Prevention of Childhood Obesity 1

Transcription

1 Prevention of Childhood Obesity 1 Running head: PREVENTION OF CHILDHOOD OBESITY Prospectus: Prevention of Childhood Obesity Through Education and Research Kim Bookout Julie Dreadin William Lodrigues Texas Woman s University

2 Prevention of Childhood Obesity 2 Abstract Childhood obesity is in epidemic proportions in the United States (U.S.) (Nemet et al., 2005; WHO, 2000). Many factors are associated with the rise in childhood obesity such as increased sedentary behaviors (e.g., time spent watching television and playing handheld video games) and decreased time for physical education programs in school. Additionally, families have become less engaged in fitness activities thereby contributing further to overweight and obesity. The aim of this educational project is to address both nutritional and physical fitness components as they relate to the prevention of obesity in childhood. Inclusion of the entire family unit is integral to the success of the program. The methodology utilized for this project is based on recommendations provided by the Texas Pediatric Society in conjunction with Texas Department of State Health Services in Pediatric Obesity: A Clinical Toolkit for Healthcare Providers (2005). This comprehensive 24-week program includes education related to nutrition, lifestyle modification, behavioral modification, increased physical activity, and nutrition/family counseling. Children (ages 4 to 18) and their families will be voluntarily enrolled in the program and followed for a two year period. Outcomes of this program will be based on physical and cognitive evaluation.

3 Prevention of Childhood Obesity 3 Problem Statement Childhood obesity is in epidemic proportions in the United States (U.S.) and worldwide. And, while recognized as a growing problem, there is no unified strategy for its prevention or treatment. Many factors are associated with the rise in childhood obesity such as increased sedentary behaviors (e.g., time spent watching television and playing handheld video games) and decreased time for physical education programs in school. Other potential factors impacting the increase in childhood obesity include the growing demands placed on families related to both parents working outside the home, decreased after school supervision, and the reliance on processed foods. It is recognized that sedentary behaviors lead to increased body mass index (BMI). And, just as obesity affects children, it affects adults as well. Families are less engaged in fitness activities for a variety of reasons. In addition to the aforementioned barriers, other potential reasons for decreased physical activity include: busy schedules, lack of motivation and an overall lack of knowledge related to health and fitness. However, children are solely reliant on their families for the purchase and preparation of food as well as determination of schedules and priorities for the family. Therefore, childhood obesity becomes a familial problem.

4 Prevention of Childhood Obesity 4 Prevalence Childhood obesity has reached epidemic proportions in recent years. It is considered the most common chronic disease in pediatrics in our present-day society (Nemet et al., 2005). Rice, Thombs, Leach and Rehm (2008) report prevalence of obesity in U.S. children ages seven to 17 years as much as 16% while another 15% are considered overweight. Prevalence has increased two-fold in the past two decades. Causality of childhood obesity is multi-factorial and includes reasons such as lower socioeconomic status, genetics, parental eating patterns, decreased physical activity, and consumption of nutritionally poor foods (Hodges, 2003; Eliakim, Nemet, Balakirski, & Epstein, 2007; Rice et al., 2008). Aims and Objectives The aim of this project is to address both nutritional and physical fitness components as they relate to the prevention of obesity in childhood. Inclusion of the entire family unit is integral to the success of the program. Specific objectives focus on education and research. Educational Objectives Participants in this program will increase knowledge related to nutrition, exercise, and chronic disease prevention.

5 Prevention of Childhood Obesity 5 Educational knowledge will be measured through pre- and posttests prior to classes for both children and adults. Physical Objectives Participants will demonstrate improvement in overall nutritional and fitness status. Measurements of weight, height, BMI, waist circumference, glucose, lipid profile, liver function and physical features (i.e., acanthosis) will be carried out at baseline and intervals over the 2-year study period. Additional Benefits The long-term effects of obesity are well understood as children progress in to adolescence and adulthood. In fact, obesity in adults is well correlated with risk of development of hypercholesterolemia, hyperlipidemia, hypertension, atherosclerosis and cardiovascular disease, and type 2 diabetes (Ball, Marshall, & McCargar, 2003). Thus, implementation of early fitness and nutrition programs may have long-lasting benefits to overall health and wellness of children as well as adults. Methods The methodology utilized for this project is based on recommendations provided by the Texas Pediatric Society in conjunction with Texas Department of State Health Services in Pediatric Obesity: A Clinical Toolkit for Healthcare Providers

6 Prevention of Childhood Obesity 6 (2005). The toolkit provides information integral to the implementation of a successful obesity prevention and management program. Items included are for both patient and provider. Provider tools are inclusive of evaluation forms, BMI charts, billing information, resource lists and a weight management algorithm. Patient tools are available in both English and Spanish and include handouts related to nutrition guidelines, sample meal plans, lifestyle guidelines, behavior guidelines and healthy lifestyle prescriptions. It is recognized that multiple programs for prevention and treatment of childhood obesity are demonstrating successful outcomes (Rice et al., 2008; Summerbell et al., 2005). Small, Anderson, and Melnyk (2007) identified a younger group (ages four to seven years) than is often described in the literature. The authors reviewed 12 randomized clinical trials that were specific to overweight and obese children ages four to seven years and were conducted internationally. One-half of the studies were focused on treatment and one-half focused on prevention. Sample sizes within the six treatment studies as well as the six prevention studies were small (n=30 to 65) and therefore statistical analyses were not conducted. The authors concluded that findings within the review were similar to the findings of Summerbell et al. (2005) and urge

