Childhood obesity: nurses' role in addressing the epidemic

Team-Based Approach to Reduce Malignancies in People with Diabetes and Obesity

PURPOSE OF REVIEW

Numerous observations have indicated an increased risk of developing various types of cancers, as well as cancer-related mortality, among patients with diabetes and obesity. The purpose of this review is to outline multiple-cancer screening among these patients through a team-based approach and to present the findings of a pioneering integrated care program designed for patients with obesity with a specific emphasis on cancer prevention.

RECENT FINDINGS

A community-based multi-cancer prevention program, which provides all services in one location and utilizes team-based approaches, is reported to be feasible and has the potential to enhance the uptake rate of multiple cancers screening among patients with diabetes and obesity. The team-based approach is a commonly utilized method for managing patients with diabetes, obesity, and cancer, and has been shown to be efficacious. Nevertheless, research on team-based cancer screening programs for patients with diabetes and obesity remains limited. Providing a comprehensive screening for colorectal, prostate, and breast cancer, as well as metabolic syndrome, during a single clinic visit has been proven effective and well-received by participants.

Barriers to health promotion with overweight or obese children, young people and their families

Childhood obesity is a worldwide public health issue requiring sustained health promotion efforts by multiple healthcare professionals. Children's nurses are the main providers of education, support and interventions for those who are overweight or obese. Despite sustained health promotion efforts, addressing overweight and obesity in children and young people is an ongoing challenge. This article details a literature review that aimed to identify the barriers that children's nurses experience when undertaking health promotion to address overweight or obesity with children, young people and their families. Three themes were identified: lack of time, training and resources; parental motivation and response; and the 'new normal'. Education and work-based training on structured interventions for addressing overweight or obesity are vital. Skills training in broaching challenging conversations with children, young people and their families sensitively and effectively is also important.

Guidelines for treating child and adolescent obesity: A systematic review

Obesity is a chronic disease that compromises the physical and mental health of an increasing proportion of children globally. In high-income countries, prevalence of paediatric obesity is increasing faster in those from marginalised populations such as low-income households, suggesting the disease as one that is largely systemic. Appropriate treatment should be prioritised in these settings to prevent the development of complications and co-morbidities and manage those that already exist. An array of clinical practice guidelines are available for managing overweight and obesity in children and adolescents, but no systematic review has yet compared their quality or synthesised their recommendations. We aimed to narratively review clinical practice guidelines published in English for treating child and adolescent obesity, to identify the highest quality guidelines, and assess similarities, conflicts, and gaps in recommendations. We systematically searched academic databases and grey literature for guidelines published. We used the AGREE II tool to assess the quality, and identified nine high quality guidelines for inclusion in a narrative review of recommendations. Guidelines predominantly recommended the delivery of multi-component behaviour-change interventions aimed at improving nutrition and physical activity. Treatment outcomes were generally focussed on weight, with less emphasis on managing complications or improving quality-of-life. There was no evidence-based consensus on the best mode of delivery, setting, or treatment format. The guidelines rarely included recommendations for addressing the practical or social barriers to behaviour change, such as cooking skills or supervised physical activity. There is insufficient evidence to evaluate pharmaceutical and surgical interventions in children, and these were generally not recommended. It should be noted that this review addressed documents published in English only, and therefore the included guidelines were applicable predominantly to high-resource settings.

Examining current physical activity interventions in Black school-age children and parents: A systematic review

Obesity is prevalent in Black children and adults; increasing physical activity (PA) can aid in reducing childhood obesity in both age groups. The purpose of this systematic review is to examine current research on PA interventions in school-age Black children. Adhering to PRISMA guidelines, a systematic search was conducted in six databases for PA interventions in Black children. A total of 13 articles met inclusion criteria (n = 7 randomized controlled trial, n = 5 quasi-experimental, n = 1 cross-sectional). The majority of the articles were on a combination of diet and PA programs (n = 9). Four articles targeted PA and parental role modeling of PA as the outcome showing positive intervention effects. Nine additional studies included PA as an outcome variable along with at least one additional obesity-related predictor. PA interventions for Black school-age children typically use a parent-child dyadic approach (n = 13), are guided by theory (n = 11) and are high quality. However, continued investigation is warranted to draw definitive conclusions and determine how to best involve parents within the PA interventions. Theory-driven higher quality trials that clearly describe the structured PA component and outcomes among Black parent-child dyads are needed.

