This paper examines the role of community health nurses in preventing childhood obesity through the framework of primary, secondary, and tertiary prevention strategies. Beginning with epidemiological context from the CDC — noting that obesity rates among children have doubled or quadrupled over the past 30 years — the paper draws on Academy of Nutrition and Dietetics guidelines to outline specific nursing interventions at each prevention level. Primary prevention emphasizes community education targeting preschool-age children and parents; secondary prevention involves one-on-one clinical work with asymptomatic overweight children; and tertiary prevention addresses symptomatic cases requiring more intensive clinical management, including pharmacological and surgical options.
Nina Davuluri of Syracuse, New York met with several dozen students at the Bell Elementary School in Tulsa, Oklahoma on June 6, 2014, to discuss her experiences with childhood obesity (Eger, 2014). This was particularly poignant because Miss Davuluri was the reigning Miss America at the time. A steady diet of white rice, naan bread, soda, sugary cereals, and cookies during her childhood had led the family physician to warn her parents that Nina and her sister were borderline obese. Her parents responded appropriately by eliminating or restricting many of the offending foods and by encouraging engagement in strenuous physical activity. Although this strategy was successful, Miss Davuluri relapsed in college and developed bulimia. Since then, she created a personalized approach to managing her diet, which helped her lose close to 60 pounds shortly before the Miss America pageant.
According to the U.S. Centers for Disease Control and Prevention (CDC, 2014), the prevalence of obese children and adolescents has doubled and quadrupled over the past 30 years. Currently, nearly one third of all children younger than 18 years of age in the United States are overweight or obese. Unfortunately, if these children are unable to return to a healthy weight, they will face an increased risk of obesity, diabetes, heart disease, stroke, and cancer during adulthood. To better understand what roles a public health nurse can assume when combating the obesity epidemic in children, this essay examines this health issue through the lens of prevention.
Disease prevention strategies can be stratified into primary, secondary, and tertiary levels (Turnock, 2012, p. 54). A primary prevention strategy involves taking steps to prevent the onset of disease. For childhood obesity, this might include educating families about the advantages of healthy diets and ample physical exercise (CDC, 2014). Secondary prevention identifies individuals in the early stages of the disease process before symptoms manifest (Turnock, 2012, p. 54). For children, this might involve tracking body mass index (BMI) over time and identifying those who may be overweight (Hoelscher, Kirk, Ritchie, Cunningham-Sabo, & Academy Positions Committee, 2013). An intervention could then be administered to halt and reverse this trend before obesity manifests. Tertiary prevention strategies are implemented after the individual has become symptomatic (Turnock, 2012, p. 54). The earliest symptoms a child may develop include hypertension and high cholesterol, but unless treated effectively, the risk for diabetes, heart disease, stroke, and cancer persists from childhood into adulthood (CDC, 2014).
A community health nurse has an integral role in primary prevention strategies for childhood obesity. The primary prevention approach advocated by the Academy of Nutrition and Dietetics (hereafter referred to as the Academy) is a community-wide education campaign directed to all members of the public, including children and their parents (Hoelscher et al., 2013). A community health nurse could create literature and deliver seminars on this topic at local community centers and schools, with the core message focusing on the benefits of a healthy diet and regular physical activity in preventing childhood obesity.
The Academy, however, emphasizes the importance of targeting the information campaign to preschool children and their parents, since this appears to be a critical period for maximizing the benefits of childhood obesity prevention efforts. Accordingly, a community health nurse could target day care centers and encourage them to improve the quality of foods served to children and increase the amount of physical activity offered. A community nurse could then track the effectiveness of these interventions by monitoring prevention strategy outcomes.
"Clinical one-on-one work with asymptomatic overweight children"
"Intensive clinical interventions for symptomatic obesity"
A community health nurse has many roles to play when disease prevention efforts are targeting childhood obesity. Primary prevention strategies almost exclusively involve educating the public about this health issue, but these roles begin to transition to a more traditional clinical function when prevention strategies involve asymptomatic and symptomatic overweight and obese children. Some of the roles involved in secondary and tertiary prevention include educator, counselor, motivator, care coordinator, and provider.
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