POSITION STATEMENT

Overweight Children and Adolescents

HISTORY:

The fastest rising public health problem in our nation is obesity, second only to tobacco use. Over the last two decades the percentage of overweight children has almost doubled and the percentage of overweight adolescents has almost tripled. Currently, in the United States, 13% of children 6 to 11 years of age and 14% of teens 12 to 19 years of age are categorized as overweight (NCHS, CDC 2001; USDHHS, 2000).

Healthy People 2010 (USDHHS, 2000) identifies specific goals to reduce the prevalence of overweight and obesity. Since most children spend a large portion of their day at school, the school can become a key setting in which to implement strategies to address this issue. The school nurse has the capacity to reach a large number of youth from varied backgrounds. The school can provide a healthy environment that supports balanced nutrition and activity.

DESCRIPTION OF ISSUE:

Nutrition and activity are essential for growth, development, and well-being. Good nutrition should be promoted early in childhood and continue throughout the life span. To maintain a healthy weight, children must learn to incorporate nutritionally balanced eating patterns and daily physical activity (60 minutes each day).

Being overweight or obese is an increasing problem in the United States, a problem that often begins in childhood. Overweight results when a child consumes more calories than are expended. Children are considered overweight when they are at or above the gender and age specific 95th percentile body mass index (BMI). Children between the 85th and 94th percentile of BMI are considered at risk for being overweight. While many interchange the words obese and overweight, the correlation between obesity (body fat) and BMI (body heaviness) is not clear for children (Kreipe, 1998; NCCDPHP, 2001).

The etiology of overweight and obesity is uncertain. There are, however, several known contributing factors (Keller & Stevens, 1996; USDHHS, 2001). For example:

• genetic influences

• physiological influences

• cultural influences

• food intake and disordered eating patterns

• lifestyle

• pregnancy

• lack of physical activity

Overweight and obesity are associated with several health risks. Children who are overweight have an increased risk of (Dietz, 1998):

• high blood pressure

• coronary heart disease

• Type II diabetes

• hyperlipidemia

• musculoskeletal disorders

• early sexual maturation

• psychosocial issues ( e.g., discrimination, low self-esteem, poor body image)

• greater likelihood of becoming obese adults

• asthma (USDHHS, 2001)

• increased risk of secondary physical inactivity related to inability to tolerate activity and/ or self-consciousness in certain physical activities

Adult obesity and overweight is associated with an increased risk of (NHLBI, 2000):

• coronary heart disease

• stroke

• gallbladder disease

• osteoarthritis

• gout

• some types of cancer (endometrial, colon, postmenopausal breast)

• sleep apnea

• decreased quality of life

• decreased lifespan

School nurses have knowledge and expertise in the areas of nutrition, weight maintenance, and exercise. This knowledge can be applied in prevention programs and interventions for students at risk or overweight. The school nurse can also refer these students to health care providers. The school nurse can work with students, parents, school personnel, and health care providers to identify students who are at risk for being overweight or obese by screening for height and weight, skin fold testing, and measuring BMI. The school nurse can also refer and follow up with students who may not be seeing a health care provider on a regular basis. In addition, the school nurse can be involved with support programs, counseling services, referrals, follow-up, and support.

RATIONALE:

Schools are a natural setting to influence the health and well-being of students. The school nurse can provide essential leadership in helping students maintain a healthy weight to decrease the burden of illness and increase in quality of life and life expectancy. The school nurse can help students deal with the problem of being overweight in a proactive manner and also help to eliminate the impact of poor nutrition on learning outcomes.

CONCLUSION:

It is the position of the National Association of School Nurses that school nurses have the expertise to meet the needs of children at risk of being overweight and to assist those students who are overweight by:

• assisting students in developing good decision-making skills related to nutrition and in establishing activity patterns to maintain normal body mass indices throughout their lives

• educating students, faculty, and parents on the following:

  • the importance of positive role modeling

  • dietary guidelines that promote balanced meals low in dietary fat

  • the need for 60 minutes of physical activity daily

  • the potential negative influence of inactivity

  • reading and interpreting dietary information on food products

  • relating dietary guidelines to food preparation

• educating coaches on the importance of proper nutrition on the athletes’ peak performance

• initiating school policies that provide for a healthy school environment, policies that relate to:

  • school breakfast and lunch programs

  • vending machines

  • prevention of discrimination or abuse toward overweight youth

  • school-based counseling

  • health promotion for school staff

• supporting families as they assist their children to achieve and/ or maintain a healthy BMI

• encouraging acceptance of body type that has been inherited, individual diversity, and a positive self-image

• identifying students who are overweight and educating and encouraging these students to find and use acceptable weight loss programs

• implementing and managing school-based weight reduction programs

• providing community-based referral sources, as appropriate

• supporting students in understanding that once weight loss is achieved, the changes must be continued throughout their lives to maintain their healthier weight

• advocating for daily physical education for all grades

School nurses could also be the primary force in:

• prevention and treatment of obesity among school staff members, as school staff often serve as role models for students

• advocating for community facilities to be available for physical activity for all people, including weekends

• advocating for research on the behavioral and biological causes of overweight and obesity

• advocating for proper education of community youth organizations on the importance of eating nutritiously

• advocating for the importance of proper nutrition in enhancing learning and increasing brain function

References/Resources:

Dietz, W.H. (1998). Childhood weight affects adult morbidity and mortality. Journal of Nutrition, 128(2), 411S–414S. 

Dietz, W.H. (1998). Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics, 101(3), 518S–525S.

Hill, J.O. & Trowbridge, F.L. (1998). Childhood obesity: Future directions and research priorities. The causes and health consequences of obesity in children and adolescents. Pediatrics, 101(3), 554–571.

Illuzzi, S., & Cinelli, B. (2000). A coordinated school health program approach to adolescent obesity. Journal of School Nursing, 16(1), 12–17.

Keller, C., & Stevens, K.R. (1996). Childhood obesity: Measurement and risk assessment. Pediatric Nursing, 21, 494–500.

Kreip, R.E. (1998). Overweight adolescents: Clinical challenges and strategies. Adolescent Health Update, 10(2), 1–8.

National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention [NCCDPHP, CDC] (2001). Body mass index-for-age BNI is used differently with children than it is with adults. Available at www.cdc.gov/nccdphp/dnpa/bmi/bmi-fo-age.htm 

National Center for Health Statistics, Center for Disease Control and Prevention [NCHS, CDC] (2001). Prevalence of overweight among children and adolescents: United States, 1999. Hyattsville, MD: Author.

National Heart, Lung, and Blood Institute, National Institutes of Health (NHLBI) (2000). The practical guide to identification, evaluation, and treatment of overweight and obesity in adults. Washington, DC: Author.

Troiano, R.P., & Flegal, K.M. (1998). Overweight children and adolescents: Description, epidemiology and demographics. Pediatrics, 101, 497–504.

United States Department of Health and Human Services [USDHHS] (2000). Healthy People 2010. Washington, DC: U.S. Government Printing Office.

United States Department of Health and Human Services, Public Health Service, Office of the Surgeon General [USDHHS] (2001). The Surgeon General’s call to action to prevent and decrease overweight and obesity 2001. Rockville, MD: Author.

Adopted: June 2002