Be Wiggle Wise and Cookie

Conscious
A Childhood Obesity Intervention Strategy

By: Tonya Bright

Jacksonville State University
Clinical Prevention and Population Health
NU 712
 Table of Contents
• Introduction • Community Outreach
• Statistics • Current Programs
• Vulnerable Population • Initiative Structure/Program
• Health Disparities • DNP Competencies
• Prevalence • Role of DNP
• Risk Factors • Resources
• Complications • Measures of Success
• Level of Prevention • Conclusion
• Lifestyle Changes • References
 Introduction

• The World Health Organization (WHO) reported 170 million

children worldwide with obesity in 2012 (Rutkow, Jones-
Smith, Walters, O’Hara, & Bleich, 2016).
• The U.S. exceeds the Healthy People 2020 goals for
prevalence of obesity (Hales, Carroll, Fryar, & Ogden,
2017).
• Surgeon General declared obesity a public health crisis due
to high prevalence and increasing trend (Anderson,
Butcher, & Schanzenbach, 2019).
 • The prevalence of childhood
obesity has tripled over the last
four decades (Anderson et al.,
2019; Killian, Kern, Ellison, Graber,
& Woods, 2020).
• Obesity is a societal problem
demanding a population-based,
multi-disciplinary, and culturally
relevant approach (WHO, n.d. -f).
Childhood
• Evidence proves the etiology of
Obesity childhood obesity is multi-faceted
and requires behavior modification,
educational campaigns, and
regulation of policies and programs
to combat the problem (Rutkow et
al., 2016).
 Statistics

• In 2019, 13.7 (18.5%) million children/adolescents

were obese in the U.S. (Anderson et al, 2019; Centers
for Disease Control and Prevention [CDC], 2109;
Imoisili et al., 2019).
• An estimated 2.6 million people die each year due to
obesity (WHO, n.d -h).
• Healthcare costs related to obesity are $14.3 billion a
year (Killian et al., 2020).
Vulnerable Population

Children
• Do not posses the information to make informed
decisions (Anderson et al., 2019)
• Do not understand the impact/consequences of
behavior (Anderson et al., 2019; WHO, n.d. –f)
• Do not have the knowledge of the causes,
interventions, or importance (Anderson et al., 2019)
• Lack control of environment- income, food, parents,
housing (Anderson et al., 2019; WHO, n.d. –f)
 Health Disparities

• Disadvantaged populations have more health conditions which

disproportionately increases the risk of obesity (Anderson et
al., 2019; Ortega-Hinojosa, MacLeod, Balmes, & Jerrett,
2018).
• People with lower income have an increased risk of obesity
(CDC, 2019; Subica, Grills, Douglas, & Villanueva, 2016 ).
• People with lower educational level have an increased risk of
obesity (CDC, 2019).
• The unequal distribution of protective health resources for
poverty-stricken neighborhoods increases the risk of obesity
(Subica et al., 2016)
 Obesity Prevalence

• Hispanics (25.8%) and Blacks (22.0%) have a

higher obesity prevalence (CDC, 2019).
• Approximately 40% of Black and Hispanic children
are overweight/obese (Let’s Move, n.d. –a).
• Asians (11.0%) have a lower obesity prevalence
(CDC, 2019).
• The risk of obesity is higher among the
socioeconomically disadvantaged
(Peckham et al., 2017).
 • Environmental
Risk • Familial

Factors • Social/economic/cultural
• Political
 Risk Factors

Environmental
• Sedentary (Anderson et al., 2019; Datar, 2017; Killian et al., 2020; Mayo Clinic, n.d.;
Sahoo, et al. 2015; Uche, Suzuki, Fulda, & Zhou, 2020; WHO, n.d. –b; WHO, n.d. –c;
WHO, n.d. –e; WHO, n.d. –g; WHO, n.d. –h)
• Poor diet- high calories, low nutrients (Anderson et al., 2019; 2020; Datar, 2017;
Killian et al., 2020; Mayo Clinic, n.d.; Peckham et al., 2016; Sahoo, et al. 2015; Uche
et al.,2020; WHO, n.d. –b; WHO, n.d. –c; WHO, n.d. –e; WHO, n.d. –f; WHO, n.d. –g;
WHO, n.d. –h)
• Stress (Mayo Clinic, n.d.)
• Imbalanced expenditure (Sahoo, et al. 2015; WHO, n.d. –f; WHO, n.d. –h)
• Portion sizes of foods (Sahoo, et al. 2015)
• Attitude towards food (Sahoo, et al. 2015)
 Risk Factors

