1. Effective Methods of Decreasing the Incidence of Childhood Obesity in the United States By Kenya Baines and Stephanie Costa

2. Background The incidence of childhood obesity has been on the rise for the last thirty years. Obesity is defined as a body mass index at or above the 95th percentile. Seventeen percent of children ages 2- 19 are obese. Obesity in children can lead to many health conditions including, high blood pressure, high cholesterol, cardiovascular disease, type 2 diabetes, sleep apnea, asthma, fatty liver disease, gallstones, GERD, and social and psychological problems such as discrimination and poor self- esteem.

3. Obesity Complications

4. Problem Statement The role of effective interventions provided by health care providers can have a positive impact in decreasing these astronomical obesity related costs. Obesity rates continue to rise with a lack of information related to the association of obesity with gender, age, ethnicity and socioeconomic status.

5. Problem Statement Effective programs and policies are needed at a global, regional and national level in order to decrease this growing epidemic.

6. Research Question What interventions are effective in decreasing the incidence of obesity in children of the United States from childhood to adolescence?

7. Purpose of the study Is to reveal the effective treatment methods and interventions needed to decrease childhood obesity rates from childhood to adolescence. To enhance the practice of NP’s in relation to the prevention of childhood obesity. To highlight effective guidelines of practice to be used by the FNP to reduce the incidence of obesity.

8. Methodology 20 articles were found. 9 were excluded. 11 articles were used in the final draft of the literature review. 6 articles are used in our presentation today. CINHAL, Google Scholar, Pub med Key search words: “childhood obesity” “prevention” “role of the NP” “effective treatment methods” Inclusion criteria included that the article must relate to childhood obesity in the United states Articles must address contribution to NP practice Exclusion criteria included any article that did not reference the United States and did not provide research based on effective treatment methods

9. Level Of Evidence

10. Level of Evidence Author/ Article/ Year PurposeSample (n)Design & Level of Evidence ResultsImplications for Practice Larsen, L., Mandleco, B., Williams, M., & Tiedeman, M. Childhood obesity: prevention practices of nurse practitioners. (2006) Describe the prevention practices of NP’s regarding childhood obesity and compare/identify relationships between prevention practices and demographic variables. Convenience sample of 99 FNP’s and PNP’s. Questionnaire Level V Although 73.7% reported being aware of childhood obesity prevention guidelines, most were not using the BMI scale. It is crucial that NP’s take the necessary steps to prevent childhood obesity by following proper guidelines. Hessler, K., & Siegrist, M. Nurse practitioner attitudes and treatment practices for childhood overweight: How do rural and urban practitioners differ? (2012) To investigate NP’s attitudes toward pediatric obesity and explore current diagnosis and treatment practices. 1088 FNP/PNP chosen randomly from the American Academy of NP’s member list. Cross sectional design, Level V Did not assess and diagnose per current guidelines. Initiation of treatment was lacking. Rural NP’s had fewer referral services. More education for NP’s is necessary. More referral services needed.

11. Author/ Article/ Year PurposeSample (n)Design & Level of Evidence ResultsImplications for practice Barlow, S., E., & Dietz, W., H. Management of child and adolescent obesity (2002) The primary aim of this study was to identify interventions used by pediatric health care providers in treatment of overweight children and adolescents to identify provider educational needs. Randomized, 940 providers Questionnaire, Level V The majority recommended "changes in eating patterns" and "limitations of low-fat diet" and "modest calorie restriction" in adolescents. The NPs in this study promoted healthy eating and activity with minimal use of highly restrictive diets or medication to control weight. Davis, M. M., Gance-Cleveland, B., Hassink, S., Johnson, R., Paradis, G., & Resnicow, K. Recommendations for Prevention of Childhood Obesity. (2007) Reviewed the most recent evidence regarding many behavioral and practice interventions related to childhood obesity, and presented recommendations to health care providers. Not listedLiterature review, Level V Suggested approaches that clinicians can use to encourage obesity prevention among children, including specific counseling strategies and practice-based, systems-level interventions. One of the most beneficial methods is when NP’s interact with and promote local and state policy initiatives designed to prevent obesity in their communities.

