Childhood obesity is one of the biggest modern health problems. In the United States, more than one child in five (age 2-5 years) is overweight or obese (Centers for Disease Control and Prevention [CDC], 2017). As stated by Cunningham, Kramer, and Venkat Narayan (2014), the number of the US children with elevated BMI has increased by 15.3% in the period from 1965 to 2000.
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Pediatric obesity is regarded as one of the primary epidemiologic factors for an early development of type 2 diabetes and cardiovascular conditions (Karnik & Kanekar, 2012). Additionally, due to multiple adverse impacts of obesity on individuals’ health, it is associated with excess cost burden. Finkelstein, Graham, and Malhotra (2014) observe that the lifetime medical cost for an obese child (age 10) can be nearly $19.630 and increase up to $39.080 in the adulthood if a timely intervention is not made.
The Early Care and Education (ECE) policy is aimed to combat and prevent childhood obesity in the United States. As stated by the CDC (2017), the majority of children (age 6 or younger) attend various child care organizations outside their homes. When attending the ECE settings instead of the regular ones, the children in working families may engage in healthier lifestyles as nutrition, and physical activities in those child care organizations are strictly controlled.
Child care centers in twenty-five states implement the ECE programs to develop healthy dietary and physical activity behaviors in children. At the state and community level, the national ECE program aims to motivate administrators and providers to improve nutrition, comply with standards related to diet and physical activities, integrate those standards in pre-service training, and increase access to healthier foods (CDC, 2011).
The policy is developed and disseminated by the CDC. For a significant time, the organization has been focused on the promotion of environmental strategies intended to increase accessibility and affordability of healthy dieting and active living to different population groups. The ECE can be considered as part of those efforts. The CDC integrates the policy at the state level − “through the Nutrition, Physical Activity, and Obesity (NPAO) cooperative agreement, 25 states receive funding to develop and implement comprehensive obesity plans to prevent obesity and other chronic diseases through healthful eating and physical activity” (CDC, 2011, p. 2).
Roles of Advanced Practice Registered Nurse
An advanced practice registered nurse (APRN) can assist the dissemination of the policy through patient education, research, and advocacy. Educational and behavioral interventions are regarded by researchers as the most efficient in prevention and treatment of childhood obesity. As stated by White et al. (2013), nurse-patient education should target “both parent and child psychosocial factors related to obesogenic behaviors” (p. 617). Considering that the lack of parental supervision may often be a risk factor for a child’s engagement in unhealthy behaviors, during patient communication, APRNs can recommend families to refer to nearby ECE facilities as it may help them eliminate the given risk to some extent.
Through collaboration with various community stakeholders, APRNs can also raise awareness of the issue and its solution in public (Vine, Hargreaves, Briefel, & Orfield, 2013). It is important to remember that high-quality evidence can largely support the policy dissemination initiatives. Thus, administration of research on childhood obesity, as well as advantages and disadvantages associated with the implementation of the ECE, is a primary requirement.
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Impacts on Clinical Practice
The ECE suggests that healthcare providers should promote healthier lifestyles during patients’ referrals to hospitals. The care that children receive from different caregivers including nurses “lays the groundwork for the development of a multitude of basic health processes, including self-regulation, attention, and, ultimately, social-emotional functioning” (Mistry et al., 2012, p. 1691). Therefore, the emphasis in the clinical practice should be made on nurses’ skills development regarding evidence-based assessment and counseling practices, as well as the overall clinical infrastructure and care model improvements (Vine et al., 2013).
Staff training courses can significantly increase practitioners’ comfort and competence in discussing childhood obesity problems with patients and families (Vine et al., 2013). A skilled APRN can educate other healthcare providers about effective educational practices and also advocate for the shift towards patient-centered care models if needed.
Interprofessional Team Roles
Clinicians often refer obese patients to interventions outside hospitals, e.g., interactive nutrition and exercise sessions, in-group physical activities, cooking courses, etc. (Vine et al., 2013). Thus, to achieve better outcomes in the ECE implementation, besides APRNs, an interprofessional team should include social workers, childhood development specialists, nutritionists, and other professionals working in diverse settings, both administering the ECE programs and not.
They can create a supportive network for those who need intervention and facilitate their referral to the ECE programs and other preventive activities. Working together, the interprofessional team members will be able to detect and address psychosocial and physiological factors defining childhood obesity, such as low incomes, genetic predisposition, etc. more efficiently. A multidisciplinary approach to patients will help target the origin of the problem in each individual case and, in this way, will lead to better outcomes.
The incidence of childhood obesity worldwide continues to increase and, therefore, many efforts are made to combat the given public health issue. The CDC aims to prevent obesity in children through the dissemination of the ECE program focused on the promotion of healthier lifestyles among educational and child care settings, administrators, and care providers. APRNs can use the ECE premises to substantiate lifestyle interventions implemented within the clinical practice and create hospital environments supporting obesity prevention. By collaborating with specialists across the disciplines, APRNs can develop health awareness in individuals and communities. A multidisciplinary approach to the ECE initiatives is that what can ensure better patient outcomes.
Centers for Disease Control and Prevention. (2011). Early Care and Education policy review. Web.
Centers for Disease Control and Prevention. (2017). Early Care and Education (ECE). Web.
Cunningham, S. A., Kramer, M. R., & Venkat Narayan, K. M. (2014). Incidence of childhood obesity in the United States. The New England Journal of Medicine, 370(5), 403–411.
Finkelstein, E. A., Graham, W. C., & Malhotra, R. (2014). Lifetime direct medical costs of childhood obesity. Pediatrics, 133(5), 854-862.
Karnik, S., & Kanekar, A. (2012). Childhood obesity: A global public health crisis. International Journal of Preventive Medicine, 3(1), 1–7.
Mistry, K. B., Minkovitz, C. S., Riley, A. W., Johnson, S. B., Grason, H. A., Dubay, L. C., & Guyer, B. (2012). A new framework for childhood health promotion: The role of policies and programs in building capacity and foundations of early childhood health. American Journal of Public Health, 102(9), 1688–1696.
Vine, M., Hargreaves, M. B., Briefel, R. R., & Orfield, C. (2013). Expanding the role of primary care in the prevention and treatment of childhood obesity: A review of clinic- and community-based recommendations and interventions. Journal of Obesity, 2013, 172035.
White, R. O., Thompson, J. R., Rothman, R. L., Scott, A. M. M., Heerman, W. J., Sommer, E. C., & Barkin, S. L. (2013). A health literate approach to the prevention of childhood overweight and obesity. Patient Education and Counseling, 93(3), 612–618.