009). The role of culture in the context of school-based BMI screening. Pediatrics, 124S50-62. doi:10.1542/peds.2008-3586H

Hanks, A. S., Just, D. R., & Wansink, B. (2013). Smarter Lunchrooms Can Address New School Lunchroom Guidelines and Childhood Obesity. Journal of Pediatrics, 162(4), 867-869. Retrieved from the CINAHL database.

Huerta, C. G., & Maville, J. A. (2013). Health promotion in nursing (3rd ed.). Clifton Park, NY: Delmar, Cengage Learning.

References Continued Nutrition and Weight Status - Healthy People. (n.d.). Healthy People

2020 - Improving the Health of Americans. Retrieved April 17, 2013, from http://www.healthypeople.gov/2020/topicsobjectives2020/overview.aspx?topicid=29

Obesity and Overweight for Professionals: Childhood: Basics - DNPAO - CDC. (n.d.). Centers for Disease Control and Prevention. Retrieved from http://www.cdc.gov/obesity/childhood/basics.html

Obesity, Bias, and Stigmatization. (n.d.). Obesity Society: Research. Education. Action. Retrieved April 17, 2013, from http://www.obesity.org/resources-for/obesity-bias-and-stigmatization.htm

Taveras, E., Gillman, M., Kleinman, K., Rich-Edwards, J., & Rifas-Shiman, S. (2010). Racial/ethnic differences in early-life risk factors for childhood obesity. Pediatrics, 125(4), 686-695. doi:10.1542/peds.2009-2100