Pediatric Surgery and School Nurse Attitudes Regarding Children with Obesity

PURPOSE

Weight bias towards individuals with obesity exists among medical professionals; yet, there is less evidence of the extent to which weight biases exist in different types of nursing professions. This study aimed to describe pediatric surgery and school nurses' weight biases towards children with obesity and examine factors associated with weight biases.

DESIGN AND METHODS

Pediatric surgery (n = 108) and school nurses (n = 177) completed a single online survey that assessed their attitudes towards weight regarding children with obesity. Responses were categorized as % agreement (responded "agree" or "strongly agree" to a given statement). Nurses also reported % time spent working with children who had obesity.

RESULTS

Almost all nurses (>93%) agreed it was important to treat patients with obesity with compassion and respect. However, many nurses endorsed statements stating that patients with obesity are often non-compliant with treatment recommendations (47%) and can be difficult to deal with (35%). Only about half of school nurses (53%) and surgical nurses (56%) felt professionally prepared to effectively treat patients with obesity. Nurses commonly reported hearing/witnessing other professionals in their field make negative comments (69%) or convey negative stereotypes (55%) about patients with obesity. School nurses who spent a greater % of time working with children with overweight had more positive weight attitudes (p = 0.04).

CONCLUSIONS

Negative attitudes towards patients with obesity were relatively prevalent in this population of pediatric surgery and school nurses.

PRACTICE IMPLICATIONS

There is a need for more educational opportunities, professional trainings, and policy initiatives to reduce weight bias among nurses.

Nurse-led interventions in the prevention and treatment of overweight and obesity in infants, children and adolescents: A scoping review

BACKGROUND AND OBJECTIVE

Nurses are well-placed in primary care, school and community settings to identify and manage paediatric overweight and obesity. This scoping review examined what types of nurse-led interventions have been undertaken for the prevention, treatment and management of obesity and overweight in infants, children and adolescents.

DESIGN

Scoping review.

DATA SOURCES

CINAHL, Cochrane Library, Embase, MEDLINE, ProQuest Central, ProQuest Dissertations & Theses Global, and Scopus. Searches were undertaken from inception to 2019.

METHODS

Database searches and handsearching were used to identify academic and grey literature, such as scientific reports and university theses and dissertations, on nurse-led interventions undertaken in school, primary health care and community settings. Studies focused on addressing overweight and obesity in children and adolescents, for studies published from 1999 onwards. Studies included focused on experimental and quasi-experimental research that implemented interventions, and described new practice or change in practice.

RESULTS

117 references encompassing 83 studies or programs were selected for inclusion. 16 trials were analysed descriptively, and 67 trials were analysed descriptively and quantitatively. The analysis structured intervention settings and outcomes using the socioecological model, encompassing intrapersonal, interpersonal, community, organisation and policy factors. Studies included were clinically heterogeneous for intervention setting and multicomponent strategies. Education for nutrition, physical activity and behaviour change was the most common strategy used, and nutrition and physical activity knowledge most consistently improved after intervention. Nursing roles focused on education; counselling and behaviour change in primary care; advocacy in school and community environments; and implementing policy in child care settings. Fifty-four studies received financial or resource funding and support to implement the study. On sustainability, seven programs and two research studies were ongoing at time of writing.

CONCLUSIONS

While the clinical heterogeneity of studies makes synthesis of outcomes complex, it demonstrates the breadth of nursing interventions to address paediatric overweight and obesity. Incentives that encourage routine health promotion, upskilling of nurses, and embedding food and nutrition education into the school curricula, are suitable strategies that support nurse-led interventions against paediatric obesity.

