The following article is a part of conference coverage from the 2021 American Association of Nurse Practitioners National Conference (AANP 2021), held virtually from June 15 to June 20, 2021. The team at the Clinical Advisor will be reporting on the latest news and research conducted by leading NPs. Check back for more from AANP 2021.
Obesity in children has reached epidemic proportions in the United States because of unhealthy changes in diet and a decrease in exercise. Although the rise in pediatric obesity predates the COVID-19 pandemic, the stressors experienced during the pandemic pulled back the metaphorical curtain to expose inequities in children’s health, said Nancy Tkacz Browne, MS, PPCNP-BC, CBN, FAANP, FAAN, at the 2021 American Association of Nurse Practitioners National Conference (AANP 2021).
“Evidence-based paradigms to treat obesity in children that can be easily implemented by nurse practitioners [NPs] are essential to stop the plethora of obesity-related illnesses in children such as hypertension, type 2 diabetes, and steatohepatitis,” commented AANP 2021 attendee Mary Koslap-Petraco, DNP, PPCNP-BC, CPNP, FAANP, clinical assistant professor at Stony Brook University School of Nursing, Stony Brook, New York.
A number of presentations on the management of childhood obesity were presented at AANP 2021. Two presentations are highlighted here.
The Disease of Childhood Obesity
Barriers to care and social determinants of health can limit treatment options for children with obesity, according to research presented by Sharon Karp, PhD, APRN, CPNP-PC, and Browne.1 Factors that affect weight — such as diet, play/activity time, sleep schedule, and chronic stress — are also directly related to a child’s socioeconomic status.
Since every family has a unique circumstance and capacity for making changes to a child’s nutrition, activity level, sleep, medication, or behavior, it is important to take the approach of meeting families where they are at, the authors said in an interview.
“When you have chronic, unremitting stress and stressors like racism and social determinants of health, which include poverty, food insecurity, or health insecurity, families are undergoing tremendous stresses in different ways. That is not only a psychological stress but also a physiologic stress, and it impairs the system that regulates our energy,” Browne said.
Taking care of the family, not simply the child, is a core value of pediatric care, the researchers said. In the context of childhood obesity, health care providers rely on caregivers and family members to play a large role in helping manage the child’s disease. The authors urged providers to be realistic and flexible, not prescriptive or paternalistic, when working with families to treat pediatric obesity since each family environment is different.
“I tell families that ‘I can talk to you about healthy lifestyle changes until I’m blue in the face, but none of them will work unless they meet your family’s lifestyle and work with what you have,’” Dr Karp said. She explained that part of the role of the provider is to find creative ways to make lifestyle changes that are suitable for each family.
Effects of COVID-19 on Obesity Risk
The COVID-19 pandemic “has shaken us and our institutions — our schools, our families, our homes, our work,” Browne said. “We add that on to what was already there, and I think that one of the only good things that has come out of it is perhaps the pandemic started helping us face some of these challenges like food insecurity and racism.”
Though socioeconomic inequities present challenges for pediatric obesity care, the authors agreed that providers do have an advantage when working with family members during the weight management process. “Nobody loves that child more than that family — you have a captive audience,” Browne said. “Some parents struggle with parenting, but all parents love their children.”
The authors proposed a step-wise approach to obesity care with 3 main goals: to address obesity-related complications, reduce chronic stress, and reduce adiposity. There are 4 stages in the method: guidance, lifestyle therapy, pharmacotherapy, and metabolic and bariatric surgery. Throughout stages 1 through 4, the authors recommend assessment and adjustment in response to the patient’s disease.
Table. Stepwise Approach to Obesity Treatment1
|Stage 1||• Guidance||Primary care|
|Stage 2||• Intensive lifestyle therapy||Primary care|
|Stages 3-4||• Pharmacotherapy |
• Device therapy
• Bariatric surgery
|Specialty obesity care|
Factors in stages 1 and 2 are not limited to diet and activity. Weight-based victimization, laboratory tests, obesity-related complications, behavioral and environmental influences, chronic stress, genetics, and sleep are among the many factors that may influence the disease for which the authors recommend providing guidance (stage 1) or intervening (stage 2).
Primary care providers are well-suited to care for patients in stage 2, according to the authors. In stage 2, the authors recommend increased frequency of patient interaction, coordination with the health care team throughout the spectrum of intervention to ensure consistent guidance and prioritization of interventions based on individual patient needs.
The next step in disease management is pharmacotherapy followed by device therapy in stages 3 and 4. Metabolic and bariatric surgery (MBS) is the next step in stages 3 and 4, followed by post-MBS pharmacology and intervention in stages 2, 3, and 4.
“It’s a team game,” Brown said. “These children are sick. They have psychosocial and physiologic diseases as young as 2 years old and they need treatment. They won’t outgrow it, and they should not wait until they are 18 to seek treatment.”
Health Belief Model: Let’s Go
The Let’s Go 5210 diet and exercise program for childhood obesity led to a significant decrease in weight and BMI over a 6-week study by Korlu Wolobah-Kuyon, DNP, CRNP, and Ruth Milstein, DNP, PMHNP-BC, of Brandman University in Irvine California.2
The investigators looked specifically at whether a program of diet and daily walking could reduce total body weight in children. They recruited 42 preteens and adolescents aged 12 to 18 years with a BMI above the 95th percentile. The baseline mean BMI was 33.16 (range 27.9 to 46.2) and weight was 169.7 lb (range 138 to 210 lb).
Mean weight after 6 weeks of the program decreased to 157.8 lb. The majority of participants dropped from overweight to normal weight and the average BMI was 30.86. Overall, the intervention led to an 11.96 lb decrease in weight and a 2.3 drop in BMI.
The program sessions were conducted virtually to comply with social distancing measures, which may have limited the study findings and adherence to the program, the study researchers noted. Also, the COVID-19 pandemic may have been a barrier to exercise and led to greater snacking.
“This model includes the critical elements of diet, exercise, and the all-important follow-up and is easy to implement. The most important element of the model is that it is and was successful and sustainable,” commented Dr Koslap-Petraco.
Visit Clinical Advisor’s meetings section for complete coverage of AANP 2021. All conference sessions are available to registered attendees through August 31, 2021.
1. Karp S, Browne NT. Childhood obesity update: opportunities for NP Impact in Primary Care. Oral presentation at: 2021 American Association of Nurse Practitioners National Conference; June 15-June 20, 2021.
2. Wolobah-Kuyon K, Milstein R. Diet and exercise: its effects on obesity in children. Poster presented at: 2021 American Association of Nurse Practitioners National Conference; June 15-June 20, 2021. Poster 54.