Familial
• Parenting style (Datar, 2017; Sahoo et al., 2015;
WHO, n.d. –c)
• Meal structure (Datar, 2017; Kracht et al., 2019; Sahoo et al., 2015; WHO, n.d. -c)
• Siblings (Datar, 2017; Kracht et al., 2019)
• Working parents (Anderson et al., 2019)
• Special needs children (Ruopeng, Guan, Mengmeng, & Donovan, 2018)
• Habits/preferences (Anderson et al., 2019; Sahoo et al., 2015; WHO, n.d. -c)
• Genetic/hormonal factors (Mayo Clinic, n.d.; Sahoo et al., 2015; Uche et al., 2020)
 Risk Factors

Social/Economic/Cutural
• Limited resources (Anderson et al., 2019; Lopez, 2020; Mayo
Clinic, n.d.; Sahoo et al., 2015; WHO, n.d. –e; WHO, n.d. –f)
• Limited access (Anderson et al., 2019; Lopez, 2020; Mayo
Clinic, n.d.; Sahoo et al., 2015; WHO, n.d. –e; WHO, n.d. –f)
• Transportation (Anderson et al., 2019; WHO, n.d. -f)
• Beliefs, values, customs (Lopez, 2020)
• Personal safety (Subica et al., 2016)
 Risk Factors

Political Factors
• Urban planning (Ortega-Hinojosa et al., 2018; WHO, n.d. -f)
• Education (Anderson et al., 2019; Sahoo et al., 2015; Uche et
al., 2020; WHO, n.d. -e; WHO, n.d. –f)
• Food processing/distribution/marketing (WHO, n.d. -f)
• School policies (Anderson et al., 2019; Lopez, 2020;
Peckham et al., 2016; Sahoo et al., 2015; Subica et al., 2016;
Uche et al., 2020; WHO, n.d. -e)
• Government policies (Lopez, 2020; Sahoo et al., 2015)
 • Psychological/emotional
• Bullying (Fu & George, 2015; Imoisili et
al., 2019)
• Depression (Fu & George, 2015; Imoisili
et al., 2019; Mayo Clinic, n.d.; Ortega-
Hinojosa et al., 2018)
• Anxiety (Fu & George, 2015; Imoisili et
al., 2019)
• Poor academic performance (Fu &
Complications George, 2015; Imoisili et al., 2019)
• Poor social skills (Imoisili et al., 2019)
• Low self-esteem (Datar, 2017; Imoisili et
al., 2019; Mayo Clinic, n.d.; Sahoo et al.,
2015; Uche et al., 2020)
 • Diabetes (Datar, 2017; Fu &
George, 2015; Imoisili et al., 2019;
Mayo Clinic, n.d.; Ortega-Hinojosa
et al., 2018; Sahoo et al., 2015;
Uche et al., 2020; WHO, n.d. –a;
WHO, n.d. -h)
• Hypertension (Datar, 2017; Fu &
Complications George, 2015; Imoisili et al., 2019;
Mayo Clinic, n.d.; Ortega-Hinojosa
(cont.) et al., 2018; Sahoo et al., 2015;
Uche et al., 2020)
• Hyperlipidemia (Datar, 2017;
Imoisili et al., 2019; Mayo Clinic,
n.d.; Sahoo et al., 2015; Uche et
al., 2020)
 • Hyperglycemia
• Heart disease
• Stroke
• Asthma
• Sleep apnea
• Musculoskeletal problems
Complications • Liver disease
(cont.) • Gallstones
• Cancer
(Datar, 2017; Kracht et al., 2019;
Mayo Clinic, n.d.; Ruopeng et al.,
2018; Sahoo et al., 2015; Uche et
al., 2020; WHO, n.d. -a)
 • Obese children often become
obese adults (Anderson et al.,
2019; Mayo Clinic, n.d.; WHO,
n.d. -a).
• Obesity causes premature
death/disability as adults
(Ruopeng et al., 2018; WHO,
n.d. -h).
Complications
(cont.) • Obesity leads to a decreased
quality of life (Sahoo et al.,
2015).
• Obesity affects physical, social,
and emotional well-being
(Imoisili et al., 2019; Mayo
Clinic, n.d.).
 Level of Prevention

