Evidenced Based Practice

Childhood Obesity
Lycia L. Harris, RN
Jacksonville State University

Evidence-Based Nursing Practice

Helps nurses make clinical decisions and answer clinical questions.

EBP creates a clinical question

Looks for evidence

Examines the clinical evidence

Helps clinical decisions be made based on the evidence

Childhood Obesity

An estimated 17% of children and adolescents are obese.

A childs Body Mass Index is used to determine if he/she is

overweight

Body Mass Index is estimated using a childs weight and height

According to CDC.gov, a child in overweight is his/her BMI is at or

above the 85th percentile and lower than the 95th percentile for other
children of the same age and weight.

Obesity is BMI greater than the 95th percentile for age and sex.

Treatment of Childhood Overweight and Obesity

This guideline sets out to show increasingly better results in the treatment
of childhood obesity and issues that cause childhood weight gain through
evidenced based practice guidelines that are common. It was conducted
by The Michigan Quality Improvement Consortium. They searched
literature about the guideline. Computer data bases were used to find
legitimate sources of information, existing protocols an national guidelines
set by other agencies such as The American Heart Association or The
American Academy of Pediatrics.

Clinical practice guidelines were developed from participating MQIC health

plan and Michigan Health Systems to develop new guidelines. The
National Guideline Clearinghouses original study was conducted July 13,
2007. The guideline was then updated by ECRI Institute December 15,
2008. The guideline was most recently updated on October 19, 2010. The
NCG plans on regular updates of this guideline.
(Michigan Quality Improvement Consortium; 2010 Jun. 1 p.)

Michigan Quality Improvement Consortium. Treatment of

childhood overweight and obesity. Southfield (MI): Michigan
Quality Improvement Consortium; 2010 Jun. 1 p.

The reason for this study :

Identify, those at risk. evaluate, treat, manage and prevent childhood

obesity

Sample /Subjects used in this study:

Children 2 years or older which have:
BMI greater than or equal to the

85th percentile

BMI greater than or equal to the 94th percentile without other risk
complications

factors or

BMI greater than or equal to 94th percentile with risk factor or other complications
BMI greater than or equal to 95th percentile who are obese with other complications or without
risk factors or complications

Michigan Quality Improvement Consortium. Treatment of

childhood overweight and obesity. Southfield (MI): Michigan
Quality Improvement Consortium; 2010 Jun. 1 p.

Method/design for the study:

Various computer data bases were searched and data compared. The number of data bases was not disclosed.
Significance of evidence was rated according to a rating scheme:

A. Randomized controlled trials

B. Controlled trials, no randomization
C. Observational studies
D. Opinion of expert panel
* Summary of findings:
In children who meet the criteria of the study group:
Obesity prevention should be taught
Increase exercise, lifestyle changes should be implemented and behavior modifications should be made
Dieting should be done based on BMI or body fat percentage

Continued summary of findings

Risk factors for obesity should be identified and treated

Referrals to specialist such as pediatric bariatric doctors or pulmonologist

or endocrine doctors should be made as needed.

Statistical significance of finding:

17% of children between the ages of 2 and 19 years of age are
overweight,
Since the 1980s childhood obesity has tripled.

U.S. Preventive Services Task Force (USPSTF). Screening

and interventions for overweight in children and
adolescents: recommendation statement.

This guideline summarizes the U.S Preventative Services Task Forces recommendations
for screening and prevention for childhood obesity based on scientific evidence. The
original version was done in 2005. It was last updated in February 2010. It asks
questions as to whether weight control measures such as medications and behavior
modification result in lower BMI percentage and weight loss. It also seeks to identify
positive outcomes of these programs as well as the long term effects as well as the
negative effects these types of programs have on those involved.

Agency for Healthcare Research and Quality (AHRQ); 2005. 11 p.

US Preventive Services Task Force. Screening for obesity in

children and adolescents: US Preventive Services Task
Force recommendation statement. Pediatrics2010
Feb;125(2):361-7. PubMed

The reason for this study:

To evaluate if behavior modification along with diet drugs can have a

positive impact on the control and/or prevention on childhood obesity.

Sample /Subjects used in this study:

Children and adolescent's ages 6- 19 years of age.

Method/design for the study:

searches by hand of published information or primary and secondary
sources as well as the use of electronic data bases.

US Preventive Services Task Force. Screening for obesity in

children and adolescents: US Preventive Services Task
Force recommendation statement. Pediatrics2010
Feb;125(2):361-7. PubMed

Fifteen articles were used concerning behavior changes(15

studies with 18 articles)

Articles were also used dealing with diet drug use.

The strength of the evidence was based on the opinion and

consensus of expert review.

Summary of findings:

Health care personnel should screen adolescents ages 6 years and

older for obesity and offer or refer them to clinicians who can help
them modify their behavior, therefore enabling them to loose weight.

Clinical implications

The clinical implications of these two studies is the importance of

prevention and treatment of childhood obesity and behavior
modification. Studies indicate that obese children become overweight
adults. Obesity usually leads to other medical conditions which are
preventable.
This information is significant for Advanced practice nurses, dietician,
physicians, nutritionist, and regular nurses as well when developing
health plans for obese children.:
Obesity prevention should be taught
Increase exercise, lifestyle changes should be implemented and behavior
modifications should be made
Dieting should be done based on BMI or body fat percentage

Practice Implementation

This information is of value in nursing care because of the increasing

incidence of adolescents and even small children who are
overweight. By understanding the increasing incidence of childhood
obesity, evidence based practice can be done to indicate what
behavior such as diet and exercise or types of nutritional information
can be taught to help overweight children get in shape and remain
healthy adults. Obesity leads to other preventable illness and
through identification and treatment, the cost of health care can
possibly be lowered due to prevention instead of measures for
treatment.

Practice Implications

Promote screening for obesity in children and adolescents

Identify at risk children

Assess nutritional status and diet behaviors

Teach parents and children healthy behaviors

Support community nutritional programs with at risk children

Offer alternatives to high calorie food and snacks

Promote healthy exercise

References:

www.cdc.gov/obesity/childhood

Michigan Quality Improvement Consortium. Treatment of childhood

overweight and obesity. Southfield (MI): Michigan Quality
Improvement Consortium; 2010 Jun. 1 p.

US Preventive Services Task Force. Screening for obesity in children

and adolescents: US Preventive Services Task Force recommendation
statement. Pediatrics2010 Feb;125(2):361-7. PubMed