12. Author/ Article/ Year PurposeSample (n)Design & Level of Evidence ResultsImplication s for Practice Heitmann, B. L., Koplan, J., & Lissner, L. Childhood obesity: successes and failures of preventive interventions. (2009) This report summarizes the main points of the session titled “Prevention of Childhood Obesity” held at the World Congress of Public Health Nutrition Not listedLiterature review, Level V The speakers were in general agreement that action is needed in the area of childhood obesity prevention and that the worldwide epidemic itself is sufficient evidence for action. Important issues here include establishing a consensus on what constitutes a good, yet realistic, design and on how to maintain scientific standards in community interventions. Hopkins, K., F., DeCristofaro, C., & Elliott, L. How can primary care providers manage pediatric obesity in the real world? (2011) To provide evidence-based interventions and clinical practice guidelines as a basis for a clinical toolkit utilizing a step management approach for the primary care provider in managing childhood obesity. Not listedLiterature review, Level V For all treatments, lifestyle modifications include attention to diet and activity level. Using current guidelines, the primary care provider can initiate and manage ongoing interventions in pediatric obesity.

13. Emerging Themes Prevention is key! Following clinical guidelines, such as the BMI scale is important for assessing children at risk. NP’s must be educated on the importance of using the correct clinical guidelines. Pay attention to family cues and develop a plan that will work best for the patient and the family as a whole. NP’s should get involved in prevention of childhood obesity at a community level.

14. Contribution to NP practice Family nurse practitioners face many barriers when implementing education related to the prevention of childhood obesity. Childhood obesity is increasing at a staggering rate in the United States and it is imperative that we as primary care providers, take the initiative in using the proper steps for prevention. Calculating the BMI for age, targeting children at risk, as well as helping families develop healthy nutrition and exercise plans.

15. Contribution to NP practice NP's should act as advocates in their communities to help overcome the major barriers that are linked to childhood obesity prevention. Nurse practitioners are at the forefront for assessing, diagnosing and treating childhood obesity.

16. Planned Methodology To continue our search for effective treatment methods using library databases. Adhere to our inclusion/exclusion criteria. Look for more community resources. Gather more data related to NP’s in our community.

17. References Barlow, S., E., & Dietz, W., H. (2002). Management of child and adolescent obesity: Summary and recommendations based on reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics, 110(Supplement), 236-238. Basics about Childhood Obesity. (2012, April 27). Retrieved February 1, 2015, from http://www.cdc.gov/obesity/childhood/basics.html Childhood obesity facts. (2014, December 11). Retrieved February 1, 2015, from http://www.cdc.gov/healthyyouth/obesity/facts.htm Davis, M. M., Gance-Cleveland, B., Hassink, S., Johnson, R., Paradis, G., & Resnicow, K. (2007, Dec 1). Recommendations for Prevention of Childhood Obesity. PEDIATRICS, 120, 229-253. http://dx.doi.org/10.1542/peds.2007-2329E Heitmann, B. L., Koplan, J., & Lissner, L. (2009). Childhood obesity: successes and failures of preventive interventions. Nutrition Reviews, 67, 89-93. http://dx.doi.org/10.1111/j.1753- 4887.2009.00167.x Hessler, K., & Siegrist, M. (2012, February 24). Nurse practitioner attitudes and treatment practices for childhood overweight: How do rural and urban practitioners differ? Journal of the American Academy of Nurse Practitioners, 2, 97-106. http://dx.doi.org/http://dx.doi.org.ezproxy.simmons.edu:2048/10.1111/j.1745-7599.2011.00673.x Hopkins, K., F., DeCristofaro, C., & Elliott, L. (2011). How can primary care providers manage pediatric obesity in the real world? Journal of the American Academy of Nurse Practitioners, 23(6), 278-288.

18. References Larsen, L., Mandleco, B., Williams, M., & Tiedeman, M. (2006, February). Childhood obesity: prevention practices of nurse practitioners. Journal of the American Academy of Nurse Practitioners, 2, 70-99. http://dx.doi.org/http://dx.doi.org.ezproxy.simmons.edu:2048/10.1111/j.1745- 7599.2006.00105.x Sonneville, K., LaPelle, N., Taveras, E., Gillman, M., & Prosser, L. (2009). Economic and other barriers to adopting recommendations to prevent childhood obesity: Results of a focus group study with parents. BMC Pediatrics, 9 Story, M., T., Neumark-Stzainer, D., R., Sherwood, N., E., Holt, K., Sofka, D., Trowbridge, F., L., et al. (2002). Management of child and adolescent obesity: Attitudes, barriers, skills, and training needs among health care professionals. Pediatrics, 110, 210-214. Trasande, L., Liu, Y., Fryer, G., & Weitzman, M. (2009). Effects of childhood obesity on hospital care and costs, 1999–2005. Retrieved from http://content.healthaffairs.org/content/28/4/w751. Wang, Y., & Lobstein, T. (2006, March). Worldwide trends in childhood overweight and obesity. International Journal of Pediatric Obesity, 1, 11-25. http://dx.doi.org/10.1080/17477160600586747