BY Tracey Boyd
Monday July 2, 2012
With more than one-third of American adults classified as obese, according to the Centers for Disease Control and Prevention, national programs and initiatives have sprouted to address weight issues earlier in life. Childhood obesity, defined as a body mass index at or above the 95th percentile for youth of the same age and sex, now affects 17% of all children and adolescents in the U.S., the CDC reports. This is triple the rate of a generation ago.
Because of the increase in childhood obesity, national initiatives, such as first lady Michelle Obama’s Let’s Move! Campaign, have encouraged parents, teachers and students to pay closer attention to food intake and activity levels. Schools also are dedicated to combatting the problem; for example, Wellspring Academy in Brevard, N.C., a boarding school for obese children ages 11 to 19.
New York and New Jersey programs also are doing their part toward prevention. In 2010, the NuHealth Foundation, the philanthropic arm of NuHealth System in East Meadow, N.Y., conducted a study of sixth- and eighth-grade students in the Roosevelt (N.Y.) Union Free School District to assess students’ BMIs and the prevalence of overweight and obese children. The results of the study showed 44% of the students in the Long Island school district were overweight or obese, higher than the CDC’s national average of about 30%.
After the study, the Long Island Community Foundation awarded $50,000 to the NuHealth Foundation for a local anti-obesity program. The grant-funded program will deliver improved care and education to reduce childhood obesity and its comorbidities through enhanced diet, fitness and nutrition education for parents, faculty and students.
Roosevelt Middle School has benefited from the childhood obesity initiative, said Susan C. Kay, RN, BSN, CPNP, MSN, a pediatric nurse practitioner in the pediatric endocrine, metabolism and lipid disorders clinics at Nassau University Medical Center. “We educate all families about the ‘healthy plate,’ on which half the plate is green, a quarter is a protein and the last quarter is a fistful of starch,” Kay said.
Staff teach families to read nutrition labels, use healthy cookbooks, explain nutrition information on fast-food chains and educate about 5-2-1-0 (five fruits and veggies each day, two hours total of TV/computer/video gaming systems, one hour of daily exercise, zero fried foods and juice), Kay said.
“With the use of a computer we do virtual food shopping with the patient to help them make healthy choices and/or healthy substitutions for favorite foods in the supermarket,” she said. “We also provide community phone numbers for sports programs in the family’s local areas to encourage exercise.”
The response to the initiative has been more than favorable. “Family dynamics have improved with education because [they] have become much more aware of the obesity issue and have learned improved ways to deal with related issues,” Kay said.
Jing Jing Mei, RN, a nurse practitioner at Haven Academy in the Bronx, N.Y., a charter school sponsored by The New York Foundling, has created programs to teach students about proper dieting and exercise to live a healthier lifestyle.
She launched an after-school sports and running club for third- and fourth-graders, a fruit and vegetable challenge to complement first lady Michelle Obama’s Let’s Move! Campaign and the option of a healthy school snack.
Mei has always wanted to teach kids how to live a healthier lifestyle. “Kids don’t have a choice in what they eat because they’re not purchasing the food,” she said. “I wanted to try to make a difference before they get to the point when they become adults and have high blood pressure or other ailments and they’re in the hospital.”
Mei’s position and healthy snack option is supported by grants from the Deerfield Foundation. Red Rabbit, a Harlem, N.Y.-based organization, provides fresh fruit, pita chips or fresh bread. The school already had a no-candy-or-sweets rule, so for Nutrition Month in March it instituted a no-sugary-drink challenge, Mei said. The change in eating has been phenomenal. “The rate of visits for abdominal complaints has decreased by about 50%,” Mei said.
To get families involved, Mei takes parents to the Union Square farmer’s market with “health bucks” to purchase nutritious foods. Funded by the New York State Department of Health and part of the GrowNYC initiative, health bucks allow families to purchase fresh fruits and vegetables. The idea for the after-school running club came from Mei’s membership in the New York Road Runners, a running club with more than 60,000 members. The club’s Mighty Milers program, geared toward elementary school students, served as her inspiration.
Mei measures students’ BMIs monthly. If a student’s BMI is considered overweight or obese, he or she is referred to a dietician who gives them a plan and coaching throughout the school year, Mei said.