• Primary prevention – reducing susceptibility or

limiting exposure, health promotion, and disease
prevention (Curley,2020)
• Prevention is a high priority (WHO, n.d. –a;
WHO, n. d. –f; WHO, n.d. -g)
• Health education (CDC, 2019)
• Improve exercise habits (Mayo Clinic, n.d.)
 Lifestyle Changes
• Limit sugar (Mayo Clinic, n.d.; WHO,
n.d. –d; WHO, n.d. -f)
• Limit fat (Peckham et al., 2017; WHO,
n.d. –d; WHO, n.d. -f )
• Limit sodium (Peckham et al., 2017;
WHO, n.d. –d; WHO, n.d. -f)
This Photo by Unknown Author is WHO,
• Limit eating out (Datar, CC BY-SA-NC
2017; Mayo
Clinic, n.d.)
• Get adequate sleep (Mayo Clinic,
n.d.)
• Eat lots of fruits and vegetables
(Kang et al., 2017; Mayo Clinic, n.d;
Peckham et al., 2017; WHO, n.d. -f)
• Stay active [60 min/day] (Kang et al.,
2017; WHO, n.d. –b; WHO, n.d. –c;
WHO, n.d. –d; WHO, n.d. -e)
• Limit TV/screen time (Mayo Clinic,
n.d.)
• Eat healthy snacks (WHO, n.d. –c;
licensed under
n.d.
-e)
• Eat family meals (Datar, 2017; Mayo
Clinic, n.d.; WHO, n.d. -c)
• Limit processed foods (Mayo Clinic,
n.d.; WHO, n.d. –d)
• Drink water instead of soda/juice
(Mayo Clinic, n.d)
• Watch portion sizes (Mayo Clinic,
n.d; WHO, n.d. -d)
 Legislation/Initiatives

• National Task Force on Obesity (Sahoo et al., 2015)

• The Healthy, Hunger-Free Kids Act of 2010 (Ruopeng et al.,
2018)
• WHO’s Commission on Ending Childhood Obesity [ECHO]
(Kang et al., 2017)
• Let’s Move Initiative (Kang et al., 2017)
• Patient Protection and Affordable Care Act (Rutkow et al.,
2016)
• The Healthy Communities Study (Kumanyika, 2018)
 • Social media for dissemination
• Interdisciplinary team of stakeholders
• Local businesses
• Religious organizations
• Schools
• Parent-teacher organization
• Student Council
Community
• Administration
Outreach • Law enforcement (school resource
officer)
• Ethnic/cultural groups
(Community Tool Box, 2020)
 • Focus on strengths, values,
and emotional/historical ties
to community
• Research data influences
balance of power, distribution
of resources, and policy-
making
Community
• Consider the current
Outreach landscape
(cont.) • Cultural
• Political
• Economic
(Subica et al., 2016)
 Educational Initiative

• Nutritional/Exercise
educational
programs
• Knowledge/Skills
• Attitudes/Behaviors
• Sample plans/menus
• Resources Available
 Initiative programs

School New programs Current programs

School is a perfect place to initiate due Weekly contests Fitness testing
to substantial portion of the day being Monthly competitions Nutritional requirements
spent at school (Ortega-Hinojosa et al.,
2018). Evaluation of outcomes Physical Education classes
Recess
Nutritional tips on menus
Workout Wednesdays
Running Club / Girls on the Run
 DNP Competencies

• I. Integrate various science-based theories to determine health

phenomena and develop strategies to address phenomena
• II. Develop approach to health care delivery considering business,
finance, economics, and sensitivity to cultural differences
• VI. Utilize effective communication/collaboration/leadership skills in
implementation process
• VII. Analyze epidemiological, biostatistical, environmental data of
population health; use clinical judgment and critical thinking; teach
individuals/groups and guide through complex transitions
(American Association of Colleges of Nursing, 2006)
 Conduct Conduct needs assessment

Discover Discover health phenomena

Include Include stakeholders in community

Role of Develop Develop strategy to address phenomena

DNP
Implement Implement: Be Wiggle Wise and Cookie Conscious

Evaluate Evaluate outcomes

Adjust Adjust plan as needed

 Physical fitness
Compare results for
testing in fall and improvement
spring

Exercise logs Steps versus time

(weekly/monthly) spent

Measure
Food logs Fruits, vegetables,
of (weekly/monthly) and snacks

Success
Class participation/winners (extra
recess time)

Grade level participation/winners

(skate/dance party)
 Conclusion

• Small changes across the population at the individual

level will translate to a significant impact on population
health (Uche et al.,2020).
• What a child learns at home and school influences the
food choices and activity level throughout life. With
intervention at the primary prevention level, childhood
obesity can be decreased over time leading to a
healthier society (Sahoo et al., 2015).
 References

American Association of Colleges of Nursing. (2006).DNP essentials: The essentials of doctoral

education for advanced nursing practice. Retrieved from

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Anderson, P., Butcher, K., & Schanzenbach, D. (2019). Understanding recent trends in

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Axner, M. (n.d.). Promoting coordination, cooperative agreements, and collaborative

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 References (cont.)

Centers for Disease Control and Prevention. (2109). Childhood obesity facts. Retrieved from

https://www.cdc.gov/obesity/data/childhood.html#Socioeconomic

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 References (cont.)
Datar, A. (2017). The more the heavier? Family size and childhood obesity in the U.S. Social

Science & Medicine, 180, 143–151. Retrieved from https://doi-org.lib-

proxy.jsu.edu/10.1016/j.socscimed.2017.03.035

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 References (cont.)
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 References (cont.)

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