School Nurses’ Perception of Childhood Obesity

Today, United States is facing many health-related problems like breast cancer, cardiovascular diseases, cancer, and others. Among these, obesity is one of the most serious health problems facing the youth of United States and evidence shows that the problem is getting worse. Childhood obesity represents a threat to the health of the U.S. population that must be considered equal to that presented by AIDS and teen pregnancy. School nurses have a great role in countering this problem.

Pamela Moyers in the article, Perceptions of School Nurses Regarding Obesity in School-Age Children, describes that obesity is defined as the increase in body weight resulting from an excessive increase in fat. Leading factors causing obesity are overeating, binge eating, and low activity levels. Obesity in children is a very serious condition, which can lead to many other medical and psychological problems. This poses a difficult situation not only for a child but also for a child’s parents. (Softli 1989)

According to Moyers, school nurses define different standards of obesity and weight problems in childhood. These guidelines, which are published vary and make it difficult to compare results. “Obesity is also a growing problem in developing countries where it is associated with substantial morbidity and where malnutrition particularly deficiencies of iron, iodine, and vitamin A, affects approximately two billion people”. Obesity in children is defined between the ages of 6-11 years and in adolescents from 12-17 years of age.

According to some school nurses, obesity puts kids at risk for many other medical conditions. “Although being overweight certainly puts kids at an increased risk of health, psychological and social problems, the reality is that the great majority of obese children have none of these problems”. Many factors can lead to obesity among children. Many researchers believe that obesity in children can somewhat be attributed to increasing advancements in technology. But primarily, overeating and lack of exercise are the main factors involved in obesity. Other factors include excess television watching, computer, and video games, lack of physical activity, lack of nutritive food, and lack of knowledge about obesity.

A publication of the National Institute Survey indicated that about 13.6 percent of children ages 6-11 and 11.5 percent adolescents ages 12-17 are overweight. Both genetic and environmental factors influence one or more components of energy balance to affect obesity. Excess television viewing and eating junk food is one of the main reasons of increasing obesity among children. “The average American child spends approximately 24 hours each week watching television, time that could be spent in some sort of physical activity”. In a study of television and children, researchers interviewed and analyzed 4,063 children aged 8-16 years.

They found that 67 percent watched 2 hours of television per day, 26 percent watched 4 or more hours per day. In television programming, about 40 percent of the commercials are about fast food and other high-fat food, which can cause overweight children.

Genetic background is responsible for many obese children. It is normal for a child to be obese because the parents are obese. Genes play an important role in causing obesity. Childhood obesity has become a serious public health problem with medical and psychological consequences that persist into adulthood.

Lack of physical activity is also an important cause of of obesity. A decrease in physical activity between both genders is contributing to a recent 70 percent increase in the rate of obesity among young adults. Children are not willing to take any king of pain due to physical activities. “50 percent of youth aged 12-21 are not active on a regular basis”. “Physical education programs are fading from school curriculums, and parents are scrambling to find time and energy to be physically active with their children”.

Drinks containing sugar can also increase adiposity in children. “Many epidemiological studies have concluded that intake of carbohydrate (CHO) or even sucrose bears no relation with body adiposity, or the relation may be negative one”. Children tend to eat fattening food and drink sugar-contained drinks. Parents do not make their kids aware of eating healthy and nutritious food. In a study published in the March 25 issue of the Journal of the American Medical Association: The purpose of this study was to assess eating unhealthy food and T.V. viewing habits and their relationship to body weight and fatness in American children.

Children are unaware of the consequences of obesity. The blood glucose level can also rise in those children who are obese. (Softli 1989) The average blood glucose level in kids who are obese is 397 mg/dL. Most parents are also unaware of this fact of obesity. Children do not know that watching television and playing computer games can cause a lot of of problems about weight and obesity, which can also lead to so many other health-related problems. A major concern about childhood obesity is that obese children become obese adults, facing many diseases like diabetes, cardiovascular disease, and another chronic disease.

