Running head: CHILDHOOD OBESITY

Childhood Obesity: A Rising Epidemic

Andrea R. VanPortfliet
Ferris State University

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Abstract
Childhood obesity is a rising epidemic in the United States, with the prevalence tripling over the
last thirty years. There are many contributing factors, including physical, emotional, and social
factors. Obesity causes many immediate and future comorbidities that can lead to premature
mortality. Obesity can affect the healthcare system in numerous ways, including staffing, quality
of care, and cause economical consequences, as well as impact the patients quality of life. Many
different interventions are being used to combat the rising rate, and the nurse can help in certain
areas. Utilization of local resources can make an impact on the rising occurrence, as well as
providing the patient with an individualized care plan that works best for them. Education and
prevention are essential in creating a safer healthcare system that provides maximal quality of
care.

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Childhood Obesity: A Rising Epidemic

Childhood obesity is a rising epidemic in the United States that needs to be addressed.
With rates increasing so rapidly, there is a concern for the health of future generations.
Childhood obesity is a condition that is commonly carried into adulthood, causing many negative
effects on the patients health and for the healthcare system as a whole. Many resources are
available to combat the rising rates, and healthcare workers need to push for prevention and
education on the issue.
Statistics
The terms obesity and overweight are often used interchangeably, which is not accurate.
Overweight is defined as having excess body weight for a particular height from fat, bone,
water, or a combination of these factors. Obesity is defined as having excess body fat, (Centers
for Disease Control and Prevention, 2015). These can also be determined from assessing the
Body Mass Index by measuring body fat based on height and weight, and comparing this to other
adult men and women. A body mass index of twenty-five to thirty is considered overweight,
while anything above thirty is considered obese (National Institute of Health, 2016). A childs
body mass index is calculated the same way, but is expressed in percentile relative to other
children (CDC, 2015). A body mass index is not always indicative of obesity as it does not take
all factors into account, so it is important to assess the patient before diagnosing.
Childhood obesity rates have been steadily climbing in the United States over the past
few decades. Prevalence has doubled in children and quadrupled in adolescents over the past
thirty years. One in three children are now considered to be obese, and the rates are continuing to
rise (CDC, 2015). In Michigan, there is evidence of improvement with rates falling from 13.9%

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to 13.2% in 2011. This is not a tremendous reduction, but with the rates so steadily climbing, any
decrease is important. Michigan has the twenty-fifth highest obesity rates in children as of 2015
(CDC, 2015). By analyzing statistics, health care workers can decide which states have the best
prevention and treatment techniques and use these in future practice.
Theory Base
Nursing theory can be useful in the health care setting because it can provide principles to
follow and increase knowledge on nursing care. By applying nursing theory along with medical
theories, patient care can be improved by providing holistic treatment approaches that focuses on
more than the diagnosis (Colley, 2003). Nursing theory can also give rise to further research on
subjects where more information is needed, resulting in improved evidence based practice.
Overall, nursing theories are a guide for nurses to improve care for their patients and provide the
best possible care.
A nursing theory that can be applied to treatment of childhood obesity is Dorothy Orems
Self-Care Deficit Theory. Her theory states that the patient should be self-reliant, and
responsible for their own care, as well as the others in their family (Petiprin, 2016). When
looking at childhood obesity, they do not have control of many of the factors that lead to obesity,
for example, the foods they are eating and whether they are getting enough physical activity.
Often times this responsibility falls on the parents, which is why this theory can be applied. This
theory also states that nursing requires collaboration with all parties involved, which can include
the patient, family, all nurses working on the case, doctors, and pharmacists. Patient knowledge
of potential health risks is crucial when treating obesity because they must be aware of the
consequences. This will encourage the patient and family to provide better self-care behaviors.
Orems theory also indicates when nursing intervention is needed, which is when the patient is

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unable to provide effective self-care for themselves, or their family (Petiprin, 2016). When
ineffective self-care is occurring, there are different ways for nurses to intervene; assisting and
doing for others, providing guidance and support, establishing an environment that is compatible
with change, and teaching (Petiprin, 2016). This theory can assist the nurse in treating childhood
obesity by indicating change is needed, and give guidance on ways to combat the issue.
Kurt Lewins Theory of Change can also be used to assist the patient and family with
treating childhood obesity. This theory incorporates three different steps that are meant to make
the patient realize they need a change in their life and make the change a daily part of their life
(Burnes, 2004). The first step, titled unfreezing, is when the patient or family realizes that a
change is needed to create a healthier lifestyle. Transition is the second step, where the patient
must make the necessary changes and realize that it is a process. Motivation and support are very
important during this phase because it is easy for the patient to fall back to their old ways. The
third step, refreeze, is when the patient must incorporate these changes into daily living and
make it their new norm (Burnes, 2004). This can be applied to obesity because once the patient
realizes they need to lose weight, they can create a plan of approach and continue using this plan
day to day. Realizing that change is necessary can be very difficult and the nurse can provide
education and guidance to prepare an individualized treatment plan that will best benefit the
patient.
Assessment of Healthcare Environment
Many resources and policies are in place to attempt to curb the rising rates of childhood
obesity. The government has regulated that all food companies must have nutritional information
on their packaging so it is easier to see what is being eaten. The Women, Infant, and Children
program is another resource available for pregnant women and mothers of young children. WIC