7 Prevention of Childhood Obesity 7 future studies be conducted to develop and test theory-based, reproducible interventions including patients and parents. Evidence-based intervention strategies identified within this review include: nutritional and activity education, cognitivebehavioral interventions, parent-directed activities, reduction of sedentary behaviors in children, and reward systems for milestones. Program Enrollment Enrollment in this comprehensive 24-week program is voluntary. Children and their families will be identified and recruited during routine well visits as well as problem-focused office visits from local pediatric practices in the Greater Lewisville area. Inclusion criteria for the program are children ages four to eighteen with BMI at 85% or greater, with at least one active parent or legal guardian. Families will meet weekly at the clinic for education related to nutrition, exercise and chronic disease prevention for a 24-week program. Following the 24-week program, periodic surveillance data will be collected at three and six month intervals for a two year period. Definition of Terms Obesity Obesity is defined as the presence of excess body fat (Miriam-Webster, 1993, p. 801). It is characterized by a weight

8 Prevention of Childhood Obesity 8 well above the mean for a child s height and age and a BMI well above the normal range (95 th percentile or greater). Overweight Overweight is defined as weighing in excess of the normal for one's age, height, and build (Miriam-Webster, 1993, p. 831). It is characterized by a BMI between the 85 th and 94 th percentile. Body Mass Index The body mass index (BMI) is a statistical measure of a person s weight scaled according to his height. BMI is defined as the individual's body weight divided by the square of their height. The formulas used in medicine produce a unit of measure of kg/m 2. Body mass index may be calculated as follows: BMI = weight (kg) /height 2 (meters 2 ). Another formula for BMI calculation is: BMI = weight (lb) x 703/ height 2 (inches 2 ). Evaluation Evaluation of outcomes for this program is two-pronged. Participants in the program will be evaluated physically and cognitively. The physical evaluation will consist of measurements of weight, height, BMI, waist circumference, glucose, lipid profile and physical features (i.e., acanthosis). Goals for physical improvement will be developed on an individual basis and unique to each participant. Cognitive

9 Prevention of Childhood Obesity 9 evaluation will be assessed with pre- and post-test scores utilizing a tool provided by the Texas Pediatric Society. Clinical findings for physical measures will be categorized into four areas of success; excellent, good, average, and poor. Participants will be evaluated at the end of successful completion of the 24-week program. The following criteria will be utilized to measure program outcomes. An excellent outcome is defined as >65% of participants demonstrate a decrease in BMI of 2.5%. A good outcome is defined as >40% of participants demonstrate a decrease in BMI of 2.5%. An average outcome is defined as >30% of participants demonstrate a decrease in BMI of 2.5%. A poor outcome is defined as 30% of participants demonstrating a decrease in BMI of 2.5%. Participants will be entered into a database that will be updated weekly to include physical findings (i.e., vital signs and weight), attendance, and verification of participation in home activities related to the program (i.e., nutrition log and exercise log). Further program evaluation will include data related to attendance, attrition rate, and non-compliance. A successful attendance rate will be defined as 70% weekly participation with a maximum of two absences over the initial 24-week program. An attrition rate of <5% is considered acceptable and will be measured only within the initial treatment program. An additional element for evaluation is that

10 Prevention of Childhood Obesity 10 of non-compliance. Non-compliance is defined as a participant that meets attendance obligations but does not comply with home activities as specified by the program (i.e., nutrition log and exercise log). A non-compliance rate of <5% is considered a satisfactory for a successful program. Participants demonstrating active participation in the program but not achieving individualized goals for weight loss/bmi reduction may be referred to appropriate specialists for further clinical evaluation. Budget The implementation of the project will occur in two phases. The first phases will be the build-out of the clinic in an established building. The second phase will be the purchasing of the hardware, equipment, marketing and set-up. The build-out of the clinic will occupy approximately 2300 square feet in a wing of a free standing medical office building (Appendix B). The quoted cost of the build-out will be $85 per square foot. With 2300 square feet of space, the total calculated build-out cost will be $195,500. This would include architectural design, all construction cost including plumbing, light fixtures, electrical, air conditioning and heating, fully functional kitchen with dishwasher, refrigerator, built-in microwave, and stove with oven. Also included in the construction costs are stained concrete floors in the waiting rooms and bath rooms,