Lack of knowledge about obesity can also lead to a shorter lifespan. Obesity is a real-life threat and it could also shorten the lifespan of a person. “Ultimately, being overweight is likely to lead to a premature death. People who are severely overweight are four times more likely to die before their expected lifespan, and people who are moderately overweight are twice as likely to die early”. (Price 1987)

Obesity itself is a big problem but it also brings so many other diseases with it. Overweight and obesity increase the risk for complications of hypertension, hyperlipidemia, diabetes, coronary heart disease, osteoarthritis, and other chronic disorders, heart diseases are due to an increase in serum cholesterol and blood pressure, and decrease in high-density lipoprotein, non-insulin-dependent Mellitus, gallbladder disease and cancer of colon, endometrium, and prostate. Obese children face the serious physical problem. (Larsen 2006)

Many physicians still deny that diabetes is a serious issue in children who are obese. Its prevalence is rising sharply particularly among minorities, according to study findings presented by investigators during a poster session at the annual meeting of the American Diabetes Association. Type 2 diabetes in children is not fully understood. Obesity is predicted as a primary culprit.

Children who are obese also face some serious psychological problems. Obese children perform poorly academically. They have poor job prospects and they are socially isolated. It is common among overweight children that they are unhappy with their weight. “Research shows that obese children feel that being overweight is a worse disability than losing a limb”. The psychological problems faced by children who are obese are influenced by parental obesity. “Maternal obesity was independently related to a different set of child behavior problems than child obesity”. Parental obesity has a large impact on childhood obesity.

Obesity affects boys and girls differently. Assessing overweight concerns may be a useful method to identify those overweight girls who are at the highest risk for associated depressive symptoms. The BMI (Body Mass Index) was significantly associated with depressive symptoms among girls. Boys could be less obese than girls. They are more likely to be down (meaning not overweight or obese) after puberty. During puberty, hormones in boys tend to turn calories into muscle but in girls, it tends to turn calories into fat. According to Nathanson once a girl starts having menstrual periods her height growth usually slows down and it could make them look chubbier.

Obesity can also lead to inflammation. Overweight children as young as eight have been found to have a smoldering type of bloodstream inflammation that in adults has been linked to heart disease. The researchers looked at 3,561 American children ages 8-16 found that they are three to five times higher at a risk to have inflammation, as marked by the presence of a substance called C-reactive protein, or protein in the bloodstream. (Larsen 2006)

There are some more factors and facts related to obesity. Many factors contribute to obesity; those factors can be categorized into non-modifiable and modifiable risk factors. “Childhood risk factors for clinically significant obesity, persistent obesity, or adult obesity are only weakly predictive. We are unable to predict which overweight kids will develop a health problem or which will remain obese into adulthood”. Indication of this problem shows that the current generation of children will grow into the most obese generation of adults in the United States history. The average yearly weight gain during these school years is seven pounds- that is 9 ounces each month. Interestingly, children who are overweight during the school years tend to have faster growth of height and reach puberty sooner.

Children who gain weight normally do not make new fat cells during this age span. Left to their own devices, most children at this age eat 35 percent of their daily intake as snacks. From five to puberty, it usually takes about a year of gaining no weight to grow into every 20 percent of extra fat weight. There are also some important statistics involved about obesity in different races. Percentage of obesity in Hispanics is 47 percent, 57 percent in blacks, 11 percent in Caucasians, and 5 percent in Asians. The obesity problem among children and adolescents continues to rise where 33 percent of the population is obese.

More than 11 million children and teenagers are overweight. According to CDC (the Centers for Disease Control), the percentage of high schoolers attending a daily physical education class plunged from 42 percent in 1991 to 27 percent in 1997. “Some 97 million people in the United States are believed to be overweight. In those 39 million are considered obese or more than 30 pounds overweight”. (Price 1987)

In the United States, one-quarter of kids from 6-18 are overweight or at a risk, this figure is twice as many as in the 1980s. “The greatest concern about the increase of overweight in children is that overweight children are at a high risk of becoming overweight adults”. “An increase in preschool obesity may have serious implication for child health”. Obesity is present in overweight children bringing so many new complications into their bodies.

Obesity is causing so many side effects by all these serious diseases and complications. The cost of curing obesity-related side effects is very high. The economic cost of obesity in the U.S. is more likely to increase as the population ages and as the prevalence of obesity grows. The annual cost of treating health problems related to obesity has been estimated at $100 billion. The economic cost of obesity to U.S. Corporations is estimated to be five percent of their total annual medical cares costs. Total direct costs of obesity-related illnesses were $51.64 billion or 5.7 percent of U.S. health expenditures for the year 1995.

