Obesity Prevention Education and Body Mass Index Protocol

1. Obesity Prevention Education and Body Mass Index Protocol Updated 8-17-17

2. The planning committee & faculty attest that no relevant financial, professional or personal conflict of interest exists, nor was sponsorship of commercial support obtained, in the preparation or presentation of this educational activity.

3. Approved Provider Statement The Arkansas Department of Health is an approved provider of continuing nursing education by the Midwest Multistate Division, an accredited approver by the American Nurses Credentialing Center's Commission on Accreditation.

4. Learning Outcomes • Define obesity and relate current trends in Arkansas and in the US. • Discuss risk factors associated with childhood obesity. • Explain health consequences of obesity. • Review history and pertinent legislation related to BMI in Arkansas • Demonstrate the process for appropriate height and weight measurement for school-age children • List resources available for nurses to combat childhood obesity.

5. Obesity Trends

6. Definition of Obesity Obesity is defined as an increased body weight in relation to height, when compared to some standard of acceptable or desirable weight.

7. Obesity and Overweight in Children Obesity in children and youth refers to age and gender- specific BMI that is equal to or greater than the 95th percentile of the CDC BMI charts Overweight/at risk for obesity in children and youth refers to a BMI that is between the 85th – 94th percentile (CDC 06-19-2015)

8. In the Past Three Decades… Number of overweight: • 6-11 year olds increased from 7% to nearly 18% • Adolescents quadrupled 5% to nearly 21%. • Overweight adults tripled

9. The Epidemic of Obesity • Obesity affects 17% of all children and adolescents -12.7 million children and adolescents • More than 1/3 of adults are obese • www.cdc.gov2011-2014

10. Obesity in the United States http://www.cdc.gov/obesity/data/trends.html

11. Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2015 ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

12. Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2016 ¶ Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011. *Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

14. Risk Factors for Obesity

15. DietInactivity High-calorie foods High-fat foods dense in calories Soft drinks, candy, and desserts high in sugar/calories Sedentary kids more likely to gain weight Inactive leisure activities

16.  Genetics Overweight family and child may be genetically predisposed to put on excess weight environment of high-calorie foods physical activity may not be encouraged

17. Heredity and Genes  80%of children with two overweight parents will become overweight  40%of children with one overweight parent will become overweight  7–9%of children with no overweight parents will become overweight http://www.surgeongeneral.gov/topics/obesity/calltoaction/fact_adolescents.htm

18. Some eat to cope with problems or deal with emotions; stress or boredom Parents may have similar tendencies Psychological

19. Environmental and Media: Temptation at Every Turn Chips, cookies, cereal, fast food, and other less healthy food choices are marketed to children via media

20. Behavioral and Socio-cultural Sedentary lifestyles  Calorie-dense foods  Large portion sizes  Excessive screen time  low energy expenditure Parent modeling - eating and exercise behaviors

21. Consequences of Obesity

22. Risk of CVD Hypertension Elevated insulin levels Dyslipidemia Elevated low density lipoprotein (LDL) Abnormal triglyceride levels

23. Psychosocial • Quality of Life • Depression and Anxiety • Negative self-esteem and poor body image • Feelings of chronic rejection, withdrawal from interaction with peers, and behavioral problems • Decreased endurance and/or participation • Social, academic and discrimination (bullying/teasing) www.cdc.gov

24. Other Health Consequences • Sleep apnea • Asthma • Risk for Kidney problem • Orthopedic disorders • Skin fungal infections • Gastrointestinal • fatty liver disease • elevated liver enzymes • gallstones and cholecystitis • gastroesophageal reflux • constipation

25. Other Health Consequences:Cancer • Esophageal • Breast • Endometrial • Colon/rectal • Kidney • Gall Bladder • Thyroid • Pancreas

26. Other Health Consequences • Endocrine disorders • T2DM • Acanthosis Nigricans • Polycystic Ovary Syndrome • Early sexual maturation Clearly, the growth in the treatment of type 2 diabetes could signal the beginning of a multitude of long-term healthcare needs for many of these children.

