Page 102 nursing.elitecme.com Complete Your CE Test Online - Click Here ● ● Hypertension: Elevated blood pressure contributes to the risk of heart disease and stroke. Obesity and diets high in saturated fats and sodium significantly increase the risk of hypertension[9] . ● ● Liver and gallbladder disease: Obesity has been linked to the development of liver and gallbladder disease. Foods high in fat and calories have been shown to exacerbate these kinds of disorders[9,30] . ● ● Malignancies: Overweight and obesity may increase the risk for the development of a number of cancers. To date, obesity has been linked to an increased risk for breast, colon, and endometrial malignancies[9,30] . ● ● Osteoarthritis: Excess weight places more stress and pressure on affected joints[9,30] . ● ● Sleep apnea and respiratory problems: Excessive weight, especially around the diaphragm and abdomen contributes to respiratory difficulties as well as sleep apnea compared to persons who are not obese[9,30] . ● ● Type 2 diabetes: Obesity is linked to the development of type 2 diabetes. Even an increased percentage of body fat (without being obese) in the abdominal region increases this risk[9] . Two recent studies further support the dangers of obesity. According to the results of a study published online in the August 15, 2013 issue of the American Journal of Public Health one in five deaths in the United States is linked to excess weight[32] . In this study, obesity appears to have an especially negative effect among black women, with almost 27% of deaths associated with overweight or obesity compared to nearly 22% in white women. Among black men, nearly 5% of deaths and among white men almost 16% of deaths were linked to overweight or obesity[32] . According to another study published online on October 16, 2013 in Family Practice, persons whose weight falls into a higher category of BMI and obesity have an increased risk for multiple chronic diseases (multi-morbidity)[33] . Multi-morbidity was defined as “the presence of two or more current conditions of a possible 11 conditions, including coronary heart disease, stroke, asthma, sleep apnea, type 2 diabetes, malignancies, gallbladder problems, back pain, osteoarthritis, and other joint problems and pain[33] . Consequences of obesity in children Jason is 10 years old. He enjoys playing games on his iPad and computer and gets very little exercise. His parents are slightly overweight and Jason is significantly overweight. Despite concerns expressed by Jason’s pediatrician and nurse practitioner, Jason’s parents do not believe that Jason’s weight is a matter of serious concern. “He’s just a little plump. He’ll outgrow it. It’s just “baby fat.” On a recent wellness visit to the pediatrician, Jason’s parents are horrified to learn that he has high blood pressure. The American Heart Association (AHA) has published a new scientific statement about the risks of obesity in children[34] . The statement, which is endorsed by the Obesity Society, notes that around 5% of children and adolescents in the United States are severely obese and therefore at high risk for developing type 2 diabetes and premature heart disease[34] . Investigators from the University of Minnesota Medical School, Minneapolis, who conducted this study, propose that “severe obesity” among children and teens is a newly defined class of risk and stress the grave consequences of this condition[34] . Another population-based study conducted by investigators at the Hacettepe University in Ankara, Turkey suggests that obesity is not just a problem in the United States[35] . The study cohort consisted of 3622 children and youth who were chosen to be representative of geographic, sex, and age groups in Turkey. Investigators found that the high rate of obesity in children and youth indicates that their risk for hypertension and chronic kidney disease as adults will be high. It was also mentioned that there is considerable concern about Turkish children’s exposure to fast food, which is high in fat and calories. Investigators believe that this exposure contributes to obesity rates[35] . The CDC has published a number of relative statistics pertaining to the health effects of childhood obesity. The organization has classified these effects as immediate and long-term. Immediate health effects include[36] : ● ● In a population-based sample of 5 to 17-year-olds, 70% of this obese sample had at least one risk factor for cardiovascular disease. This and other studies indicate that obese youth are more likely to have risk factors for cardiovascular disease. Such risk factors include elevated cholesterol or hypertension. ● ● Obese adolescents are more likely to develop pre-diabetes. Pre- diabetes is a condition in which blood glucose levels suggest that there is a high risk for development of diabetes. ● ● Obesity in children and adults places them at greater risk for bone and joint problems and sleep apnea. They are also at risk for the development of poor self-esteem and social bullying. Long term effects of being overweight and obesity in children and adolescents include[36] : ● ● Cardiovascular disease, cerebrovascular disease, type 2 diabetes, and osteoarthritis in adulthood. EBP alert!: Some research findings suggest that children who became obese as early as the age of two were more likely to become obese as adults[36] . This makes it imperative that nurses work with families to help children achieve and maintain an appropriate weight. ● ● Development of various malignancies including breast, colon, endometrium, esophagus, kidney, pancreas, gall bladder, thyroid, ovary, cervix, multiple myeloma, Hodgkin’s lymphoma, and prostate in adulthood. Prevention and reduction in obesity in children The best “treatment” of obesity in children is to prevent it. Since research shows that the rate of childhood obesity is at an alarming rate in the United States and that obesity exists even in toddlers, it is imperative that nurses and other healthcare professionals work with parents and families to encourage healthy lifestyle habits including healthy eating and physical activity[9,36] . Most parents and families and even most adolescents and even most children can respond appropriately when asked about weight loss strategies. Eat less, eat healthy (increase amounts of fruits and vegetables and decrease amounts of high-fat, high-calorie foods), and increase physical activity. If almost everybody knows this, why isn’t everybody doing it? The dietary and physical activity behaviors of children and adolescents are influenced by their families, friends, schools, and childcare settings. They are also influenced by how their healthcare providers talk to them about their eating habits. If children and adolescents feel