Disease treatment is very expensive and the cost for different diseases varies. For example, the cost of treating gallbladder disease is about $2.59 billion per year in the United States alone. To treat postmenopausal breast cancer and colon cancer the cost is $1.85 billion per year and $3.23 billion for hypertension. Direct costs were found to be $6.99 billion for coronary heart disease, $32.4 billion for non-insulin-dependent diabetes mellitus. The investigators found that approximately $45.8 billion expenditure (6.8 percent of total health care expenditures) can be attributed to obesity.

Obesity is a rising problem in the United States and taking some important steps may prevent it. School nurses and parents of obese children should take the steps to decrease obesity. Treatment and prevention programs should be developed outside the clinical setting such as in the school and community. Educational efforts should be directed toward policymakers, health care professionals, community leaders, and parents. Obesity is controllable and therefore it should be prevented. BMI (Body Mass Index) can determine if a child is obese. With the help of of charts, such as weight-for-age and weight-for-height and through this we can prevent obesity in children.

Children must also take initiative and try to reduce the risk of being overweight. Children must stay active and with that also participate in physical activities such as sports. Kids must intake a healthy diet and consume about 2,000 calories a day. One study showed 80 percent of U.S. children reported taking part in three or more physical activities per week. With a combination of healthy eating and regular physical activity, they can live a healthy lifestyle.

Exercising should be encouraged in children with different environments. “Themed play areas can encourage exercise and even reinforce health concepts, such as nutrition”. “A successful fitness program is vital to help reserve some of the unhealthy trends that are facing this country’s youth”.

Parents should be those that are most responsible for teaching their children about obesity. Parents should be aware of preventing obesity in their children. Parents must be encouraged to be involved in schools and community programs. Parents need to underscore lessons at home. “The parent is the one who has to provide the context”. Parents must teach the children to dine together, preventing kids to minimize time spent in front of the television. This prevents them from overeating and also encourages a balanced diet.

School nurses must give them lessons about obesity in school so that children can be more aware of the facts and consequences. Educational efforts should be used towards policymakers, health care professionals, and community leaders. Schools are fighting fat by teaching their children to eat healthy food and greens. But sometimes school nurses may also have a poor understanding of obesity (58.4 percent) and although their knowledge about prevention is much better (74.6 percent).

Schools must take responsibility to provide nutrition and physical activity opportunities to students to make children learn about the importance of nutrition and physical activity in overall health. Everybody should take initiative to prevent obesity in children.

Obesity in children is discouraging; especially to their self-image and ego and in some cases it can also be dangerous. Children need to be agile and active and if they are obese, this would be an obstacle in their daily activities. Some parents, by being overprotective, forget what is good for their children. For kids to be healthy, healthy diets and increased physical activity is necessary, rather than protective confinement. Also, if parents practice a strong and healthy lifestyle, automatically the kids would be encouraged to do the same. Thus parents determine their kid’s future by giving them the gift of health.

School nurses can develop a practice of taking healthy diets in students. Healthy diets and exercises discussed can go a long way to provide a healthy body and mind. These days, it is said that obesity is a disorder of energy balance in our body. But this disorder can be rectified by proper diet and exercise. A proper diet is necessary because each kind of food has different nutrients, which contribute in different ways to our body.

According to Moyers, although it seems that while obesity is not a disease, it is a cause for many diseases. It not only causes discomfort, crumbled self-image, and psychological problems but also is causes of fatal diseases like heart problems and clogging of arteries. Since this is the era of competition, survival of the fittest is key, and only the person who is best at everything survives and succeeds. Thus not only the active mind, but also the active body is a key to gaining success in this world. And obesity is a big hurdle in that pathway, which we all should avoid and work against.

References

Larsen, L, Mandleco B, Williams M, Tiedeman M., Childhood obesity: prevention practices of nurse practitioners. (eng; includes abstract), Journal Of The American Academy Of Nurse Practitioners [J Am Acad Nurse Pract], ISSN: 1041-2972, 2006.

Moyers, Pamela., Perceptions of School Nurses Regarding Obesity in School-Age Children.

Price, JH, Desmond SM, Ruppert ES, Stelzer CM, School nurses’ perceptions of childhood obesity. (eng; includes abstract), The Journal Of School Health [J Sch Health], ISSN: 0022-4391, 1987.

Softli, M., A school nurse’s observation on gross obesity in childhood. (eng), The Washington Nurse [Wash Nurse], ISSN: 0734-5666, 1989.