Delegation of Nursing Care in the School Setting

Position Statement for Childhood Obesity

Summary
The current epidemic of childhood overweight and obesity threatens the health of children and adolescents. The role of the school nurse is to identify individual students at risk for overweight and obesity through the screening process and to develop appropriate interventions. Health education theory such as the Health Belief Model and Transtheoretical Model, when applied to the issue of overweight and obesity can have positive outcomes. The school nurse may skillfully employ these theoretical models in health instruction with the student and parent to assist them to achieve positive changes in health behavior.

History
Healthy People 2010, a federal program mandated by the U.S. Department of Health and Human Services, identifies and targets goals to improve the health of Americans. The over all objectives are to increase the life span of Americans and to decrease disparity in the delivery of healthcare. The issue of overweight and obesity is among the top ten issues. The school is a key setting in which to implement positive strategies to reduce the prevalence of overweight and the adverse health consequences that occur.

Description of the Issue
In 2001, the U.S. Surgeon General issued the “Call to Action to Prevent and Decrease Overweight and Obesity”

(http://www.surgeongeneral.gov/topics/obesity/calltoaction/CalltoAction.pdf).

The document served to raise awareness of the increase in numbers of obese Americans, particularly children and youth. “Over the past three decades, the prevalence of childhood obesity (defined in this report as a gender- and age-specific body mass index (BMI) at or above the 95 th percentile on the 2000 CDC BMI charts) has more than doubled for preschool children aged 2-5 years and adolescents aged 12-19 years, and it has more than tripled for children aged 6-11 years”. Koplan, J., Liverman, C. and Kraak, V. editors, p.24. The Centers for Disease Control and Prevention (CDC) maintain statistics relative to the incidence of obesity and the concomitant adverse health effects. It is known that overweight and obesity contribute to the development of coronary artery disease, type 2 diabetes, stroke, sleep apnea, hypertension, hyperlipidemia, asthma, depression, g all bladder disease, and joint disorders. In March of 2005 the New England Journal of Medicine published scientific research predicting a decreased life expectancy for the current generation of children.

The cost of health care for the treatment of obesity related health issues places a financial burden on families as well as the national health care system. It is critical that society must disrupt the trend toward further overweight and obesity and begin to reverse the incidence, thus improving health and longevity.

Rationale
It is the position of the New Jersey State School Nurses Association that the certified school nurse is uniquely placed within the school community to perform an instrumental needs assessment concerning the population of students who may be overweight and thus at risk for obesity. The school nurse is educated to use evidence based theory as it applies to the nursing process for the benefit of school children. Therefore the school nurse in New Jersey should include in her/his practice the following actions:

Screen students for height, weight and BMI-for-age
Use the CDC growth charts to record BMI-for-age
Use a referral form for parents to give to their health care provider
Provide parents verbal and written communication to educate them about BMI
Maintain students’ confidentiality
Counsel parents and students to assist them in planning for optimal health
Provide resources for students, families and staff to promote nutrition and physical activity
Encourage school boards to develop policy relative to school nutrition; to provide only foods of sound nutritional value for school meals and snacks
Educate the PTO and other after school entities to discourage the serving of foods of minimal nutritional value
To discourage marketing of foods of poor nutritional value on school premises
To coordinate the development of the school wellness advisory council, a part of which being a nutrition committee
To provide health education materials to the school community to foster the concept of fitness and good nutrition
To facilitate the NJ Core Curriculum Content in health education and Physical Education
To advocate for research in all areas relating to student health
To influence local, state and federal legislation by becoming politic ally attuned (making recommendations and supporting policy to improve nutrition and physical activity initiatives; for example: increasing availability of well-lighted parts and recreation areas and improving accessibility to fresh fruits and vegetables, particularly to disadvantaged populations)

References
Butler, J.T. (2001). Principles of health education and health promotion(3 rded). UnitedStates: Wadsworth

Koplan, J., Liverman, C. and Kraak, V. editors, Preventing Childhood Obesity: Health in the Balance, Institute of Medicine, National Academies Press, Washington, DC, 2005

Illuzi, S., & Cinelli, B. (2000). A coordinated school health program approach to Adolescent obesity. Journal of School Nursing, 16 (1), 12-17.

Mosca, Nancy. (2004). The School Nurse Role. Making a Difference for Overweight Children. Castle Rock, CO: National Association of School Nurses

National Center for Chronic Disease Preventionand Health Promotion, Centers for Disease Control and Prevention (NCCDPHP, CDC0 (2001). Body mass index-for-age is used differently with children than it is with adults. Available at www.cdc.gov/nccdphp/dnpa/bmi/bmi-for age.htm

National Center for Health Statistics, Centers for Disease Control and Prevention (NCHS, CDC) (2001). Prevalence of overweight among children and adolescents: United States, 1999. Hyattsville, MD: Author.

New Jersey Department of Education (2004). New Jersey core curriculum content standards for comprehensive health and physical education. Retrieved September 20, 2005 from http://www.nj.gov/njded/aps/cccs/chpe

Olshansky, S. et al. A Potential Decline in Life Expectancy in the United States in the 21 st Century. The New England Journal of Medicine, March 17, 2005, 1138-1145

Preston, S. Deadweight – The Influence of Obesity on Longevity. The New England Journal of Medicine, March 17, 2005, 1135-1137.

Stokols, D. (1996). Translating social ecological theory into guidelines for community health promotion. American Journal of Health Promotion, 10 (4), 282-298.

Taras, H. (2005, August). Nutrition and student performance at school, Journal of School Health, 75 (6), 199-213.

Taras, H. (2005, August). Physical activity and student performance at school. Journal of School Health, 75 (6), 214-218.

Troiano, R. P., & Flegal, K.M. (1998). Overweight children and adolescents: Description, epidemiology and demographics. Pediatrics, 101, 497-504.

United States Department of Health and Human Services (USDHHS) (2000). Healthy People 2010. 2 nd ed. 2 vols. Washington, D.C.: U.S. Government Printing Office.