The Visiting Nurse Service of New York offers a program for obese adolescents who have diabetes or other chronic health conditions, said Sandra Eger-McTernan, RN, MSN, a pediatric clinical nurse specialist and pediatric nurse practitioner for the maternal newborn pediatrics program. The program, staffed by nurses who work closely with a nutritionist and social worker, counsel and educate children and families on healthy choices and the importance of medical followup and medication compliance, Eger-McTernan said.
VNSNY nurses teach patients and families about the dangers of processed meals and sugary drinks and how to include vegetables and high-fiber foods daily.
“Families need to know where to get healthy foods at a reasonable cost, how to enforce portion control and provide the emotional support to the patient,” Eger-McTernan said.
In a two-year pilot, VNSNY provided long-term care management services to almost 50 patients with type 1 diabetes from ages 11 to 17. Patients from the Berrie Center at Columbia-Presbyterian in Manhattan and Montefiore Medical Center in the Bronx received regular visits by a VNSNY certified diabetes educator and social worker. To keep in regular contact with VNSNY clinicians, patients received Blackberry Smartphones with a diabetes application.
VNSNY is implementing a new short-term program this summer that emphasizes an interdisciplinary team approach to pediatric patients of all ages with type 1 and 2 diabetes, said Joann Ahrens, MPA, manager of special projects for children and family services at VNSNY.
“A majority of patients in a our diabetes program are teenagers and require support and close followup,” Eger-McTernan said. “We see them often and discuss plans with their primary [physicians] and specialists. Patients and parents/caregivers learn a lot and make adjustments to avoid re-hospitalizations and long-term complications. That is our goal.”
Turn child obesity around ASAP
ChildObesity180 is a diverse team of leaders working at Tufts University in Boston to reverse the trend of childhood obesity.
Experts and leaders from public, nonprofit, academic and private sectors have come together to address the childhood obesity crisis. The team comprises 19 senior decision-makers from the highest levels of government, academia, public health advocacy, community organizations, the food industry and the media.
The organization spearheads three initiatives to fight childhood obesity, one of which is the Active Schools Acceleration Project. ASAP consists of four phases:
• Identifying innovation
• Replicating best practices in diverse environments
• Expansion of viable programs to national-level impact
• Achieving long-term sustainability
The innovation competition, which launched in February, aims to identify the most effective approaches to school-time physical activity. ChildObesity180 is seeking innovation on all fronts, from grass-roots programs to established national movements to the latest developments in cutting-edge technology. Funded by a consortium of the nation’s leading health plans, the competition will unearth a range of effective on-the-ground programs in schools across the nation.
Two for one
In May 2011, a program was created in New Jersey to help identify and recruit at-risk youth who struggle with weight issues and have parents with diabetes. Project Inspire, a Johnson and Johnson-funded initiative, is part of a larger educational program that targets Spanish-speaking diabetics and their families, said Marlene Spina, RN, BSN, bilingual diabetes nurse educator for the Robert Wood Johnson University Hospital Outpatient Diabetes Education Services & Community Health Promotion Program in New Brunswick, N.J.
“The program is a free, five-day interactive summer program that inspires 20 New Brunswick children ages 10 to 13 to live a healthy and active life,” Spina said. “It provides information about nutrition and the importance of making healthy food choices through creative games and fun activities, as well as one hour of exercise and other sports-related physical activities daily. All participants learn to prepare and enjoy healthy snacks, view cooking demonstrations and eat a healthy lunch.”
Spina develops daily lesson plans, presents a topic in an open-discussion format and facilitates interactive games related to what she has taught. “Progress is measured by a pre-class assessment of their knowledge relating to nutrition and making healthy food choices, and the same questions in a post- program assessment,” Spina said. “The pre- and post-assessments are then compared … to see if the child’s knowledge of healthy eating has increased.”
Children who need to continue with physical activity programs are referred to local sports and fitness programs, Spina said. The last day, students prepare a healthy snack for their parents, receive certificates of participation, partake in a bicycle raffle and go bowling or swimming, depending upon funding.
“The cost of obesity and all of its comorbidities is crippling the health of this nation,” Eger-McTernan said. “Prevention starting in utero, teaching new moms nutrition and health habits, can reverse this trend.”