nursing.elitecme.com Page 83 Complete Your CE Test Online - Click Here 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 that they are being “scolded” they may rebel against healthy eating and lifestyle suggestions[9,36] . Recommendations must be practical. If the family has a limited income, the adults who purchase food may be more likely to purchase what is inexpensive, regardless of its health benefits, than what is healthy, especially if the costs exceed what they are able to spend. Think about the causes and risk factors for obesity. If family members are overweight or obese, it is likely that their dietary and lifestyle habits contribute to the child’s unhealthy weight. It is also likely that the entire family would benefit from adopting a more healthy diet and increasing the amount of exercise they get[9,36] . Schools play an important role in facilitating the development of a healthy environment. What kinds of food are being served in the school cafeteria? What kinds of foods and beverages are available in vending machines on school property? Nursing consideration: Healthcare providers, families, and friends must be aware that some eating disorders are triggered after affected persons have attempted to diet. The rewards they receive for losing weight (i.e. positive comments, improved performance in athletics, etc,) may make adolescents feel that they need to lose weight even to the point of near starvation (i.e. anorexia nervosa). Or they may indulge in purging behaviors (i.e. self-induced vomiting, abuse of laxatives and diuretics). The point is to be aware of those who are at risk for eating disorders as they adopt more healthy diets[20,21] . Here are some recommendations for counseling parents, children, and adolescents about weight loss[9,36,37,38] : ● ● Involve the entire family in efforts to adopt more healthy diets and to increase physical activity. ● ● Encourage the entire family to eat the same meal. The overweight or obese child or adolescent should not have to eat “different” foods from the rest of the family. For example, it is unrealistic to expect the affected child or adolescent to eat fruits and vegetables and lean meats while the rest of the family eats fried foods and elaborate desserts. ● ● Physical exercise should involve the entire family. Do not make exercise a punishment or something that is boring. Find an activity that family and friends enjoy and can do together to help the child or adolescent lose weight. ● ● Find out if the affected child or adolescent has friends that can support him/her in weight loss efforts. Going out for hamburgers and fries after the high school basketball game is not a good option for someone who needs to lose weight. Friends should encourage the intake of more healthy options such as salads or grilled chicken. Some recent research studies provide some more information about how to prevent or treat overweight or obesity in children. The results from one such study showed that having an older sibling who is overweight or obese is a strong predictor of childhood obesity. This is especially true if the sibling is of the same sex[39] . A research team evaluated data from a 2011 online survey of 3663 adults with at least one child younger than 18 years of age[39] . The