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Assessing the Knowledge Assessing the Knowledge of Nurse Practitioners of Nurse Practitioners

about Childhood Obesityabout Childhood Obesity

David Summerfield, BSN, CNOR, RNFADavid Summerfield, BSN, CNOR, RNFA

A Project Submitted to theUniversity of North Carolina Wilmington in Partial Fulfillment

Of the Requirements for the Degree ofMasters of Science in Nursing

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IntroductionIntroduction

Prevalence of overweight children Prevalence of overweight children has increased to almost 19 % in the has increased to almost 19 % in the U.S. and 30% in NC U.S. and 30% in NC (1)(1)

The health consequences related to The health consequences related to childhood obesity are numerous childhood obesity are numerous (2,3,4)(2,3,4)

400,000 deaths a year are the result 400,000 deaths a year are the result of diseases linked to poor diet and of diseases linked to poor diet and low activity levels low activity levels (5)(5)

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INTRODUCTION

Overweight adolescents have a 70 percent chance of becoming overweight or obese adults. (6)

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IntroductionIntroduction

Obesity is costlyObesity is costly $2.1 billion a year in NC $2.1 billion a year in NC Over $117 billion a year in the U.S Over $117 billion a year in the U.S (7)(7)

How can NPs decrease morbidity How can NPs decrease morbidity associated with childhood obesity? associated with childhood obesity?

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Purpose

Examine the knowledge NPs have about childhood obesity.

Determine if NPs are following the AAP recommendations when evaluating overweight or obese children.

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RecommendationsRecommendations

Prevention of Pediatric Overweight Prevention of Pediatric Overweight and Obesity , 2003, American and Obesity , 2003, American Academy of Pediatrics Academy of Pediatrics (8)(8)

Proposes strategies for early Proposes strategies for early identification of excessive weight identification of excessive weight gain by using body mass index, for gain by using body mass index, for dietary and physical activity dietary and physical activity interventions, and for advocacy and interventions, and for advocacy and research. research.

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Recommendations

Calculate and plot BMI once a year on all children and adolescents.

Use change in BMI to identify rate of excessive weight gain relative to linear growth.

Encourage parents and caregivers to promote healthy eating patterns.

Routinely promote physical activity. Recommend limitation of television

and video time to a maximum of 2 hours per day.

Body Mass Index

Is derived from commonly available data—weight and height

The ratio of weight in kilograms to the square of height in meters.

Correlates well with more accurate measures of body fatness

At risk of overweight = BMI between 85th and 95th percentile for age

Overweight/Obese = BMI => 95th percentile for age

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Literature Review

Larsen, L., Mandleco, B., Williams, M., & Tiedeman, M. (2006). Childhood obesity: Prevention practices of nurse practitioners. Journal of the American Academy of Nurse Practitioners, 18, 70-79. (9)

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Literature Review

Barlow, S., Dietz, W., Klish, W., & Trowbridge, F. (2002). Medical evaluation of overweight children and adolescents: Reports from Pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics, 110, 222-228. (10)

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Materials and MethodsMaterials and Methods

A cross-sectional survey of NPs in the A cross-sectional survey of NPs in the U.S. was used. U.S. was used.

Approval from the UNCW Institutional Approval from the UNCW Institutional Review Board (IRB) was obtained.Review Board (IRB) was obtained.

Survey was posted on the internet.Survey was posted on the internet. The survey was a 25 item self-The survey was a 25 item self-

administered questionnaire. administered questionnaire. Inclusion criteriaInclusion criteria SPSS softwareSPSS software

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ResultsResults

47 surveys completed, 45 were 47 surveys completed, 45 were includedincluded

4 male and 41 female respondents4 male and 41 female respondents Median age was 45.6 years (range = Median age was 45.6 years (range =

24 to 68)24 to 68) Median length of practice was 8.7 Median length of practice was 8.7

years (range 1 to 35)years (range 1 to 35) Family practice (22), Pediatric practice Family practice (22), Pediatric practice

(12) and other types of practices (11)(12) and other types of practices (11)

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ResultsResults

78% 78% admitted admitted to being to being aware of aware of the AAP the AAP guidelines guidelines

Aware of Guidelines

Not Aware of the Guidelines

35

10

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ResultsResults

51% report 51% report adhering to adhering to the the guidelines guidelines either often either often or alwaysor always

Adherent to guidelines

Not adherent to guidelines

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ResultsResults

78% use 78% use BMI to BMI to identify identify overweight overweight or obese or obese childrenchildren

General Appearance

Weight for Height

BMI

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35

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ResultsResults

A one-way AVOVA A one-way AVOVA reveals a trend reveals a trend toward differences toward differences between NPs in between NPs in family and family and pediatric practices pediatric practices and adherence to and adherence to guidelines(F(2)=2.guidelines(F(2)=2.78, p<.07)78, p<.07)

02468

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NPs in aFamily

practicesetting

NPs in aPediatricpracticesetting

NPs in allother

practices

Adhere Do not adhere

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ResultsResults

91% always or often encourage healthy eating patterns

Encourages Healthy EatingPatternsDoes not encourage

41

4

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ResultsResults

84% promote physical activity and recommend limiting TV and video time

Recommend Physicalactivity and limitingTV/ Video timeDo not recommend

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7

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ResultsResults

93% are comfortable talking with family/pt about obesity.