27. Acanthosis nigricans type III associated with obesity, insulin-resistant states and endocrinopathy Acanthosis nigricans is a disorder that may begin at any age Velvety thickening Gray to brown to black in body creases Neck, armpits, groin Darker skinned people have darker lesions http://www.aocd.org/skin/dermatologic_diseases/acanthosis_nigrica.html (James, et al 2005)

28. Typical Acanthosis Nigricans of the Neck

29. Typical Acanthosis Nigricans of the Axillae

30. Economic Burden of Obesity The Economic Estimates of the impact of obesity are astronomical: 1995 - Approximately $52 billion was attributed to obesity 2006 - This figure had increased to $147 billion 2010 – Increased to $215 billion Researchers have estimated that by 2030, if obesity trends continue unchecked, obesity-related medical costs alone could rise by $48 to $66 billion a year in the U.S.

31. Economic Burden of Obesity Obesity is the No. 1 driver of increasing health care costs in the US today Diabetes contributes to health care disparities in the United States

32. Rising obesity rates - result of a number of trends in the US (F as in Fat, 2015) Nutritious foods are more expensive than calorie-dense, less nutritious foods Americans walk less and drive more -- even for trips of less than one mile Adults often work longer hours & commute farther (convenience food) Parks & recreational spaces are not considered safe or well maintained in many communities Children engage in less physical activity in school ↑ screen time

33. Arkansas Initiativeand Recommendation for BMI in Schools

34. AR Preventive Nutrition and Physical Activity Summit • Purpose: to develop specific strategies to control the obesity epidemic in Arkansas • Occurred: March 8, 2003 • Funded by: National Institute of Health Nutrition Academic Award • Support from: UAMS, ADH, ACHI, ACH, others • State-wide summit

35. Act 1220 of 2003 • Creates an Arkansas Child Health Advisory Committee • Limits access to food/beverage vending machines • Reports ALL money received from food and beverage contracts. • Convenes an advisory committee in each school district • Incorporates nutrition/physical activity goals into annual plans

36. Act 1220 of 2003 States: “Require schools to include as part of the Student Health report to parents an annual body mass index percentile by age for each student; and require schools to annually provide parents with an explanation of the possible health effects of body mass index, nutrition, and physical activity.” (in a confidential, private and accurate manner)

37. Act 201 of 2007 • Individual students will participate in BMI assessments in kindergarten and in grades 2, 4, 6, 8, and 10. • BMI measurements will be eliminated for students in grades 11 and 12.

38. Act 201 of 2007 • Parents can provide written notice to the school if they choose to exclude their children from BMI assessments. • Community Health Nurses will work with schools to assure that proper protocol is followed during the BMI assessments.

39. AAP Recommendation Accurately weigh and measure to monitor growth Calculate and plot BMI once a year in all children and adolescents Use changes in BMI to identify rate of excessive weight gain relative to linear growth (AAP, 2007, reaffirmed in 2010)

40. Childhood BMI is gender & agespecific http://www.cdc.gov/nccdphp/dnpa/obesity/childhood/defining.htm; 2009

41. BMI for Age and Gender: Used for children and teens because of their rate of growth and development Provides a reference for adolescents that can track body size throughout life Compares well to laboratory measures of body fat (Barlow, 2007)

42. Body Mass Index What it is and is not! An inexpensive, effective, easy-to-perform screening tool using height and weight -Not intended to be used as the sole diagnostic measure (CDC)

43. Perspectives About the Use of BMI Measurement Identify referrals and resources for children and parents Promote policies that  access to healthful foods and daily physical activity

44. Clinical Instruction for BMI Assessment

45. Prior to Assessment • Contact school administration and teachers • Determine assessment team • Screener • Recorder • Determine date and place and which students to be assessed

46. Day of Assessment • Equipment • Calibration of scales • Station set up • Preparation of child • Data collection forms or computer

47. Recommended Equipment • Stadiometer (page 4 in training manual) • Measures height • Portable or permanently affixed to wall • Provided by ACHI • Tape wood board to wall for stability • Carpenter’s triangle for headpiece

48. Scales • Tanita HD-314 • Portable • Measures up to 330 lbs • Digital read-out • Tanita HD-351 • Portable • Measure up to 440 lbs • Digital read-out • Previous weight is visible

49. Recommended Equipment Step Stool -Height measurements to ensure measurement line is read at eye level Batteries (Check type & number required) Name Tags – children and staff Office Supplies Container for personal items

50. Recommended Equipment • Standard Weight • A standard weight should be used to test the scale for accuracy (NOTE: do not use non-standard weight such as bag of sugar) • If the readout is more than ½ pound off then change the batteries in the scale • If the readout is still more than ½ pound off DO NOT use the scale