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Journal of Pediatric Surgical Nursing:
doi: 10.1097/JPS.0000000000000017
Pediatric Obesity Column

Pediatric Obesity Update

Browne, Nancy T. MS, PPCNP-BC, CBN; Haynes, Beverly B. MSN, RN, CPN

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Nancy T. Browne, MS, PPCNP-BC, CBN, Falmouth, ME.

Beverly B. Haynes, MSN, RN, CPN, Bariatric Surgical Coordinator, Children’s of Alabama, Birmingham, AL.

The authors declare no conflict of interest.

Correspondence: Nancy T. Browne, MS, PPCNP-BC, CBN. E-mail: nancytkacz@sbcglobal.net

Welcome to the second Pediatric Obesity column! This column’s mission is to provide information and resources to the pediatric surgical nurse caring for children affected by obesity and also to share focused assessment and intervention strategies that can be incorporated into the practitioner’s daily practice.

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A “10-MINUTE” BEDSIDE ASSESSMENT AND EDUCATION INTERVENTION ABOUT CHOOSING HEALTHY BEVERAGES

The assessment of any patient includes dietary questions. This is especially important when that child is affected by overweight or obesity. Observing what the child’s family drinks is a good indication of the child’s beverage choices; an opportunity for education may be as close as the child’s bedside during other routine care.

The human body is approximately 50%–65% water after 1 year of age. Water is necessary for all functions of the body. Often, the choice for replacement of the water used for daily bodily functions is a high-calorie beverage. These beverages may lead to obesity and, in turn, diabetes, hypertension, joint pain, cancers, and other obesity-related comorbidities.

The average American child takes in about 100 pounds of sugar a year. This is about one-fourth pound or 28 teaspoons everyday. Children only need about six to nine teaspoons a day to meet the body’s glucose needs. Carbonated soft drinks contain 10–11 teaspoons of sugar per 12 ounce serving. Drinking one soft drink a day can add up to about 50 pounds of sugar a year. In addition, what we consider a serving size has become distorted over the last 15 years, and many “servings” of soda sold currently are in a 20-ounce bottle; consumers may not be aware that 20 ounces is considered 2.5 servings per bottle. Education about how to correctly read nutritional labels as the dangers of sugar-sweetened beverages is an important health promotion activity by nurses for their patients and families.

A quick lesson that can be done at the bedside is to ask children to find the nutrition label on the bottle or can of the beverage. The very first box tells the serving size and how many servings are in the container. Children may be surprised to find how much volume they are consuming compared to the suggested serving size. Next, encourage children to find the grams of sugar in the beverage. Four grams of sugar is approximately one teaspoon of sugar. Therefore, a soft drink with 41 grams of sugar is about 10 teaspoons of sugar, already above the daily energy needs for a child’s body.

When the nurse does an assessment and observes a need, this quick educational guide may plant a seed that will start a family and patient on a healthier path. Resources are included at the end of this column for more in-depth information and printable handouts.

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RESOURCE SECTION: THE AMERICAN ACADEMY OF PEDIATRICS: WEIGHT-BASED VICTIMIZATION

The American Academy of Pediatrics (AAP) is one of many professional groups providing resources to healthcare professionals addressing childhood obesity. These resources are concentrated in the AAP’s Section of Obesity (SOOb) webpage located at http://www2.aap.org/obesity/index.html.

Currently, the SOOb is featuring a webinar on their home page entitled, “The Importance of Addressing Weight-Based Bullying With Your Pediatric Patients.” The AAP’s Institute for Healthy Weight produced the 2-hour webinar, which features four experienced speakers: Rebecca Puhl, PhD, Yale Rudd Center for Food Policy and Obesity; Sandra Hassink, MD, FAAP, President of AAP and Pediatrician in Nemours Weight Management Program; Angie Hasemann, RD, CSP, Registered Dietitian, University of Virginia Children’s Fitness Program; and Scott Kahan, MD, MPH, Director, Strategies to Overcome and Prevent Obesity Alliance

Dr. Puhl begins the webinar with a review of the current research literature on weight-based victimization (WBV). She begins with a historical look at WBV in the literature. Research estimates that 60% of children affected by obesity have been teased, bullied, or physically abused because of their weight. Dr. Puhl discusses current research on the forms of WBV, consequences of WBV for its recipients, and who is perpetrating the WBV.

Dr. Hassink addresses the need to routinely assess all at-risk children for WBV. She feels that the number of children affected by obesity and WBV has been underreported in her experience. Often, her patients have not shared their negative experiences with parents or friends. Her simple advice is that, as pediatric professionals, we need to ask the question every time no matter what the purpose of our clinical interaction with our patient. She reminds us that WBV affects the entire family who often need guidance about intervention and supportive strategies. She provides specific strategies on assessment questions and helpful interventions for the child and family. Dr. Hassink states that one of the most supportive messages is simply to validate to the child that the victimization they have experienced is wrong, not their fault, and not supportable. She also encourages the pediatric healthcare worker to ask if the child feels he is safe; intervention then follows as with the discovery of any other unsafe situation for a child.