Only 42% felt their recommendations were effective.

60% list the family as the biggest barrier.

Other barriers: low activity levels, expensive food, lifestyle, fast food, and TV/video time

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ConclusionsConclusions The NPs in this sample need to The NPs in this sample need to

become more familiar with the become more familiar with the AAP recommendations.AAP recommendations.

Because NPs are not following the Because NPs are not following the recommendations children may recommendations children may not be getting properly evaluated.not be getting properly evaluated.

The barriers to proper evaluation The barriers to proper evaluation must be overcome.must be overcome.

Interventions

There needs to be local, state, There needs to be local, state, and national level CMEs to help and national level CMEs to help educate NPs on how to evaluate educate NPs on how to evaluate the pediatric population for the pediatric population for overweight and obesity.overweight and obesity.

Utilize cost effective programs Utilize cost effective programs (H.E.A.T.) (H.E.A.T.) (11)(11)

Use an algorithm.Use an algorithm.

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AlgorithmAlgorithm

(12)

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Future ResearchFuture Research

Studying the best way to implement Studying the best way to implement the guidelines to improve the guidelines to improve compliance compliance

Determine why NPs in family Determine why NPs in family practice do not follow the guidelines practice do not follow the guidelines as well as NPs in a pediatric practiceas well as NPs in a pediatric practice

Determining what the barriers to Determining what the barriers to implementing the guidelines are implementing the guidelines are and how can we overcome themand how can we overcome them

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Limitations

Small sample size Voluntary, online survey

References

1.1. Obesity and Overweight: Childhood Overweight.Obesity and Overweight: Childhood Overweight. (May 22, 2007). Retrieved May 29, 2007, from (May 22, 2007). Retrieved May 29, 2007, from http://www.cdc.gov/nccdphp/dnpa/obesity/childhoodhttp://www.cdc.gov/nccdphp/dnpa/obesity/childhood/index.htm/index.htm

2.2. Harbaugh, B. I., Jordan-Welch, B., Bounds, W., & Harbaugh, B. I., Jordan-Welch, B., Bounds, W., & Blom, L. (2007). Blom, L. (2007). Nurses and Families Rising to Nurses and Families Rising to the Challenge of Overweight Children. the Challenge of Overweight Children. The Nurse The Nurse Practitioner, 32Practitioner, 32(3), 31-35.(3), 31-35.

3.3. Ribeiro, J., Guerra, S., Oliveira, J., Anderson, L., Ribeiro, J., Guerra, S., Oliveira, J., Anderson, L., Duarte, J & Mota, J. (2004). Body fatness and Duarte, J & Mota, J. (2004). Body fatness and clustering of cardiovascular disease risk factor in clustering of cardiovascular disease risk factor in Portuguese children and adolescents. Portuguese children and adolescents. American American Journal of Human BiologyJournal of Human Biology, , 16,16, 556-562. 556-562.

References

4. Poussa, M., Schlenzka, D., & Yrjonen, T. (2003). Body mass index and slipped capital femoral Epiphysis. British Journal of Pediatric Orthopedics, 12, 369-371.

5. CDC, MMWR, 20046. Torgan, C. (2002). Childhood obesity on the rise. The NIH

Word on Health. Downloaded from: http://www.nih.gov/news/WordonHealth/jun2002/chilhnoodobesity.htm Accessed: April 15, 2008.

7. www.surgeongeneral.gov/topics/obesity/calltoaction/fact_glance.htm

8. AAP policy statement (2003). Prevention of Pediatric Overweight and Obesity. Accessed from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/2/424 on April 12, 2007

References

9. Larsen, L., Mandleco, B., Williams, M., & Tiedeman, M. (2006). Childhood obesity: Prevention practices of nurse practitioners. Journal of the American Academy of Nurse Practitioners, 18, 70-79.

10. Barlow, S., Dietz, W., Klish, W., & Trowbridge, F. (2002). Medical evaluation of overweight children and adolescents: Reports from Pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics, 110, 222-228.

11. H.E.A.T. program, NAPNAP. http://www.napnap.org/index_home.cfm

12.12. Algorithm for screening procedure Algorithm for screening procedure http://www.cdc.gov/nccdphp/dnpa/growthcharts/traihttp://www.cdc.gov/nccdphp/dnpa/growthcharts/training/modules/module3/text/page3b.htmning/modules/module3/text/page3b.htm