Rates of childhood obesity are increasing steadily, said the Centers for Disease Control and Prevention. In August 2021, approximately 22 percent of children in the United States were obese, a 19 percent increase over the previous year.
Pediatric nurse practitioners (PNPs) aren’t content to let that statistic stand, and those who’ve chosen this career understand why our population needs more of them. Based on December 2020 exam statistics from the Pediatric Certification Nursing Board, approximately 20,000 pediatric nurse practitioners currently practice in the United States, according to Michele Stickel, director of marketing and strategic projects at the National Association of Pediatric Nurse Practitioners.
“The pandemic has magnified the problem of pediatric obesity and its complications,” said Kristen Samaddar, MD and Natalie Lutz, CPNP, in their study published in Contemporary Pediatrics in February 2022. They called the problem “a public health crisis.”
“We have yet to truly understand the long-term effects of quarantine and isolation on a child’s mental and physical health,” they said. “It will be critical to address the physical, mental, and social implications of pediatric obesity.”
Childhood obesity brings with it an increased risk of high blood pressure and high cholesterol, type 2 diabetes, breathing problems such as asthma and sleep apnea, joint problems, fatty liver disease, and more.
The scope of pediatric obesity can feel overwhelming, and treating it requires a long-term, focused, one-on-one approach. That’s just the type of challenge pediatric nurse practitioners relish—one of nine national NP certifications.
The American Association of Nurse Practitioners said most PNPs have 15 years’ experience, and they work in settings such as pediatric offices, hospitals, specialty clinics, school-based health centers, and urgent or convenient care clinics.
In addition to treating obesity in the clinic or other practice settings, nurse practitioners (NPs) can shine in areas of science and research, just as Lutz does, amassing data and analyzing it to determine why childhood obesity continues to increase, and what steps can be taken to curb this unhealthy trend now and later.
“Nurse practitioners have a very holistic philosophy of care,” said AANP President April Kapu, DNP, APRN, ACNP-BC, FAANP, FCCM, and FAAN. “A nurse practitioner makes sure to take time needed to research the elements of the circumstances around a child—knowing it’s important that the family or caregiver is engaged as well as the child.”
That means looking at the big picture and weighing the components of nutrition and the social determinants of health, said Kapu. “For example, does a child live in a safe environment where they can play in a yard, with other kids in the neighborhood? Access to exercise is part of living a healthy lifestyle, and community and environment are part of that too.”
“The pandemic has had a significant negative impact on families most at risk for obesity,” said Samaddar and Lutz.
Kapu said NPs understand that COVID-19 further influenced children to play video games and sit at their computers, instead of being outside. “They know that kids are socially connected to community centers and church and that physical activities are available there.”
Due to COVID, many of those facilities were closed for months for group activities, and children paid the price.
“Nurse practitioners have been innovative and creative during conversations with the child and family to figure out how to make those things possible and make them fun—and how to do them at home,” Kapu said.
“It’s so important to inform parents and families about ways to change the home environment,” said Sharon Fruh, PhD, RN, FNP-BC, FAANP, professor and associate dean for research, evaluation, and development at the University of South Alabama College of Nursing. In her research paper published in the Journal of the American Association of Nurse Practitioners in January 2021, she cited the importance of families helping establish healthy habits and encourage healthy behavior changes.
“Having healthy food offerings available helps children make better choices, and having family meals together helps establish good, healthy habits,” she said.
Asking what children eat daily is one aspect of prevention, Kapu said, but so is assessing the economic climate in the family to ensure access to healthy foods is readily available.
“Kids who may not have been able to go to school didn’t have access to nutritional meals normally served there, and a nurse practitioner will understand the context of that and be able to structure a plan that’s doable,” she said. “They’re very good at knowing what resources are available for kids and families, and those become a part of the plan of care.”
“We have a great deal of training in primary and secondary prevention and wellness, plus we put a strong focus on health promotion,” said Fruh.
