SCHOOL NURSING INTERVENTIONS TO PREVENT CHILDHOOD OBESITY: Integrative Literature Review

SCHOOL NURSING INTERVENTIONS TO PREVENT CHILDHOOD OBESITY: Integrative Literature Review Sara Hewitt Faculty Sponsor: Elizabeth P. Anderson RN, PhD Background: Childhood obesity is a serious public health crisis. Obese children are more likely to become obese adults, and are at a higher risk for developing heart disease, type 2 diabetes, and cancer. To date, schools have been the primary target setting to implement obesity prevention programs. While there has been considerable research on these school-based obesity prevention programs, most overlook the school nurse as a potential resource. School nurses can lead BMI screening programs, nutrition and physical education lessons, and provide counseling. Objective: To examine the different potential evidence-based nurse-led intervention to prevent obesity in school children and determine which are shown to have optimal concrete objective outcome with BMI measurements. Method: An integrative literature review was conducted using the framework from Whittemore and Knafl (2005). The search of the literature was conducted on a computer using the databases CINAHL, PubMed, PsycInfo. publication dates within the last ten years (2008-2018). Six studies that all used BMI as a tool to measure program effectiveness were analyzed to evaluate the programs and the state of the literature. Results: A total of six evidence-based nurse led interventional children obesity school based program studies were reviewed and analyzed. All studies objectively measured as outcomes BMI before and after implementation for evaluation of effectiveness. Two themes emerged. The first theme involved 4 studies that had a Group Session Programs with Significant Decrease in BMI. The most successful study, demonstrated a significant drop in mean BMI percentile scores of 2.3 points, from 76.1 to 73.8 (p \u3c .01). This was a 12-week after-school intervention program consisting of weekly fitness exercise and nutrition education by dietitian and nurse, complimented by journal writing and tracking with apedometer. The next most significant study, had significantly greater decreases in BMI ( p\u3c .01) in students in the professional-facilitated intervention, which incorporated physical education, motivational interviewing, general health education lessons over 2 years. The third most significant study, was conducted over 2 years with initial screening followed by adaptive care management (small group sessions outside school, health education program) involving only obese students. Finding: screening program was a success, when compared to the control group there was a significantly lower increase in BMI (+0.6 vs +0.7 kg/m2; p = 0.030) and a greater decrease in the prevalence of overweight and obesity (−0.6% vs −2.3%, p = 0.039). The fourth most significant study, showed a significant decrease in BMI in females (p = 0.047), physical activity plus nutritional health education with family after school but the BMI decrease was not significant in males (p=0.150). The second theme involved 2 studies that were school nurse led Nongroup Session Programs that Did Not Have a Significant Decrease in BMI. Both studies utilized counseling or motivational interviewing as the major (or sole) component of the intervention, and utilized one-on-one sessions as opposed to groups. Conclusion: Major limitations: lack of theoretical/conceptual model and representativeness for generalizability. Future research recommendations: 1) for the theoretical/conceptual model Etiology of Childhood Obesity (Lytle, 2009) for prevention and treatment to guide evidence-based nursing practice. 2) maintain BMI measurements. 3) inclusion of more diverse school age populations in the school district areas, ethnicities, socio-economic status, ages, and weight/BMIs. 4) school nurse and dietician in the implementation of multi-faceted obesity prevention such as weekly treatment/prevention programs that have physical education with nutritional educational components in a school group setting. 5) journal writing and technology with online physical activity monitoring with pedometer to further motivate students. Key Words: “childhood obesity” “pediatric obesity” “obesity” “adolescent, nursing” “nurse” “school nurse” “school” “BMI” “Body Mass Index””screening” “prevention” “health” “promotion” “ education