11 Prevention of Childhood Obesity 11 carpet in the exam rooms, office, and hallways, and commercial recreational carpet for the weight room and activity room. The clinic will comply with all city and state commercial codes and the American Disabilities Act codes for access. The time frame to complete the build-out will be 65 days. All prices were provided by Brass Key Builders at current market prices. The initial cost of furniture, equipment, and a computer system with software is budgeted at $45,000. The computer system will consist of four laptops, a wireless internet router and software applications at a cost of approximately $16,500. The exam room tables and equipment will cost approximately $10,800 and waiting room and office furniture is budgeted at $3,500. Additional items such as blood pressure cuffs, scales, and miscellaneous items will be shared with neighboring clinic space and will not represent an expense. The equipment proposed for the exercise room will be four treadmills, four stair climbers, two universal gym units, free weights, two elliptical machines and 14 mats at a price of approximately $14,200. The fulltime staff will consist of one administrative assistant, two medical technicians, and a nurse practitioner as the manager. The contracted employees will include one exercise physiologist, one dietician, and one pediatrician. The contracted labor will bill directly to the insurance company and not charge the clinic for any services provided.

12 Prevention of Childhood Obesity 12 Monies received from the grant will be utilized for the initial start-up cost and aid in the monthly clinic expenditures until clientele can be established. The monthly expenses will consist of rent ($2,500), salaries for fulltime employees ($6,000), clinic insurance ($450), utilities ($550), and miscellaneous items such as coffee, water, drinks ($250), and janitorial services ($500). Marketing will be budgeted at $500 per month. The estimated monthly budget for operating expenditures is estimated at $10, Additional food items for use in nutritional counseling demonstrations will be donated by local merchants. The clinic will generate sustained income by billing the insurance companies for services rendered. Services will be billed using two main evaluation and management codes, (new patient visit) and (return patient visit). The average patient will have 13 clinic appointments, one as a new patient, and 12 return visits, during the active treatment phase. The long term maintenance visits will be billed at a level. The average amount collected for a new patient visit, 99204, is $164 and $103 for a return appointment coded as These amounts are based on a current contractual agreement with Southwest Physicians Associates. During the active phase of treatment (12 weeks) the revenue from one patient will be $1297. That will average an income of $432 per

13 Prevention of Childhood Obesity 13 month per patient in active treatment. In order to meet the operating expenses ($10,700) of the clinic, the clinic must maintain 25 patients in the active phase of treatment. An excess of 25 patients in the active treatment phase plus all patients in the maintenance phase (12 weeks)of treatment will be profit for the clinic. Summary Childhood obesity is in epidemic proportions in the United States (U.S.) and worldwide. Causality of childhood obesity is multi-factorial and includes reasons such as lower socioeconomic status, genetics, parental eating patterns, decreased physical activity, and consumption of nutritionally poor foods. Implementation of early fitness and nutrition programs may have long-lasting benefits to overall health and wellness of children as well as adults. A 24-week comprehensive program is planned for implementation in a suburban setting to include children and their families who are identified as overweight and obese. Both the child and his family will participate in nutritional programs and demonstrations, fitness programs, and lifestyle and behavioral counseling. While grant monies are desired for the initial start-up, sustainability of the program is established through the ability to bill and collect future funds through contractual agreements with a regional physicians association.

14 Prevention of Childhood Obesity 14 References Ball, G., Marshall, J. & McCargar, L., (2005).Physical activity, aerobic fitness, self-perception, and dietary intake in at risk of overweight and normal weight children. Canadian Journal of Dietetic Practice and Research, 66(3), Ball, G., Marshall, J., & McCargar, L., (2003). Fatness and fitness in obese children at low and high health risk. Pediatric Exercise Science, 15, Eliakim, A., Nemet, D., Balakirski, Y., & Epstein, Y.(2007). The effects of nutritional-physical activity school-based intervention on fatness and fitness in preschool children. Journal of Pediatric Endocrinology & Metabolism, 20(6), Hodges, E. (2003). A primer on early childhood obesity and parental influence. Pediatric Nursing, 29(1), Mirriam Webster s Collegiate Dictionary (10 th ed.). (1993). Springfield, MA: Mirriam-Webster. Nemet, D., Barkan, S., Epstein, Y., Friedland, O., Kowen, G., & Eliakim, A. (2005). Short- and long-term beneficial effects of a combined dietary-behavioral-physical activity intervention for the treatment of childhood obesity. Pediatrics, 155(4), e443-e449).

15 Prevention of Childhood Obesity 15 Rice, J., Thombs, D., Leach, R., Rehm, R. (2008). Successes and barriers for a youth weight-management program. Clinical Pediatrics, 47(2), Small, L., Anderson, D., & Melnyk, B. (2007). Prevention and early treatment of overweight and obesity in young children: A critical review and appraisal of the evidence. Pediatric Nursing, 33(12), Summerbell, C., Waters, E., Edmunds, L., Kelly, S., Brown, T., & Campbell, K. (2005). Interventions for preventing obesity in children. Cochrane Datbase of Systematic Reviews, 2005(3), Art. No.: CD DOI: / Cd pub2. Texas Pediatric Society (2005). Pediatric obesity: A clinical toolkit for healthcare providers. Austin, TX: Author. WHO, (2000). The WHO cross-national study on health behavior in school-aged children from 28 countries: Findings from the United States, Journal of School Health, 70(6),