Role of Nutrition Education in Prevention of Childhood Obesity in Low-Income Families

Childhood obesity has steadily become a problem in the United States. Data from the Center for Disease Control and Prevention (CDC) show an increase of prevalence of obesity in children and adolescents. In addition, a decrease in level of education shows an increase of prevalence of obesity. A study by Rogers et al. (2015), stated childhood obesity is associated with obesity in adulthood and will have a higher rates of obesity risk factors, such as hyperlipidemia, or diabetes. In addition, the author states that race is not a significant correlation with obesity when income is taken into account. The purpose of this paper is to investigate the influence of nutrition education in preventing childhood obesity in low-income families.

Disease Overview

Obesity or overweight is defined as a weight above what is considered as healthy. It is often measured by the Body Mass Index (BMI). For a child to be categorized as overweight, he or she must have a BMI greater than or equal to the 85th percentile but less than 95th percentile. In addition, for a child to be considered as obese, he or she, must have a BMI greater than or equal to 95th percentile (Rogers et al., 2015). Over the years there has ben a steady increase of overweight/obesity in the United States. The prevalence of obesity from 2009-2010 was 18.4% for the ages 12 to 19 years old and from 2014-2016 there was an increased from 9.3% to 13.7% among child age two to five years old (Deavenport-Saman et al., 2019; Rogers et al., 2015).

Childhood obesity is greatly affected by socioeconomic status (SES). The SES is comprised of factors such as education, and income. According to Rodgers et al., 2015, an increase of 23-33% obesity prevalence from families with low SES, in 2003-2007. Challenges of families with low SES have are due to having low education level, low-income and communities they live in. If the parent has a lower level of education, they will be less aware of the impact of physical activity and healthy eating when providing a healthier lifestyle and model healthy behaviors for their children at home and realize that their child is overweight (Gibson et al., 2016; Rogers et al., 2015). Furthermore, Low-income families tend to live in low-income communities, where they have a reduce access to supermarkets and places to exercise (i.e. parks). Plus, they may have numerous access to convenience store and fast food chain, which promotes poor nutrition and little or no physical activity (Rogers et al., 2015).

Data suggest that obesity in childhood is associated with a high likelihood of obesity in adulthood, about 70% chance a child to remain overweight or obese as an adult. Furthermore, if the child continues to remain to be overweight/obese they are at a higher chance of acquiring one or more of these medical conditions: hypertension, diabetes, hyperlipidemia and higher incidence of stroke, myocardial infarction, which is why it is important to address this health disparity to prevent children in acquiring these medical conditions that may affect their quality of life in adulthood (Rogers et al., 2015).

CARS Article 1

The article by Rogers et al. (2015) was published on December 2015 in the Childhood Obesity journal, a peer-reviewed health journal focused on real-world obesity prevention. There are twelve authors responsible for the information presented in this article; eight authors are affiliated with the University of Michigan Health system; three authors are associated with Massachusetts Department of Public health and one author is affiliated with the University of Michigan School of Nursing. The article provided contact information for Kim A. Eagle MD, to address any correspondence regarding the article. There are 42 supporting articles listed in the reference list, which 39 of the resource does not meet the five-year mark and that makes it ineligible to be recognized as a credible source. This article explores the connection on how low-income status and race/ethnicity affects childhood obesity. Furthermore, the study is based on 2009 summarized data from 68 Massachusetts school district.

CARS Article Two

The article was published on February 2018 in the Maternal and Child Health Journal, a peer-reviewed medical journal covering maternal and child health. There are six authors responsible for the information presented in the article. Five of the authors is affiliated with Teachers College, Columbia University. One is affiliated with the Department of Community and Family Heath, College of Public Health, University of South Florida. All the authors hold a high educational degree (PhD, MS, or MA) and four of them specialized in nutrition. The article provided contact information for all the authors in email form. In addition, the article provided a disclosure that the authors had no conflict of interest in this work. There are 45 supporting articles listed on the reference list, which 42 of the resource does not meet the five-year mark and that makes it ineligible to be recognized as a credible source. The article explores the challenges and facilitators in promoting a healthy environment at home. In addition, the study conducted focused group interviews involving 16 low-income parents of elementary school children.