It’s not unusual for an NP to spend considerable time evaluating a situation, she said. Plus, NPs may see patients more frequently on an ongoing basis, and because of their unique perspective gleaned from helping such a diverse patient base, NPs are ideally positioned to help patients fend off obesity.
“NPs also know that obesity prevention starts when a mother has a baby, and they can work with them from that point on,” she said.
At NAPNAP, the Childhood Obesity Prevention Special Interest Group (SIG) offers members the opportunity to stay abreast of the latest educational offerings with collaboration and participation in health policy initiatives impacting this increasing health problem.
NAPNAP’s national conference was held in person in March, where members could finally meet face-to-face, and the virtual conference was set for April. They meet at least quarterly online to talk about research or other timely topics, and exchange ideas regularly via email or in a discussion forum. Their SIG is the largest of 18 in NAPNAP.
A trio of SIG members joined us to share more about why childhood obesity is so important to them, and what they’re doing to hold forth against this mounting public health challenge.
“Understanding social influences helps us develop interventions that make sense to our patients,” said Laura Roettger, PhD, CPNP-PC, MSN, assistant professor and director of the pediatric nurse practitioner program at Thomas Jefferson University in Philadelphia. She practices at Complete Care Health Network in Medford, New Jersey. “We also collaborate with multiple professionals within the healthcare system to coordinate that care.”
She said that planning ahead and knowing patients before they come in, along with creative scheduling, can help maximize what can be done during a visit. “Our nursing background helps us focus on the number one priority that should be addressed then, and the patient can come in for a follow-up visit later to address other issues.”
Pediatric nurse practitioners’ training and experience helps them know just how to say what they need to say so it doesn’t sound like a command but invites a positive discussion.
Behavior change for anyone can be a challenging task, but to help a child get on the right path, they should be included in counseling and decision-making, said Lydia Yeager, DNP, MSN, RN, CPNP-PC, AE-C, and director of care management and school-based health at Ryan Health in New York City.
“When talking to parents, don’t ignore the child,” she said. “Utilize motivational interviewing to help the patient to come around to their goals. Ask the child, ‘What are the healthy foods you think you should try in the next two weeks?’ When patients come up with strategies, they’re more likely to succeed.”
In any situation, whether it’s obesity or another lifestyle improvement, telling someone what to do is not going to help them achieve their goals, she said.
And no matter how many “Great job!” accolades are bestowed on a patient, for many, the process is slow going and replete with ups-and-downs. Nurse practitioners are renowned for their tenacity with patients, and they employ evidence-based solutions to help patients stay the course to achieve their goals.
“It can be frustrating, and ‘successes’ aren’t always cut-and-dry successes,” said Marilou Shreve, DNP, APRN, CPNP-PC, MSN, and associate professor at the Eleanor Mann School of Nursing at the University of Arkansas.
In her experience, the process can sometimes take years for families. “If they have passion, a lot of them will succeed again after they fail, and hopefully, each failure will not be as low as the first one,” she said. “But it can be difficult to keep them motivated.”
She likes to remind them that “You didn’t get here overnight and you’re not going to change behavior overnight, so please don’t expect that.”
Shreve has found that the first six months may show good results, but perhaps the second six-month period won’t be as stellar, and that can be disappointing. She also makes this promise during that all-important first visit: “This is the only visit during which I will ever mention your weight.”
Focusing instead on behaviors and activities and monitoring a patient’s lab work shifts the focus away from just “a weight issue,” she said. “Instead, I like to say, ‘This is what you do to be healthy.'”
Even though parents may want to see a daily weigh-in, Yeager seconds the focus on instead talking about healthy eating, regular exercise, and good mental health. “Patients who have the most success don’t own scales,” she said.
She’s also a fan of parents taking children to the supermarket and showing them nutritious food. “Then allow them to pick what they want, come home, and make a healthy snack,” she said.
Innovative approaches like this clearly show that pediatric nurse practitioners’ knowledge, experience, creativity, and persistence are powerful tools in the battle against pediatric obesity. And although this disease may be at epidemic levels, this tireless and talented group of healthcare professionals knows success here is measured in one pediatric patient at a time.