Assessing the Knowledge of Nurse Practitioners about ...
Assessing the Knowledge ofAssessing the Knowledge of
Nurse Practitioners aboutNurse Practitioners about
Childhood ObesityChildhood Obesity
David Summerfield, BSN, CNOR, RNFADavid Summerfield, BSN, CNOR, RNFA
A Project Submitted to the
University of North Carolina Wilmington in Partial Fulfillment
Of the Requirements for the Degree of
Masters of Science in Nursing
Prevalence of overweight children hasPrevalence of overweight children has
increased to almost 19 % in the U.S. andincreased to almost 19 % in the U.S. and
30% in NC30% in NC (1)(1)
The health consequences related toThe health consequences related to
childhood obesity are numerouschildhood obesity are numerous (2,3,4)(2,3,4)
400,000 deaths a year are the result of400,000 deaths a year are the result of
diseases linked to poor diet and lowdiseases linked to poor diet and low
activity levelsactivity levels (5)(5)
Overweight adolescents have a 70 percent chance of
becoming overweight or obese adults. (6)
Obesity is costlyObesity is costly
$2.1 billion a year in NC$2.1 billion a year in NC
Over $117 billion a year in the U.SOver $117 billion a year in the U.S (7)(7)
How can NPs decrease morbidityHow can NPs decrease morbidity
associated with childhood obesity?associated with childhood obesity?
Examine the knowledge NPs have
about childhood obesity.
Determine if NPs are following the
AAP recommendations when
evaluating overweight or obese
Prevention of Pediatric OverweightPrevention of Pediatric Overweight
and Obesity , 2003, Americanand Obesity , 2003, American
Academy of PediatricsAcademy of Pediatrics (8)(8)
Proposes strategies for earlyProposes strategies for early
identification of excessive weight gainidentification of excessive weight gain
by using body mass index, for dietaryby using body mass index, for dietary
and physical activity interventions, andand physical activity interventions, and
for advocacy and research.for advocacy and research.
Calculate and plot BMI once a year on all
children and adolescents.
Use change in BMI to identify rate of
excessive weight gain relative to linear
Encourage parents and caregivers to
promote healthy eating patterns.
Routinely promote physical activity.
Recommend limitation of television and
video time to a maximum of 2 hours per
Body Mass Index
Is derived from commonly available data—weight
The ratio of weight in kilograms to the square of
height in meters.
Correlates well with more accurate measures of
At risk of overweight = BMI between 85th and 95th
percentile for age
Overweight/Obese = BMI => 95th percentile for age
Larsen, L., Mandleco, B., Williams, M.,
& Tiedeman, M. (2006). Childhood
obesity: Prevention practices of nurse
practitioners. Journal of the American
Academy of Nurse Practitioners, 18,
Barlow, S., Dietz, W., Klish, W., &
Trowbridge, F. (2002). Medical
evaluation of overweight children and
adolescents: Reports from
Pediatricians, pediatric nurse
practitioners, and registered dietitians.
Pediatrics, 110, 222-228. (10)
Materials and MethodsMaterials and Methods
A cross-sectional survey of NPs in the U.S.A cross-sectional survey of NPs in the U.S.
was used.was used.
Approval from the UNCW InstitutionalApproval from the UNCW Institutional
Review Board (IRB) was obtained.Review Board (IRB) was obtained.
Survey was posted on the internet.Survey was posted on the internet.
The survey was a 25 item self-administeredThe survey was a 25 item self-administered
Inclusion criteriaInclusion criteria
SPSS softwareSPSS software
47 surveys completed, 45 were included47 surveys completed, 45 were included
4 male and 41 female respondents4 male and 41 female respondents
Median age was 45.6 years (range = 24 toMedian age was 45.6 years (range = 24 to
Median length of practice was 8.7 yearsMedian length of practice was 8.7 years
(range 1 to 35)(range 1 to 35)
Family practice (22), Pediatric practice (12)Family practice (22), Pediatric practice (12)
and other types of practices (11)and other types of practices (11)
admitted toadmitted to
being awarebeing aware
of the AAPof the AAP
Aware of Guidelines
Not Aware of the Guidelines
51% report51% report
adhering toadhering to
the guidelinesthe guidelines
either often oreither often or
alwaysalways Adherent to guidelines
Not adherent to guidelines
78% use78% use
BMI toBMI to
or obeseor obese
Weight for Height
A one-way AVOVAA one-way AVOVA
reveals a trendreveals a trend
toward differencestoward differences
between NPs inbetween NPs in
family and pediatricfamily and pediatric
practices andpractices and
adherence toadherence to
8, p<.07)8, p<.07)
NPs in a
NPs in a
NPs in all
Adhere Do not adhere
patterns Encourages Healthy Eating
Does not encourage
activity and limiting
TV/ Video time
Do not recommend
93% are comfortable talking with family/pt
Only 42% felt their recommendations were
60% list the family as the biggest barrier.