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CARS Article 3

The article is based on a community-academic partnership which covers childhood obesity in low-incomed families. The article is published in the American Journal of Public Healthy on April 2019 issue. The authors Deavenport-Saman, Piridzhanyan, Solomon and Yi are affiliated with the Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Phillips is with the office of Women’s health, Los Angeles County of Department of Public Health and Tony Kuo is with the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health. The contact information for the authors is not provided in the article but they are available respectively at the organization they are affiliated with. A disclaimer was provided that the authors had no conflict of interest in this study. Furthermore, the Institutional review board approval was obtained from Children’s Hospital Los Angeles. There are seven supporting articles listed in the reference list. Two of the resources does not meet the five-year mark that makes it ineligible to be recognized as credible source.

Nursing Level Intervention

According to a study by Fisher et al. (2019), influencing childhood behaviors of developing healthy eating habits is critical. Accordingly, it is crucial to provide education to both the patient and family member, especially to parents of young children, is a key aspect of preventing childhood obesity. The nurse plays an important role when it comes to giving education and providing the right tools to patients’ and their parent’s in order to be successful. Before the nurse take the next step providing education, the nurse needs to assess the barriers that may hinder promoting a healthy food environment such as their socioeconomic status, race, and health literacy (Rogers et al. 2015). Furthermore, according to Luesse et al. (2018), assessing the parent and the child’s, perception about healthy habits or home-food environment is important to be promote healthy eating habits.

According to study by Luesse et al. (2018), parents are aware of the significance in displaying good behavior to form good habits in their children, especially regarding their eating habits, by increasing vegetable consumption. However, parents may face the challenge of having a child who dislike vegetables, which makes food preparation frustrating and exhausting with time and financial burden. Although, a study by Fisher et al. (2019, p3-9), provided insight in giving education about solid fats and added sugars and labeling high empty caloric foods (candy, chips, etc.) as “WHOA” food and low empty caloric foods (water, fruits, vegetable, etc.) as “GO” foods to parents, which help decrease their child’s intake of high empty caloric food by 91kcal/day which has not been statistically significant but it is “clinically significant within the context of obesity prevention.” In addition, adding the authoritative food parenting to promote structure in eating habits, such as setting limits, establishing eating routines and providing children with guided choice, has been successful in reinforcing good behavior and eating habits. Respectively, nurses play an important role in providing information on how to reduce the risk of childhood obesity by providing example of food to increase (vegetables, fruits, whole grains etc.) and food to decrease (candy, chips, soda etc.).

Organization Level Intervention

Interventions tailored for children coming from low-income family at an organizational level, requires program to reduce food insecurities, improve nutrition and physical activity. In a study by Hoelscher et al. (2015), examined multiple level of interventions of preventing childhood obesity, which includes community organizations, family and environment. At the organization level Hoelscher et al. (2015) examined early care and education centers and schools and their impact in preventing obesity. Coordinated Approach to Child Health (CATCH) is one of the programs available in Texas, which includes child nutrition services, physical education, classroom curricula, and family outreach, and has proven to be appropriate for low-income families and is effective in preventing obesity (p.76). Another organization level intervention that has been used in school is U.S. Department of Agriculture (USDA) ChooseMyPlate dietary guideline, help promote and teach children and parents on eating a balanced meal, which has been effective in providing information about the food groups and their nutrient content. Both organizations have spread awareness when it comes nutrition education.

