Identifying social determinants of health (SDOH) that have the greatest impact on childhood obesity is key in combating this national health care crisis. Through analysis of a secondary data set and utilization of the social-ecological model (SEM) for children in the state of Alabama as part of my dissertation (pending publication), I found the SDOH of household income to have an inverse correlational relationship with childhood obesity.

The current public health/medical theories relating to why lower household incomes have greater instances of childhood obesity include the following: 1) inability in general to purchase healthier foods; 2) a greater proportion of income is allocated to housing and, therefore, less money to purchase healthier foods; and 3) lower income households live in locations with poor access to parks, playgrounds, and green space. All of these factors preclude people with low household incomes from engaging in healthy behaviors and limit physical activity.

Figure. Social ecologic model of health. Source: CDC.

Statewide innovations, strategies, and programs should be geared towards using SDOH as a guide to address childhood obesity. Policy change must be a part of the solution. Stakeholders should invest in resources focused on the identification of SDOH factors that have the potential to negatively impact childhood obesity. Further implications from my research suggest a critical element in efforts to identify SDOH factors that have the greatest impact on childhood obesity rates is to meet children where they are. Frontline health care workers including nurses, nurse practitioners, and PAs can aid in this endeavor. We have firsthand access to children in the clinical setting. It is through these encounters that we have the potential to ask relevant questions and obtain the data necessary to further understand the impact of SDOH on childhood obesity.

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Strategies for Managing Childhood Obesity in Clinical Practice

Oftentimes, childhood obesity is discussed in the clinical setting as an afterthought during a routine well-child examination. Clinicians must schedule appointments specifically geared towards discussing weight management for the child and plausible interventions. This intentional engagement can help clinicians identify specific SDOH factors that affect that particular child. At the clinic in which I practice, individualized weight-management appointments are provided to all children in the greater than 95th percentile for body mass index. During this appointment, body tape measurements are taken to gain a clearer understanding of actual body composition. Biomarkers are drawn to include insulin, hemoglobin A1C, thyroid panel, and comprehensive metabolic panels to rule out medical etiology.

Dietary counseling sessions are also performed during this visit. This counseling includes education relating to the identification of foods that contain healthy proteins and fats and the reduction of processed carbohydrates. Accurate dietary recall is a foundational element when addressing childhood obesity. It is common for the child and the family to believe caloric intake is not the issue. Therefore, families receive and are shown how to properly use a dietary journal. When discussing methods to increase physical activity, I take the time to individualize a physical activity plan of care. Routine, mundane physical activity for children is not the key to long-term engagement/buy-in. I find out what type of physical engagement the child is interested in and enjoys. Together, we set short-term and long-term goals. I incorporate the use of a physical activity log to keep track of progress. Families also receive bulleted educational pamphlets intended to reinforce the dietary and physical information discussed.

Incorporating SDOH Factors Into Obesity Treatment Plans

Once the identification of SDOH factors that have an impact on the patient occurs, it is then up to the clinician to be aware of community-specific resources that may be available. These resources will vary from state to state. For example, if the clinician discovers affordability of healthier food options is the problem, are there local food banks that the family can be referred to receive healthier food options at reduced or free rates? If the clinician discovers the child does not have access to safe green space in efforts to increase physical activity, are there local community centers that the child could easily access? There is no one size fits all formula when addressing childhood obesity. However, clinician awareness of resources, creativity, and prioritization of finding solutions are steps in the right direction.

LaToya A. Patterson, PhD, CRNP, CNS, MLT, is a full-time clinical nursing instructor at the University of Alabama in Huntsville College of Nursing and a practicing board-certified family nurse practitioner at Riverside Family Health in Decatur, Alabama. Dr Patterson is a United States Air Force veteran (E-5) with a passion for teaching students and providing care for patients of all ages, cultures, and ethnicities.

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