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is a federal assistance program that supplies qualifying families with nutritious foods, nutrition
education, and other health screenings. The goal of WIC is to provide lower income families
with the help they need to raise a healthy family (Women, Infants, and Children, 2015). School
Wellness Programs are also becoming more prevalent in schools to provide children with
healthier meals. The national school breakfast and lunch program was created to provide lowcost or free meals to students who cannot afford them (CDC, 2015). Lets Move, started by first
lady Michelle Obama, is a program that is dedicated to solving the problem of childhood obesity.
This involves the push for creating a healthier start for children, empowering parents and
caregivers, providing healthy foods in schools, improving access to healthy affordable foods, and
increasing physical activity, (Lets Move!, 2010). There are many local resources available to
help with the different factors contributing to childhood obesity. Nurses can make an impact on
the prevalence of childhood obesity by becoming familiar with any local resources or programs
that could benefit their patients and families.
Many different factors can contribute to the occurrence of childhood obesity, including
environmental, genetic, and behavioral factors (Clarke Sheehan, 2006). Many times there is not
one specific cause for obesity, but a result of a number of factors working together to increase the
risk. Diet and exercise is a large cause of obesity. Fast food and high calorie foods are becoming
more common in the American diet. Advertisements for fast food and less healthy foods is
common and can influence what a child prefers to eat. Unhealthy foods in combination with
overeating can cause the child to have an excess of calories resulting in weight gain. A lack of
exercise can also contribute to weight gain. With television, video games, social media, and cell
phones becoming more popular, children are not getting the needed amount of physical activity
to expend the calories being consumed (Anderson & Butcher, 2006).

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Parental influence can also have a huge impact on children becoming obese. Children are
not old enough to cook their own meals, decide what is being eaten, or to understand the
importance of daily physical activity. It is the parents responsibility to ensure their child is being
fed properly and getting enough exercise. Foods to which children are routinely exposed to
shape preferences and consumption, (Berkowitz & Borchard, 2009). This means that a child
who grows up eating unhealthy will prefer these foods later in life. Portion sizes are also
influenced by the parents; how much they serve the child and the size of their own portions.
Some parents are not educated on what types of foods are considered unhealthy and do not know
the proper portion sizes for a child. They may not know that a child should be getting thirty
minutes of exercise daily (Berkowitz & Borchard, 2009). Uneducated parents are a huge
contributing factor to childhood obesity, and can be addressed very easily with proper education.
A child can be predisposed to obesity due to their genetic makeup, but usually this works
in conjunction with other factors as well. A child who has a history of psychological disorders,
for example depression, may have poor coping mechanisms. They will be more likely to overeat
and eat the wrong foods. Depression causes the child to feel hopeless and unmotivated so they
will be less likely to participate in physical activity (Clarke Sheehan, 2006). By treating these
disorders, the child can be rid of the symptoms and start working towards a healthier lifestyle.
Certain environmental factors can also put a child at risk for obesity. Socioeconomic
status can affect the diet of a child because healthy food is not affordable for many families.
Certain families may not have access to these foods as well, which could be due to lack of
transportation, or unavailability in their area (Berkowitz & Borchard, 2009). Single parents may
also be working additional jobs to meet the expense of their family, which leaves them with little
time to cook meals. Often times, this leads to preparing quick, unhealthy meals. A child may

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grow up in a dangerous area that is unsafe to play outdoors, decreasing their amount of physical
activity (Berkowitz & Borchard, 2009). Of these contributing factors, many can be addressed and
improved. While some situations cannot be fixed, alternate approaches and tactics can be
recommended.
Implications and Consequences
Obesity affects many different parts of the body and causes immediate and long term
health problems. An obese patient is at risk for many different comorbidities that can eventually
lead to premature mortality. Some immediate health risks are cardiovascular disease, high
cholesterol, high blood pressure, prediabetes, bone and joint problems, and psychological
problems. The long-term health risks for an obese patient include heart disease, diabetes,
osteoarthritis, and an increased risk for stroke and certain types of cancer (CDC, 2015). These
conditions can lead to an increase in illness and hospitalization for the patient, and can eventually
lead to premature mortality.
The rising rates of obesity is also affecting nurses and the quality of care they are able to
provide. There has been an increase in obesity associated hospitalizations, causing there to be a
lack of available nurses able to care for them. A patient of larger physical size can also
complicate nursing interventions. Skin care, respiratory challenges, assessment and
resuscitation measures, altered drug absorption, intravenous access, and immobility can pose
nursing concerns, (Gallagher Camden, 2009). An obese patient is more at risk for pressure
ulcers and poses a challenge in maintaining skin integrity. This occurs because the patients are
harder to perform regular turns on, causing there to be increased pressure in certain areas for a
prolonged length of time. These patients have excess body fat which, depending on the
medication, alters drug absorption. This can pose a problem for nurses because some medication