Ms. Hasemann concentrated her section on the strength of the multidisciplinary team working with children affected with obesity. She shared excellent open-ended questions to assess for WBV. Her focused questions are useful for healthcare professionals who have short, episodic interactions with at-risk children and their families, such as in ambulatory surgery and postanesthesia care units.

Finally, Dr. Kahen concentrated on several organizations and Web sites that offer concrete strategies and resources on how to assess and intervene with recipients of WBV. He believes that there is a gap in the current education of healthcare professionals about this topic; he advocates for pediatric healthcare professionals to develop and provide education about WBV within hospital units, organizations as a whole, and in the community.

The 2-hour webinar is an excellent overview of WBV and provides specific strategies for intervention. We encourage all to visit this AAP Web site for more information on WBV and for other excellent resources on pediatric obesity.

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LITERATURE REVIEW

A recent New York Times headline reads “Obesity Rate for Young Children Plummets 43% in a Decade.” Similar headlines and leads into news broadcasts used similar words. While a decrease in childhood obesity of any kind is encouraging, the details in the actual report are more sobering.

The report is “Prevalence of childhood and adult obesity in the United States, 2011–2012” by Ogden, Carroll, Kit, and Flegel, researchers from the National Center for Health Statistics, Centers for Disease Control and Prevention in Rockville, MD. Anyone who has written in the field of obesity (pediatric or adult) over the past 20 years most likely will have begun their manuscript with the incidence of childhood obesity, and their primary source would undoubtedly have been Ogden et al. So, it is with confidence that one can read Dr. Ogden’s latest report published February 15, 2014 in the Journal of the American Medical Association.

We encourage all to read this article thoroughly to become better informed about the actual findings and then to provide better commentary to fellow professionals and the general community when reaction to this report is less than accurately interpreted that childhood obesity epidemic is waning. According to Dr. Ogden’s report, in 2011–2012, prevalence of obesity was 16.9% in U.S. youth; this was unchanged compared with data from 2009 to 2010, and there was no significant change since 2003–2004. However, in the subgroup analyses, the prevalence of obesity in children 2–5 years of age decreased from 14% in 2003–2004 to 8.1% in 2011–2012. No doubt, this is encouraging for these children; the opportunity is to attempt to identify why and if factors are discovered that can be generalizable to other age groups.

Within the larger groupings of childhood obesity and age groups lie data for gender and ethnicity that speak to our most at-risk groups. For example, Asian youth may have different distribution, type, or degree of body fat at the same BMI than other ethnic groups. The article provides detailed obesity rates for four ethnic groups in four distinct age groups. Data of obesity rates for Hispanic males and African American females continue to be higher than other subgroups. This level of detail is especially important as pediatric surgical nurses practice with diverse age groups and ethnic communities. We recommend this article to identify the children in our practice pattern most at risk for overweight and obesity and for the comorbidities that accompany this excess weight.

Reviewed article: Ogden, C. L., Carroll, M. D., Kit, B. K., & Flegal, K. M. (2014). Prevalence of childhood and adult obesity in the United States, 2011–2012. JAMA, 311, 806–814.

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Bibliography

American Heart Association. ( nd). Nutrition labels 101. Retrieved from http://www.heart.org/idc/groups/heart-public/@wcm/@global/documents/downloadable/ucm_321860.pdf
Dairy Council of California. ( 2012). ReThink your drink. Retrieved from http://www.healthyeating.org
National Heart Lung and Blood Institute. ( 2013 September 30). Portion distortion. Retrieved from http://www.nhlbi.nih.gov/health/public/heart/obesity/wecan/eat-right/portion-distortion.htm
Tavernise S. Obesity rate for young children plummets 43% in a decade. The New York Times. Retrieved from http://www.nytimes.com/2014/02/26/health/obesity-rate-for-young-children-plummets-43-in-a-decade.html?action=click&module=Search&region=searchResults%230&version=&url=http%3A%2F%2Fquery.nytimes.com%2Fsearch%Fsitesearch%2F%23%2Fsabrina%2Btavernise%2F7days%2F&_r=0
The Nutrition Source. ( nd). Retrieved from http://www.hsph.harvard.edu.nutritionsource/healthy-drinks-full-story
The USGS Water Science School. ( 2014 February 24). The water in you: What does water do for you? Retrieved from http://water.usgs.gov.edu/propertyyou/html
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FEEDBACK:

We welcome your feedback, opinions, and suggestions for content. We encourage you to send your comments directly to Beverly Haynes (Beverly.Haynes@childrensal.org) or Nancy Browne (nancytkacz@sbcglobal.net).

Copyright © 2014 American Pediatric Surgical Nursing Association

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