Policy Level Intervention

According to Gunderson (2019, p91), food assistive program such as Supplemental Nutrition Assistance Program (SNAP or food stamp), the National School Lunch Program and the School Breakfast Program has been successful in “reducing food insecurity among low-income children.” These programs may have been successful in decreasing food insecurity among low-income families, but these programs are not designed to reduce childhood obesity. The SNAP program was established in 1964 as the Food Stamp Act to aid individuals and families who are low- to no-income and to be eligible at the federal level, the “household must have a net income below the poverty line” and “household assets must add up to less than $2000” some sources such as a house is not taken into account (Gundersen 2015, p94). There has been a slight increase on the countable assets to $2250 and $3500 based on if a family member is age 60 or older or is disabled (USDA 2019). Gunderson (2019) explores the idea of restricting SNAP purchases and concludes it may have negative consequence instead of reducing the consumption of unhealthy foods. Even though SNAP program is not effective in providing resources and information regarding informed decision when it comes to food, programs such as Early Care and Education (ECE) policy has been successful in preventing or childhood obesity (Hoelscher et al. 2015)

Summary

Overall, providing nutrition education to parent is important when it comes to preventing childhood obesity. It is done by making parents aware of food choices and help establishing good eating habits for their children. Decreasing obesity outcome is lower if improper and untailored nutrition education is provided, since children and parents from low-income does not have enough time resources to provide an adequate and balanced meal. While appropriate education to children and parents from low-income household produce desirable outcomes. A nurse can provide education related to nutrition and parental guidelines to support and promote good eating behaviors. In addition, a nurse can provide resources such as MyPlate to increase food knowledge of both the child and parents. A nurse can also connect patient and family members to vital resources such as dietician/nutritionist, who can help increase patient knowledge in health and nutrition and help identify other barriers that may be preventing children in receiving acceptable assistance.

References

1. CDC. (2019) Childhood obesity facts. Retrieved from https://www.cdc.gov/obesity/data/ childhood.html.
2. Deavenport-Saman, A., Piridzhanyan, A., Solomon, O., Phillips, Z., Kuo, T., & Yin, L. (2019). Early childhood obesity among underserved families: A multilevel community–academic partnership. American Journal of Public Health, 109(4), 593–596. https://doi-org.tacomacc.idm.oclc.org/10.2105/AJPH.2018.304906
3. Fisher, J. O., Serrano, E. L., Foster, G. D., Hart, C. N., Davey, A., Bruton, Y. P., . . . Polonsky, H. M. (2019). Title: Efficacy of a food parenting intervention for mothers with low income to reduce preschooler’s solid fat and added sugar intakes: A randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity, 16 doi:http://dx.doi.org.tacomacc.idm.oclc.org/10.1186/s12966-018-0764-3
4. Gibson, L., Allen, K., Byrne, S., Clark, K., Blair, E., Davis, E., & Zubrick, S. (2016). Childhood overweight and obesity: maternal and family factors. Journal of Child & Family Studies, 25(11), 3236–3246. https://doi-org.tacomacc.idm.oclc.org/10.1007/s10826-016-0485-7
5. Gundersen, C. (2015). Food Assistance Programs and Child Health. Future of Children, 25(1), 91–109. Retrieved from http://search.ebscohost.com.tacomacc.idm.oclc.org/ login.aspx?direct=true&AuthType=ip,uid&db=c8h&AN=107785909&site=ehost-live
6. Luesse, H. B., Paul, R., Gray, H. L., Koch, P., Contento, I., & Marsick, V. (2018). Challenges and facilitators to promoting a healthy food environment and communicating effectively with parents to improve food behaviors of school children. Maternal & Child Health Journal, 22(7), 958–967. https://doi-org.tacomacc.idm.oclc.org/10.1007/s10995-018-2472-7
7. Rogers, R., Eagle, T. F., Sheetz, A., Woodward, A., Leibowitz, R., Song, M., … Eagle, K. A. (2015). The relationship between childhood obesity, low socioeconomic status, and race/ethnicity: Lessons from Massachusetts. Childhood obesity, 11(6), 691–695. doi:10.1089/chi.2015.0029
8. U.S. Department of Agriculture. Start simple with MyPlate. Retrieved from https://www.choosemyplate.gov/eathealthy/start-simple-myplate
9. USDA (2018). A short history of SNAP. Retrieved from https://www.fns.usda.gov/snap/short-history-snap.
10. USDA (2019). SNAP eligibility. Retrieved from https://www.fns.usda.gov/snap/recipient/eligibility