Association of maternal obesity and childhood obesity: implications for healthcare providers

The purpose of this critical appraisal was to assess the available literature on the association of maternal obesity as a risk factor for childhood obesity and to explore the implications for incorporating this evidence into practice. The increasing prevalence of childhood obesity, with its documented adverse health effects, is a critical public health threat in the United States and worldwide. Research studies have documented increased rates of childhood obesity associated with maternal obesity. Healthcare providers are challenged to expand their competencies to recognize the association of maternal obesity and childhood obesity and to address both primary and secondary prevention of childhood obesity. Stopping the cycle of obesity before it becomes the leading cause of preventable disease and death in the United States is a priority for community health nurses.     

Obesity: America's epidemic

The health risks of overweight and obesity have been well documented. For example, even a 15-lb. weight gain increases a person's risk of diabetes by 50%. In turn, losing as little as 11 lbs. can reduce a person's risk of diabetes by the same percentage. Why, then, aren't more Americans losing weight? This article explores the rising incidence of overweight and obesity in the United States, the reasons so many people fail to lose weight or maintain a weight loss, and the potential for nurses to turn the tide on this epidemic.     

Obesity and the metabolic syndrome.

The prevalence of marked obesity is increasing rapidly among adults and has more than doubled in 10 years. Sixty-one percent of the adult population of the United States is overweight or obese. Americans are the fattest people on earth. Paradoxically these increases in the numbers of persons who are obese or overweight have occurred during recent years when Americans have been preoccupied with numerous dietary programs, diet products, weight control, health clubs, home exercise equipment, and physical fitness videos, each "guaranteed" to bring rapid results. Overweight and obesity are also world problems. The World Health Organization estimates that 1 billion people around the world are now overweight or obese. Westernization of diets has been part of the problem. Fruits, vegetables, and whole grains are being replaced by readily accessible foods high in saturated fat, sugar, and refined carbohydrates. Since class 3 obesity (morbid or extreme obesity) is associated with the most severe health complications, the incidence of hypertension, stroke, heart disease, diabetes, and peripheral vascular disease will increase substantially in the future. Recently, obesity alone has been implicated in the development of cardiac hypertrophy and CHF. The metabolic syndrome associated with abdominal obesity, which includes insulin resistance, dyslipidemia, and elevated CRP levels, identifies subjects who have an increase in cardiovascular morbidity and mortality. Twenty to 25% of the adult population in the United States have the metabolic syndrome, and in some older groups this prevalence approaches 50%. The prevalence of overweight children in the United States has also been increasing dramatically, especially among non-Hispanic blacks and Mexican-American adolescents. Overweight children usually become overweight adults. Atherosclerosis begins in childhood. The degree of atherosclerotic changes in children and young adults can be correlated with the presence of the same risk factors seen in adults. As health providers, our direction is obvious!     

Obesity in pre-school chldren: issuse and challenges for community based child health nurses

Childhood obesity is becoming a topical issue in both the health literature and the popular media and increasingly child health nurses are observing preschool children who appear to be disproportionately heavy for their height when plotted on standardized growth charts. In this paper literature related to childhood obesity in New Zealand and internationally is explored to identify current issues, and the implications of these issues for nurses in community based child health practice are discussed. Themes that emerged from the literature relate to the measurement of obesity, links between childhood and adult obesity and issues for families. A theme in the literature around maternal perception was of particular interest. Studies that investigated maternal perceptions of childhood obesity found that mothers identified their child as being overweight or obese only when it imposed limitations on physical activity or when the children were teased rather than by referring to individual growth graphs. The implications for nursing in the area of child health practice is discussed as nurses working in this area need an understanding of the complex and often emotive issues surrounding childhood obesity and an awareness of the reality of people's lives when devising health promotion strategies.     