REGISTRATION NUMBER

Not applicable. Tweetable abstract: Scoping r/v - what interventions are led by nurses to address paediatric obesity? 83 studies investigate nurses' work in school, primary health, community care.

Perceptions of Obesity Prevention Policies: Socioeconomic Assessment in the Turkish Capital

PURPOSE

The purpose of this study was to inform public policy opportunities to reduce childhood obesity by identifying parents' perceptions of factors contributing to childhood obesity, attribution of responsibility, and the extent of their support for public prevention policies with attention to socio-economic status.

DESIGN AND METHODS

In 2015, 2066 parent-child dyads across socio-economic strata from 43 randomly selected schools in Ankara completed surveys and measurements to examine perceptions, attribution, and prevention policies related to childhood obesity.

RESULTS

Parents across the socio-demographic spectrum recognized obesity as a serious problem. Unhealthy food availability was identified as the leading cause of while industry and media were credited with having the greatest responsibility for childhood obesity. There was strong public support for policy strategies targeting schools, marketing, and the built environment, though support tempered as socio-economic status and parental education decreased.

CONCLUSIONS

This survey provided insight into parents' knowledge and beliefs surrounding childhood obesity as well as their endorsement of related prevention strategies. Educational messages that address variations in SES to describe the causes of childhood obesity and connect those causes to actionable community prevention strategies may improve community support for enhanced policy actions within and beyond school settings.

Breastfeeding and autoimmunity: Programing health from the beginning

Breast milk is not only a completely adapted nutrition source for the newborn but also an impressive array of immune-active molecules that afford protection against infections and shape mucosal immune responses. Decisive imprinting events might be modulated during the first months of life with potential health long-term effects, enhancing the importance of breastfeeding as a major influence on the immune system correct development and modifying disease susceptibility. The aim of this review was to clarify the link between breastfeeding and autoimmune diseases, inquiring the related mechanisms, based on data available in the literature. Being breastfed was associated with a lower incidence of diabetes, celiac disease, multiple sclerosis and asthma, explained by the protection against early infections, anti-inflammatory properties, antigen-specific tolerance induction, and regulation of infant's microbiome. The protective role of human milk in idiopathic juvenile arthritis, rheumatoid arthritis, and inflammatory bowel diseases remains controversial. On the other hand, the breastfeeding mother faces a health-challenging period in life. High levels of prolactin may lead either to the development of autoimmune diseases in susceptible mothers or exacerbations of current immune-mediated disorders. These features raise the question if mothers with autoimmune diseases, mainly systemic lupus erythematosus, should avoid breastfeeding.

Childhood type 2 diabetes: Risks and complications

The universal endocrine pathological state affecting young individuals and adults is type 2 diabetes mellitus, which has seen a significant increase in the last 30 years, particularly in children. Genetic and evnironmental factors are the causative agents for this pathological state in children. This rapid and wide spread of the disease can be controlled by enforcing amendments in environmental factors such as diet, physical activities and obesity. In young infants breastfeeding may be a key modulator of the disease. Associated disorders co-observed in the patients of type 2 diabetes mellitus include renal failure, heart problems and circulatory dysfunctionalities, such as cardiac failure and vision disability. These associated disorders become more pronounced in young patients when they reach puberty. To overcome the lethal outcomes of the disease, early screening of the disease is crucial. The present review focused on the latest updates in the field, as well as plausible risks and complications of this pathological state.

Addressing childhood obesity using a multidisciplinary approach with social workers

Childhood obesity can be effectively addressed with behavioral interventions in programs such as CATCH and Planet Health using a multidisciplinary approach. Social workers and school nurses are in close contact with children and youths at risk of obesity and their families within the school setting and are prepared to lead a multidisciplinary team in program planning, implementation, and evaluation related to reducing childhood obesity.