Other barriers: low activity levels, expensive
food, lifestyle, fast food, and TV/video time
The NPs in this sample need toThe NPs in this sample need to
become more familiar with the AAPbecome more familiar with the AAP
Because NPs are not following theBecause NPs are not following the
recommendations children may not berecommendations children may not be
getting properly evaluated.getting properly evaluated.
The barriers to proper evaluation mustThe barriers to proper evaluation must
be overcome.be overcome.
There needs to be local, state, andThere needs to be local, state, and
national level CMEs to help educatenational level CMEs to help educate
NPs on how to evaluate the pediatricNPs on how to evaluate the pediatric
population for overweight and obesity.population for overweight and obesity.
Utilize cost effective programsUtilize cost effective programs
Use an algorithm.Use an algorithm.
Future ResearchFuture Research
Studying the best way to implementStudying the best way to implement
the guidelines to improve compliancethe guidelines to improve compliance
Determine why NPs in family practiceDetermine why NPs in family practice
do not follow the guidelines as well asdo not follow the guidelines as well as
NPs in a pediatric practiceNPs in a pediatric practice
Determining what the barriers toDetermining what the barriers to
implementing the guidelines are andimplementing the guidelines are and
how can we overcome themhow can we overcome them
1.1. Obesity and Overweight: Childhood Overweight.Obesity and Overweight: Childhood Overweight. (May 22,(May 22,
2007). Retrieved May 29, 2007, from2007). Retrieved May 29, 2007, from
2.2. Harbaugh, B. I., Jordan-Welch, B., Bounds, W., & Blom, L.Harbaugh, B. I., Jordan-Welch, B., Bounds, W., & Blom, L.
(2007).(2007). Nurses and Families Rising to the Challenge ofNurses and Families Rising to the Challenge of
Overweight Children.Overweight Children. The Nurse Practitioner, 32The Nurse Practitioner, 32(3), 31-35.(3), 31-35.
3.3. Ribeiro, J., Guerra, S., Oliveira, J., Anderson, L., Duarte, JRibeiro, J., Guerra, S., Oliveira, J., Anderson, L., Duarte, J
& Mota, J. (2004). Body fatness and clustering of& Mota, J. (2004). Body fatness and clustering of
cardiovascular disease risk factor in Portuguese childrencardiovascular disease risk factor in Portuguese children
and adolescents.and adolescents. American Journal of Human BiologyAmerican Journal of Human Biology,, 16,16,
4. Poussa, M., Schlenzka, D., & Yrjonen, T. (2003). Body mass index
and slipped capital femoral Epiphysis. British Journal of
Pediatric Orthopedics, 12, 369- 371.
5. CDC, MMWR, 2004
6. Torgan, C. (2002). Childhood obesity on the rise. The NIH Word
on Health. Downloaded from:
htm Accessed: April 15, 2008.
8. AAP policy statement (2003). Prevention of Pediatric Overweight
and Obesity. Accessed from
s;112/2/424 on April 12, 2007
9. Larsen, L., Mandleco, B., Williams, M., & Tiedeman, M. (2006).
Childhood obesity: Prevention practices of nurse practitioners.
Journal of the American Academy of Nurse Practitioners, 18, 70-
10. Barlow, S., Dietz, W., Klish, W., & Trowbridge, F. (2002). Medical
evaluation of overweight children and adolescents: Reports from
Pediatricians, pediatric nurse practitioners, and registered
dietitians. Pediatrics, 110, 222-228.
11. H.E.A.T. program, NAPNAP.
12.12. Algorithm for screening procedureAlgorithm for screening procedure