Managing pandemic related obesity in schools

The article by Dr. Sheela N. Magge, “Childhood Olives and the Impact of COVID-19” Provides Insight into the Causes of Obesity through a Comprehensive Review of the Epidemiology, Genetic Considerations, Assessment, Screenings, Comorbidities, and Available Treatments for Pediatric/Adolescent Patients diagnosed with obesity. The article is presented at a critical time as children return to school, many of whom have been homeschooled for 18 months. These children and adolescents may not have experienced their usual play, sports, exercise routines and eating patterns and may have gained more than the normal amount of weight for age and height. Since many K-12 schools only require a physical exam at specific learning levels, not all children will have seen their primary care providers before returning to school in the fall of 2021. centers (SBHCs) will play an important role in assessing the child’s health status with regard to obesity, the potential for co-morbidities and implementing appropriate management strategies.

The role of school nurses and nurse specialists in the assessment of obesity in school-age children

Each year, school nurses perform multiple screenings for school-aged children, including measurements for height, weight, body mass index (BMIs), blood pressure measurements, vision, hearing and scoliosis. This year it is especially important for school nurses and nurse specialists in SBHCs to compare the results of this screening with previous measurements. Children who have gained more than the expected amount of weight should be further evaluated for possible co-morbidities by reviewing their personal and family medical history. School nurses and nurses should also take a nutritional history and suggest changes that can help obese children initiate behavioral changes in their lifestyle to improve health care outcomes.

School nurses may refer the children to their primary care providers for further evaluation based on personal and family medical history. GPs can begin a plan of action with children and adolescents using shared decision-making techniques to improve dietary choices. Both school nurses and nurse practitioners can engage families in the conversations about healthy eating to develop a goal for the child and even the family to improve food choice. School nurses and nurses may also offer weight management programs in school to involve children/adolescents in their eating and physical activities that promote healthy behavior.

Screening for prediabetes and diabetes and appropriate measures

Screening for prediabetes and diabetes in overweight and obese school-age children and adolescents with a strong family history of diabetes includes both primary and secondary prevention strategies for prediabetes, diabetes, and related co-morbidities. Comparing the results of previous blood work with the most recent blood test helps identify trends in the body’s ability to control glucose levels, showing a trend toward levels indicative of prediabetes. Early identification of these trends, along with the support and identification of resources to incorporate nutritional, behavioral and physical activity interventions to reduce overweight and obesity, is step 1 in helping the child/adolescent and family to reduce overweight. or control obesity. In the article by Dr. Magee is included a table that presents the prediabetes and diabetes blood tests and confirms laboratory tests with a 2 hour blood glucose tolerance test.

Overweight and obesity and feelings about self and mental health

A quick review of the literature using CINHAL and search terms ‘adolescent obesity and mental health’ revealed 190 studies and the use of ‘obesity and mental health and children and adolescents’ revealed 178 papers examining the relationships between overweight and obesity in the pediatric/adolescent population. adolescent population. Adolescents focus on their personal body image and the way others perceive them. Asking children and adolescents how they feel about themselves is an important part of any annual healthcare visit. About 1 in 3 preadolescents (11-13 years old) and 1 in 4 adolescents experience a mental health problem.1

Of relevance to mental health in the pediatric/adolescent populations is a study examining the association between weight status and mental health in children ages 10 to 17 in Massachusetts.2 Study results showed that overweight/obese children, especially girls, were more likely to than normal-weight children to have parent-reported negative emotions. The researchers concluded that this evidence suggests a link between weight status and mental health. In addition, the authors reported that lower levels of physical activity were associated with negative mental health outcomes

In a more recent study, researchers conducted a two-year longitudinal study to examine physical and mental health trajectories of change in youth diagnosed with severe obesity.3

The study was conducted in a tertiary Canadian children’s center. The study participants ranged in age from 3 to 17 years. Study retention was 82.9%. Study results include analysis of anxiety and depression in the children. Results showed that the mental health, quality of life and cardiometabolic health of children and adolescents of all ages improved over the 2-year study period.3

Clearly, pediatric health care providers should assess infants, children, and adolescents for overweight and obesity and provide resources for strategies to reduce the incidence and prevalence of overweight and obesity in the populations we serve. In addition, school nurses and nurse practitioners who interact regularly in school settings should play an active role in primary and secondary prevention strategies to not only reduce the incidence of overweight and obesity, but also to prevent anxiety and depression commonly seen in overweight children. or being obese. Implementing evidence-based strategies in school settings to reduce the incidence of adolescents entering adulthood with an elevated BMI and potential for multiple comorbidities is an important role for school nurses and nurse practitioners.

References

1. Hoying J, Melnyk B. COPE: A pilot study with city-dwelling sixth-grade minority youth to improve physical activity and mental health outcomes. The Journal of School Nursing. 2016;32(5):347-356. doi: 10.1177/1059840516635713

2. Lu E, Dayalu R, Diop H, Harvey E, Manning S, Uzogara S. Weight and Mental Health Status in Massachusetts, National Survey of Children’s Health, 2007. Matern Child Health J. 2012;16(S2):278-286 .doi:10.1007/s10995-012-1145-1

3. Buchholz A, Howard A, Baldwin K, et al. Health trajectories of severely obese children following a weight management program. child health care. 2019;25(7):439-446. doi:10.1093/pch/pxz088

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