It is the position of the National Association of School Nurses that school nurses have the knowledge and expertise to promote the prevention of overweight and obesity and address the needs of overweight and obese youth in schools. The school nurse collaborates with students, families, school personnel, and health care providers to promote healthy weight and identify overweight and obese youth who may be at risk for health problems. The school nurse can refer and follow up with students who may need to see a health care provider. The school nurse also educates and advocates for changes in the school and district that promote a healthy lifestyle for all students.
Overweight and obesity are an increasing problem in the United States that often begins in childhood. Obesity in children can lead to serious health concerns, once only seen in adults. The rates for overweight and obesity in youth have tripled in the past 30 years, and currently almost 32% of youth between 2 and 19 are overweight or obese, at or above the 85th percentile (Centers for Disease Control [CDC], 2010).
DESCRIPTION OF ISSUE
The etiology of overweight and obesity is not completely understood but thought to be complex and have multi-factorial contributing factors (Crawford et al., 2010; Johnson, Williams & Spruill, 2006; CDC, 2009). Contributing factors may include:
Children and adolescents who are overweight and obese are at higher risk for health concerns such as:
(CDC, 2008; Copstead-Kirkhorn & Banasik, 2009):
Good quality nutrition and physical activity are essential for growth, development, and well-being. Behaviors that encourage healthy nutrition, portion control, and physical activity should be promoted early in childhood and continue throughout the life span. To maintain a healthy weight, children and families should incorporate nutritionally balanced eating patterns and daily physical activity of a moderate to vigorous level for at least 60 minutes each day. The Dietary Guidelines for Americans states that eating patterns established in youth often last into adulthood making early development of healthy nutrition and physical activity behaviors a priority (U.S. Department of Agriculture [USDA] & USDHHS, 2010).
The Physical Activity Guidelines for Americans states that regular physical activity in youth promotes health and fitness and makes it less likely they will develop risk factors for chronic illnesses and more likely that youth will continue as healthy adults (USDHHS, 2008).
Healthy People 2020 (U.S. Department of Health and Human Services [USDHHS], 2011) identifies specific goals to achieve and promote maintenance of healthy body weights. Since most children spend a large portion of their day at school, the school is a key setting to implement strategies to address this issue. The school can provide a healthy environment that supports balanced nutrition and activity.
The school nurse has the capacity to reach a large number of youth, can provide essential leadership in helping students maintain a healthy weight to prevent overweight and obesity and decrease the burden of illness, and increase the quality of life and life expectancy. School nurses are able to address the potential serious health problems resulting from overweight and obesity.
The reality of preventing and treating overweight and obesity requires multiple strategies. A school nurse can impact a child and his/her family to make healthy lifestyle changes through:
Identifying students who may need further evaluation by conducting screenings (height, weight and body mass index [BMI]) and assessing students for possible risk factors associated with overweight and obesity (hypertension, acanthosis nigricans, risk for type 2 diabetes, and family history);
Making necessary referrals to health care providers for further assessment and treatment;
Developing individualized health plans that address elevated BMIs which place students at risk for chronic health concerns;
Identifying community resources for referral for overweight and obese students;
Providing education and information to parents and families about nutrition, physical activity and community resources;
Encouraging follow up for counseling and psychological support for students;
Promoting healthy messages that encourage the consumption of healthy foods and encourage physical activity in and after school;
Encouraging role modeling of healthy lifestyle choices by parents and teachers;
Promoting nutrition and activity assessment by the school to help the child and adolescent identify healthy behaviors and set goals; and
Educating the school community about evidence based healthy lifestyle changes, daily physical activity requirements, and preventable health risks associated with overweight/obesity.
School nurses initiate and lead the school community to influence policy and protocols related to wellness and can be the primary force in:
Development of youth-related wellness policies,
Prevention and treatment of obesity among school staff members, as school staff often serve as role models for students,
Promoting walk to school and bike to school programs, and
- Community and school facilities to be available for physical activity for all people including after school and weekend times,
- Research on the behavioral and biological causes of overweight and obesity,
- Proper education to community youth organizations about the importance of making healthy food choices and obtaining the daily recommended amount of physical activity,
- The importance of proper nutrition in enhancing learning and increasing brain function,
- Nutritional school lunches,
- Easy access to drinking water, and
- Daily physical education at all schools.
School nurses recognize the impact of healthy eating and physical activity on academic success, promote healthy lifestyles for all students, and assist students who are overweight and obese obtain a healthy lifestyle. School nurses are in the prime position to influence the behavior of children and adolescents in developing good decision-making skills related to nutrition and physical activity to develop and achieve healthy lifestyles.
Centers for Disease Control. (2008). Childhood obesity. Retrieved from http://www.cdc.gov/HealthyYouth/obesity/
Centers for Disease Control. (2009). Obesity and overweight for professionals: Causes. Retrieved from http://www.cdc.gov/obesity/causes/index.html
Centers for Disease Control. (2010). Childhood overweight and obesity. Retrieved from http://www.cdc.gov/HealthyYouth/obesity/
Copstead-Kirkhorn, L.C. & Banasik, J.L. (2009). Pathophysiology. (4th ed.). St Louis: Elsevier, Inc.
Crawford, A. G., Cote, C., Couto, J., Dakinran, M., Gunnarsson, C., Haas, K., Haas, S., Nigam, S. C., & Schuette, R. (2010). Prevalence of obesity, type II diabetes mellitus, hyperlipidemia, and hypertension in the United States: Findings from the GE centricity electronic medical record database. Population Health Management, 13, 151-161. doi: 10.1089/pop.2009.0039
Johnson, R. L., Williams, S. M., & Spruill, I. J. (2006). Genomics, nutrition, obesity, and diabetes. Journal of Nursing Scholarship, 38, 11-18. doi: 10.1111/j.1547-5069.2006.00071.x
U.S. Department of Health and Human Services. (2008). 2008 physical activity guidelines for Americans. Rockville, MD: Author. Retrieved from www.health.gov/paguidelines
U.S. Department of Health and Human Services. (2010). The Surgeon General’s vision for a healthy and fit nation. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General. http://www.surgeongeneral.gov/library/obesityvision/index.html
U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2010, December).Dietary guidelines for Americans (2010, 7th Edition). Washington, DC: U.S. Government Printing Office. http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf
United States Department of Health and Human Services [USDHHS]. (2011). Healthy people 2020. Washington, DC: U.S. Government Printing Office.
Acknowledgement of Authors:
Melissa Mehrley, MSN/Ed, RN
Nancyruth Leibold, EdD, MSN, RN, PHN, LSN
Revised: June 2011