Review of Childhood Obesity: From Epidemiology,Etiology, and Comorbidities to Clinical Assessment and Treatment

Childhood obesity has emerged as an important public health problem in the United States and other countries in the world. Currently 1 in 3 children in the United States is afflicted with overweight or obesity. The increasing prevalence of childhood obesity is associated with emergence of comorbidities previously considered to be “adult” diseases including type 2 diabetes mellitus, hypertension, nonalcoholic fatty liver disease, obstructive sleep apnea, and dyslipidemia. The most common cause of obesity in children is a positive energy balance due to caloric intake in excess of caloric expenditure combined with a genetic predisposition for weight gain. Most obese children do not have an underlying endocrine or single genetic cause for their weight gain. Evaluation of children with obesity is aimed at determining the cause of weight gain and assessing for comorbidities resulting from excess weight. Family-based lifestyle interventions, including dietary modifications and increased physical activity, are the cornerstone of weight management in children. A staged approach to pediatric weight management is recommended with consideration of the age of the child, severity of obesity, and presence of obesity-related comorbidities in determining the initial stage of treatment. Lifestyle interventions have shown only modest effect on weight loss, particularly in children with severe obesity. There is limited information on the efficacy and safety of medications for weight loss in children. Bariatric surgery has been found to be effective in decreasing excess weight and improving comorbidities in adolescents with severe obesity. However, there are limited data on the long-term efficacy and safety of bariatric surgery in adolescents. For this comprehensive review, the literature was scanned from 1994 to 2016 using PubMed using the following search terms: childhood obesity, pediatric obesity, childhood overweight, bariatric surgery, and adolescents.     

Obesity and the African-American adolescent in mississippi: an overview

Obesity is one of the most common conditions seen in medical practice, and is one of the most difficult to treat. This condition is often perceived as a cosmetic problem, but it is associated with a number of chronic medical conditions including, but not limited to, heart disease, hypertension, and dyslipidemia. Youth obesity has increased at an alarming rate in the United States and in other developed countries around the world. Given the high prevalence of obesity among adults in the United States, it is not surprising that pediatric obesity is also on the rise. The current trends in obesity among African-American adolescents in the state of Mississippi remain alarming and disheartening. Since obesity starts in early childhood and extends into the adolescent years and possibly into adulthood, behavior modification is the key to preventing the onset of obesity in all population groups.     

Obesity in Infancy: Questions, More Questions, and Few Answers

Current literature presents conflicting views about the existence of infant obesity and its role as a risk factor for later life obesity and comorbidity. This article reviews extant literature and addresses the issues raised about obesity and overweight status in the first 2 years of life. The epidemic increase in childhood obesity stimulates questions about the effects of body weight changes during infancy upon future health status. The influence of maternal obesity and family inheritance patterns is a significant risk for childhood obesity, yet the picture is unclear for birthweight, infant weight gain, and growth parameters in the earliest years of life. Prevention, management, and treatment are indicated when families present with obesity patterns among their members.     

School-based interventions for overweight and obesity in minority school children

The prevalence of childhood overweight and obesity in the United States has resulted in a number of school-based health interventions. This article provides a review of research that addressed childhood overweight and obesity in minority, U.S. elementary schools. All studies reported some benefits in health behaviors and/or anthropometric measures. Effectiveness was greater when program objectives were specific, implemented across the school environments, extended into the community, and were culturally relevant. Because minority school children are disproportionately affected by overweight and obesity and poor health behaviors, and since schools may be the primary setting to address childhood overweight and obesity in communities, school nurses can be an advocate for school-based programs and facilitate success.     