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dosages are calculated using the ideal body weight, which would result in the obese patient
getting too little. It is also more difficult to gain intravenous access on a patient with excess
adipose tissue covering the veins (Gallagher Camden, 2009). Many hospitals do not have
policies for safe handling of obese patients, which makes quality of care difficult for many
nurses (Trasande, Lui, & Weitzman, 2009).
Patients are also adversely affected by obesity. An obese child is likely to grow into an
obese adult and develop comorbidities associated with obesity. This will lead to increased
hospitalizations to treat these comorbidities, resulting in missed work and school. Childhood
obesity is associated with lower academic performance and a lower quality of life for the child
(Sahoo, Sahoo, Choudhury, Sofi, Kumar, & Bhadoria, 2015). Childhood obesity can also lead to
emotional and psychological issues, as it is one of the most stigmatized conditions. They can be
excluded from activities, experience bullying from other children, face discrimination, and have
lower self-esteem (Sahoo et al., 2015). Comorbidities associated with obesity can have a
devastating effect on the quality of life for the patient, as can the social stigmas and
discrimination.
Healthcare facilities are faced with rising costs of care due to the increased
hospitalizations related to childhood obesity. An even larger cost is incurred when obese children
become obese adults because they will start experiencing the comorbidities and secondary
illnesses (Hammond & Levine, 2010). The estimated annual cost of treating obesity-related
illness in adults is $147 billion. In 2008 obesity related illness cost Medicare $19.7 billion and
Medicaid $8 billion, which was paid by the general public, whose tax dollars fund these
programs (Trasande et al., 2009). This can affect the healthcare system because more resources
are being used to combat obesity, which is associated with 36% increase in inpatient and

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outpatient health care spending and a 77% increase in medication use (Cawley, 2010). Since
obesity is just recently being recognized as an illness, the diagnosis does not consistently result
in further reimbursement or risk adjustment, causing many hospitals to lose money (Trasande et
al., 2009). Overall, obesity is causing an increase in costs for the hospitals, and for the general
public funding government insurance.
Quality and Safety Improvement
Prevention is the most important way to improve this issue. This can be done through
proper education to the patients and the family. Parents have a huge influence on what their
children eat and how much physical activity they get, so education is the first step to progressing
to safe and maximum quality of care. Lifestyle changes are very important for the child at risk
for becoming obese. Nutrition counseling is an option for these patients, as well as participation
in school sports, after school activities, and helping the parents plan different family activities
every evening to promote exercise.
When prevention is not an option, there are other ways to treat obesity in the child. Diet
and exercise are the first option in treatment, but when conventional action does not work,
medications and surgery is available (Cawley, 2010). Orlistat is the only approved drug for
childhood obesity; it works by preventing absorption of fat in the intestines. Weight loss surgery
is another option for a severely obese child who cannot lose weight through diet and exercise.
There are many potential risks and complications associated with this surgery, so it is only an
option when all other treatment attempts have failed (Spear, Barlow, Ervin, Ludwig, Saelens, &
Schetzina, 2007).
The American Nurses Association provides professional standards for nurses to follow
which provide direction for practice and ensure excellence of care. When discussing childhood

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obesity, many standards can be applied (American Nurses Association, 2010). Education is
always important to provide to our patients and their family so they have a full understanding of
their diagnosis and the expected treatment plan. Educating parents with obese children or
children at risk could result in lower rates of obesity. Collaboration with all parties involved in
treatment of the child is important to create an individualized plan. It is also important to
collaborate with the patient so they feel involved in their treatment. Resource utilization is
another standard that can be applied to treating childhood obesity (ANA, 2010). Providing
families with information on local resources and those available in the hospital can be beneficial.
In conclusion, childhood obesity is a growing problem for many individuals across the
United States. This issue is affecting nurses, the health of the patient, the healthcare system, and
the economy. Nursing theory can be applied to help guide the nurse through treatment and care
plan options. Although some contributing factors cannot be fixed, many children can lose weight
and achieve a healthier life with simple lifestyle changes. Prevention and education is key to
combat the rising rates, and nurses can make an impact by providing guidance and assistance to
patients in need.

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