Assessing the Knowledge of Nurse Practitioners about Childhood Obesity

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Assessing the Knowledge of Nurse Practitioners
about Childhood Obesity

• David Summerfield, BSN, CNOR, RNFA

A Project Submitted to the University of North
Carolina Wilmington in Partial Fulfillment Of the
Requirements for the Degree of Masters of Science
in Nursing
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Introduction

• Prevalence of overweight children has increased
  to almost 19 in the U.S. and 30 in NC (1)
• The health consequences related to childhood
  obesity are numerous (2,3,4)
• 400,000 deaths a year are the result of diseases
  linked to poor diet and low activity levels (5)

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INTRODUCTION

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

• Obesity is costly
• 2.1 billion a year in NC
• Over 117 billion a year in the U.S (7)
• How can NPs decrease morbidity 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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Recommendations

• Prevention of Pediatric Overweight and Obesity ,
  2003, American Academy of Pediatrics (8)
• Proposes strategies for early identification of
  excessive weight gain by using body mass index,
  for dietary and physical activity interventions,
  and for advocacy and 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.

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Body Mass Index

• Is derived from commonly available dataweight
  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 gt 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 Methods

• A cross-sectional survey of NPs in the U.S. was
  used.
• Approval from the UNCW Institutional Review Board
  (IRB) was obtained.
• Survey was posted on the internet.
• The survey was a 25 item self-administered
  questionnaire.
• Inclusion criteria
• SPSS software

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Results

• 47 surveys completed, 45 were included
• 4 male and 41 female respondents
• Median age was 45.6 years (range 24 to 68)
• Median length of practice was 8.7 years (range 1
  to 35)
• Family practice (22), Pediatric practice (12) and
  other types of practices (11)

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Results

• 78 admitted to being aware of the AAP guidelines
  

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35
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Results

• 51 report adhering to the guidelines either
  often or always

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Results

• 78 use BMI to identify overweight or obese
  children

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3
35
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Results

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

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Results

• 91 always or often encourage healthy eating
  patterns

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41
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Results
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• 84 promote physical activity and recommend
  limiting TV and video time

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Results

• 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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Conclusions

• The NPs in this sample need to become more
  familiar with the AAP recommendations.
• Because NPs are not following the recommendations
  children may not be getting properly evaluated.
• The barriers to proper evaluation must be
  overcome.

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Interventions

• There needs to be local, state, and national
  level CMEs to help educate NPs on how to evaluate
  the pediatric population for overweight and
  obesity.
• Utilize cost effective programs (H.E.A.T.) (11)
• Use an algorithm.

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Algorithm
(12)
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Future Research

• Studying the best way to implement the guidelines
  to improve compliance
• Determine why NPs in family practice do not
  follow the guidelines as well as NPs in a
  pediatric practice
• Determining what the barriers to implementing the
  guidelines are and how can we overcome them

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Limitations

• Small sample size
• Voluntary, online survey

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References

• Obesity and Overweight Childhood Overweight.
  (May 22, 2007). Retrieved May 29, 2007, from
  http//www.cdc.gov/nccdphp/dnpa/obesity/childhood/
  index.htm
• Harbaugh, B. I., Jordan-Welch, B., Bounds, W.,
  Blom, L. (2007). Nurses and Families Rising to
  the Challenge of Overweight Children. The Nurse
  Practitioner, 32(3), 31-35.
• Ribeiro, J., Guerra, S., Oliveira, J., Anderson,
  L., Duarte, J Mota, J. (2004). Body fatness and
  clustering of cardiovascular disease risk factor
  in Portuguese children and adolescents. American
  Journal of Human Biology, 16, 556-562.

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References

• Poussa, M., Schlenzka, D., Yrjonen, T. (2003).
  Body mass index and slipped capital femoral
  Epiphysis. British Journal of Pediatric
  Orthopedics, 12, 369- 371.
• CDC, MMWR, 2004
• Torgan, C. (2002). Childhood obesity on the rise.
  The NIH Word on Health. Downloaded from
• http//www.nih.gov/news/WordonHealth/jun2002/chil
  hnoodobesity.htm Accessed April 15, 2008.
• www.surgeongeneral.gov/topics/obesity/calltoaction
  /fact_glance.htm
• AAP policy statement (2003). Prevention of
  Pediatric Overweight and Obesity. Accessed from
  http//aappolicy.aappublications.org/cgi/content/f
  ull/pediatrics112/2/424 on April 12, 2007

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References

• 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.
• 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.
• H.E.A.T. program, NAPNAP. http//www.napnap.org/in
  dex_home.cfm
• Algorithm for screening procedure
  http//www.cdc.gov/nccdphp/dnpa/growthcharts/train
  ing/modules/module3/text/page3b.htm