Obesity in Hispanic Americans

The prevalence of obesity among Hispanic American populations is generally greater than among white populations in the United States. Among Mexican Americans, the prevalence of obesity was higher than among either Cuban Americans or Puerto Ricans. It is well known that the prevalence of diabetes increases with increasing levels of obesity or body mass index. However, it does not appear that the high prevalence of obesity in Mexican Americans completely accounts for the higher prevalence of diabetes seen in this ethnic group. Among Mexican Americans, the association of selected cardiovascular disease risk factors, high-density lipoprotein cholesterol subfractions and systolic blood pressure, was similar to that seen among other U.S. populations. Individuals with diabetes had higher values than seen among those without diabetes. In a comparison of nutrient intake in two Mexican-American populations, one rural and one urban, there were no major differences other than higher calorie intakes in the rural population compared with the urban population. In addition, the diet in the rural population, based on higher levels of the Keys score, was more atherogenic than that of the urban population.     

Practical Strategies for Engaging Individuals With Obesity in Primary Care

Although widely recognized as a chronic disease that requires long-term, structured, and multidisciplinary management, obesity remains largely underdiagnosed and undertreated. The prevalence of obesity continues to increase dramatically, with the highest rates seen in the United States. Despite the availability of several clinical practice guidelines, published studies suggest that health care professionals (HCPs) infrequently and inconsistently follow guideline recommendations. Barriers to HCP participation in obesity management are likely to inhibit obesity counseling in primary care. Improving HCP obesity-related practices and counseling is important. This article discusses current practices, barriers to effective obesity management, and recommendations to improve HCP obesity management and counseling, based on findings from a PubMed search and clinical experience. The aim of the article is to share best-practice strategies for engaging patients.     

An Evidence-Based Review of Obesity and Bariatric Surgery

Obesity has reached epidemic levels in the United States. In 1998, the National Heart, Lung, and Blood Institute published guidelines on the identification, evaluation, and treatment of overweight and obese adults. Despite these guidelines, health care providers are still doing a poor job of treating obesity. Millions of Americans meet the weight criteria for bariatric surgery, yet few actually undergo it. Many factors may contribute to this, including patient and provider attitudes regarding obesity and bariatric surgery, cost, and insurance coverage. Recently, numerous publications have described the safety and efficacy of bariatric surgery.     

Exercise for preventing childhood obesity

Childhood obesity is a key public health issue in the United States and around the globe in developed and developing countries. Obese children are at increased risk of acute medical illnesses and chronic diseases-in particular, osteoarthritis, diabetes mellitus, and cardiovascular disease, which can lead to poor quality of life; increased personal and financial burden to individuals, families, and society; and shortened lifespan. Physical inactivity and sedentary lifestyle are associated with being overweight in children and adults. Thus it is imperative to consider exercise and physical activity as a means to prevent and combat the childhood obesity epidemic. Familiarity with definitions of weight status in children and health outcomes like metabolic syndrome is crucial in understanding the literature on childhood obesity. Exercise and physical activity play a role in weight from the prenatal through adolescent time frame. A child's family and community impact access to adequate physical activity, and further study of these upstream issues is warranted. Recommended levels of physical activity for childhood obesity prevention are being developed.     

Obesity in children and adolescents

The prevalence of obesity in increasing worldwide, and its complications are now better recognized. As childhood obesity tracks into adulthood, the treatment and prevention of this condition is necessary early in life. This review describes the public health impact of pediatric obesity, its risk factors, and suggestions for its treatment and prevention, including behavior modifications, decrease in inactivity, increase in physical activity, and dietary changes.     

Parental disconnect between perceived and actual weight status of children: A metasynthesis of the current research

Purpose: Obesity is one of the most common chronic diseases in childhood. Many studies offer a variety of explanations for the alarming increase in childhood obesity; however, none discuss why an apparent disconnect exists in parental perceptions of their child's weight status. The purpose of this article was to review the current research literature on parental perceptions about their children's weight.
Data source: The articles included in this review were retrieved through a literature search using PubMed. Key words used to obtain relevant articles include childhood obesity , childhood overweight , and parental perception .
Conclusions: Several studies looked at parental perceptions of childhood obesity generated from the United Kingdom, Australia, Italy, and the United States. Universally, parents were more likely to misperceive their child's weight. This was especially true for parents who were themselves overweight.
Implications for practice: If parents do not recognize their child as at risk for overweight or overweight, they cannot intervene to diminish the risk factors for pediatric obesity and its related complications. More research is needed to identify why this phenomenon occurs. Only then can effective interventions be initiated.     

