Journal of Pediatric Health Care
Volume 23, Issue 6 , Pages A15-A16, November 2009

NAPNAP Position Statement on the Identification and Prevention of Overweight and Obesity in the Pediatric Population

Article Outline

 

The National Association of Pediatric Nurse Practitioners (NAPNAP) is committed to promoting healthy eating and active lifestyles for children and families. The problem of childhood overweight and obesity is epidemic, leading to related physical and psychological co-morbidities, some of which include cardiovascular disease, type II diabetes, insulin resistance, metabolic syndrome, and mental health disorders (Bindler and Bruya, 2006, St. Jeor et al., 2004). In response to unprecedented levels of overweight in the pediatric population, NAPNAP encourages pediatric health care providers to make as high priority: (a) the early identification of infants and children at risk for overweight and (b) provision of age-specific anticipatory guidance on healthy eating and physical activity for parents, families, and caretakers.

Obesity, a multifactorial condition with lifelong physical, social, and economic implications, often has its origins in childhood with the interaction of genetic and environmental factors. The pediatric nurse practitioner (PNP) is in a unique position to identify and intervene to prevent the occurrence and complications of obesity and overweight within the context of family and community (e.g., well-child, child care, and school settings). The evidence for successful interventions once a child is obese is discouraging. The earlier the identification and prevention, the more likely the success in helping families establish healthy eating and activity patterns and preventing long-term adverse consequences of childhood overweight (Bindler and Bruya, 2006, Forrest and Riley, 2004, Halfon and Hochstein, 2002).

Children who are overweight (≥85th percentile body mass index [BMI] for age and sex) at more than one time during their early childhood visits between 2 and 5 years of age were shown to be five times more likely to be overweight at 12 years of age than healthy-weight children during the same period (Nader et al., 2006). Based on these results, prevention is the only effective strategy for reducing the unprecedented levels of childhood overweight (Wofford, 2008).

NAPNAP encourages all pediatric health care providers to partner with parents, families, and communities in the prevention and early identification of overweight, obesity, and obesity-related morbidity across the lifespan as well as to:

1.Focus on early identification of childhood overweight through accurate measurement and documentation of height and weight parameters and BMI beginning at age 2 years and blood pressure beginning at age 3 years (American Academy of Pediatrics [AAP], 2003); Hagan, Shaw, & Duncan, 2008; NAPNAP, 2006).

2.Conduct a thorough history including family history and eating and physical activity patterns (AAP, 2003; Hagan et al., 2008; NAPNAP, 2006).

3.Use culturally sensitive family-focused interventions when working with children who are overweight or obese and focus on health, not weight (NAPNAP, 2006).

4.Increase community awareness about the impact of the psychosocial consequences of overweight with children, families, and the public (NAPNAP, 2006).

5.Implement motivational interviewing (MI) techniques when counseling youth and families on lifestyle changes (Gance-Cleveland, 2007; NAPNAP, 2006; Schwartz et al., 2007).

6.Partner with a variety of related disciplines to support community-based obesity prevention programs aimed at teaching both healthy eating and healthy activity habits.

7.Advocate for school and public policies that support healthy eating and activity education for children, availability of appropriate nutrition and foods, and physical activity and healthy lifestyles (NAPNAP, 2006).

8.Include didactic and clinical practicum experiences related to pediatric overweight and obesity in the educational programs of nurse practitioners who care for children.

9.Continually expand knowledge and skills in overweight/obesity prevention and management.

10.Generate, participate in, and utilize evidence-based practice and research focused on the prevention and management of overweight and obesity in childhood.

Strategies focused on building healthy eating habits and increasing physical activity provide more stable long-term results when compared with strategies focused on limiting negative behaviors related to nutrition and activity (Wofford, 2008). A family focus on increasing awareness of overweight and lifestyle change can improve the health outcomes of the next generation of children. NAPNAP, an organization which promotes optimal health for children, acknowledges the critical role of pediatric health care providers in identifying childhood overweight and in partnering with families to meet this important goal.

The National Association of Pediatric Nurse Practitioners would like to acknowledge the contribution made by the following members in the development of this statement: Karen G. Duderstadt, PhD, RN, CPNP, Work Group Leader; Deborah Anderson, MS, RN, CPNP-PC; Cheri Barber, MSN, CRNP; Diane Evans, RN, CPNP; Bonnie Gance-Cleveland, PhD, PNP, RNC; Lynn Gilbert, PhD, RN, APRN-BC; Elaine Gustafson, MSN, APRN, PNP-BC; Linda Jacobson, CPNP, APRN; Ann Sheehan, MSN, CPNP; Ann S. Taub, CPNP; Dolores C. Jones, EdD, RN, CPNP, CAE (Staff); Heather Keesing, MSN, RN, FNP-BC (Staff).

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References 

  1. American Academy of Pediatrics. (2003, reaffirmed 2007). Prevention of pediatric overweight and obesity. Pediatrics, 112, 424–430. Retrieved April 22, 2009, from http://aappolicy.aappublications.org/cgi/content/full/pediatrics;112/2/424.
  2. Bindler R, Bruya M. Evidence for identifying children at risk for being overweight, cardiovascular disease, and Type 2 diabetes in primary care. Journal of Pediatric Health Care. 2006;20:82–87
  3. Forrest C, Riley A. Childhood origins of adult health: A basis for life-course health policy. Health Affairs. 2004;23:155–164
  4. Gance-Cleveland B. Motivational interviewing: Improving patient education. Journal of Pediatric Health Care. 2007;21:81–88
  5. Hagan JF, Shaw JS, Duncan P. Bright futures: Guidelines for health supervision of infants, children, and adolescents. 3rd ed. Chicago, IL: American Academy of Pediatrics; 2008;
  6. Halfon N, Hochstein M. Life course health development: An integrated framework for developing health, policy, and research. Milbank Quarterly. 2002;80:433–479
  7. Nader PR, O'Brien M, Houts R, Bradley R, Belsky J, Crosnoe R, et al. Identifying risk for obesity in early childhood. Pediatrics. 2006;118:e594–e601
  8. National Association of Pediatric Nurse Practitioners. Identifying and preventing overweight in childhood: Clinical practice guideline. Journal of Pediatric Health Care. 2006;20(Suppl. 2):S1–S63
  9. Schwartz RP, Hamre R, Dietz WH, Wasserman RC, Slora EJ, Myers EF, et al. Office-based motivational interviewing to prevent childhood obesity: A feasibility study. Archives of Pediatric Adolescent Medicine. 2007;161:495–501
  10. St. Jeor ST, Hayman LL, Daniels SR, Gillman MW, Howard G, Law CM, et al. Prevention Conference VII: Obesity, a worldwide epidemic related to heart disease and stroke: Group II: age-dependent risk factors for obesity and comorbidities. Circulation. 2004;110:e471–e475
  11. Wofford L. Systematic review of childhood obesity prevention. Journal of Pediatric Nursing. 2008;23:5–19

 Adopted by the National Association of Pediatric Nurse Practitioners' Executive Board on June 27, 2009.

 All regular position statements from the National Association of Pediatric Nurse Practitioners automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

 Correspondence: NAPNAP National Office, 20 Brace Rd, Suite 200, Cherry Hill, NJ 08034-2633.

PII: S0891-5245(09)00211-9

doi:10.1016/j.pedhc.2009.07.004

Journal of Pediatric Health Care
Volume 23, Issue 6 , Pages A15-A16, November 2009

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