Cultural considerations for treatment of childhood obesity

Childhood obesity has become one of the most common health problems facing children in America. Results from the Third National Health and Nutrition Examination Survey reveal that ethnic minority children in the United States are at particular risk for development of cardiovascular disease due to their disproportionate levels of obesity. In treating childhood obesity among ethnic minorities, practitioners need to be mindful of the cultural norms surrounding body size. Additional concerns that must be addressed include the effects of target marketing of unhealthy foods toward ethnic minorities and environmental deterrents to outside physical activities, to name a few. Strategies given to address the problem of childhood obesity among ethnic minorities include, increasing the child's physical activity, reducing television viewing and the adoption and maintenance of healthy lifestyle practices for the entire family.     

Obesity and diabetes in African American women.

Obesity has reached near epidemic proportions in the United States. The prevalence of obesity is high among African Americans, particularly African American women. The risk of diabetes is significantly related to obesity. The risks of morbidity and mortality associated with diabetes poses serious problems for the African American community. It is vital that nurses be at the forefront in initiating research studies, developing strategies for use in practice and providing education to the public about the potentially deadly consequences of obesity.     

Childhood obesity: what can be done to help today's youth?

Childhood obesity is at epidemic proportions in the United States today. This epidemic has created a public health crisis. Although several initiatives are under way to address childhood obesity, including legislative bills before Congress and a call by the National Academy of Sciences for society to band together to stop the rise in the rates of childhood obesity, none of these efforts address what can be done today to help those youth that are considered morbidly obese and who have failed to find solutions with the standard medical treatment plan. This article discusses the use of bariatric surgery as a possible solution, presents a case study to illustrate the impact bariatric surgery can have on youth who are morbidly obese, and defines the pediatric nurse's role in helping to assure that youth are included in the current legislative process.     

Addressing the childhood obesity crisis: a call to action

The prevalence of childhood obesity is increasing in the United States and globally. Associated with numerous comorbid conditions, childhood obesity is also recognized as a risk factor for multiple chronic conditions and premature mortality in adult life. Children and adolescents, particularly those from ethnic minorities and rural low income populations, bear an excess burden of obesity and its attendant comorbidities. A major contributor to childhood obesity is a physical and social environment that promotes foods high in fat and calories and minimizes the opportunities for physical activity. Despite the strong environmental influences that encourage overeating and sedentary behavior, weight maintenance is viewed as a personal responsibility. Addressing the obesity crisis requires a paradigm shift away from blaming individuals for the lack of will power to control their eating and physical activity to one of recognizing the "toxic" or "obesigenic" environment as a primary determinant. This article addresses the obesity crisis from individual, family, local community, and public policy perspectives. Emphasis is placed on the role of nurses and nursing, acting to promote change with individuals and families and acting as advocates for multilevel policy initiatives, in reversing the epidemic and improving the health of future generations.     

Critical interactionism: an upstream-downstream approach to health care reform

Currently, per capita health care expenditures in the United States are more than 20% higher than any other country in the world and more than twice the average expenditure for European countries, yet the United States ranks 37th in life expectancy. Clearly, the health care system is not succeeding in improving the health of the US population with its focus on illness care for individuals. A new theoretical approach, critical interactionism, combines symbolic interactionism and critical social theory to provide a guide for addressing health care problems from both an upstream and downstream approach. Concepts of meaning from symbolic interactionism and emancipation from critical perspective move across system levels to inform and reform health care for individuals, organizations, and societies. This provides a powerful approach for health care reform, moving back and forth between the micro and macro levels. Areas of application to nursing practice with several examples (patients with obesity; patients who are lesbian, gay, bisexual, and transgender; workplace bullying and errors), nursing education, and research are also discussed.