Nursing Instructor Publishes Article Streamlining Approach to Childhood Obesity

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Marilou Shreve

Information about treating childhood obesity can be overwhelming to health practitioners, but a new article written by a University of Arkansas nursing instructor may help.

Marilou Shreve, a clinical instructor of nursing in the Eleanor Mann School of Nursing, wrote an article published last month in Clinical Advisor that streamlines the process for primary care providers to do the initial identification of pediatric obesity, followed by evaluation and early treatment. Shreve also stressed that health practitioners need to address obesity as a health issue in order to avoid making parents feel guilty.

In the article, "Assessing and Treating Pediatric Obesity," Shreve said community primary care clinics should be among the first to identify children who are obese, but many providers are reluctant to address childhood obesity with patients and their families because of sensitivity about the subject. Providers also lack knowledge on how to properly assess and develop a plan for treatment of obesity, Shreve said.

Shreve said her interest in pediatric obesity goes back to 2005 when she opened one of the first nurse practitioner-owned clinics in Arkansas.

"Over the years, our patients were getting bigger and heavier and had more health issues," she said.

Obesity is associated with health conditions such as cardiovascular disease, diabetes, sleep apnea, metabolic syndrome, fatty liver disease, hypertension and orthopedic problems. Childhood obesity has been steadily increasing for the past 30 years, according to research, with 18 percent of children and adolescents between the ages of 2 and 18 nationwide considered obese.  

A visit to the Arkansas Children's Hospital weight management clinic in Little Rock, where Shreve followed health-care providers as they worked, spiked her interest in the issue.

"Because I was the owner of a clinic, I needed to be a role model," Shreve said. "That pushed me to get my doctorate. I had to choose a special area of study, and I chose pediatric obesity.

The reality is that it's really difficult to treat kids. It's so time-consuming and just now, after 10 years, (medical insurance) reimbursement is catching up."

Shreve earned a Doctor of Nursing Practice from the University of Missouri-Kansas City in 2010 and is an advanced practice registered nurse.

"One of the huge issues is how to work with parents," she continued. "When you start talking to parents, it can feel accusatory. Literature shows that's a large barrier for providers."

When she followed the health-care team at Arkansas Children's Hospital, it helped her understand to approach the problem from a health standpoint.

"Don't talk about the child being overweight," Shreve recommended. "Instead, focus on health issues such as that, when bones are growing, extra weight can put too much stress on them. Children may have abnormal lab work or acanthosis, which is darkening skin at the neck, underarms, groin, knuckles or elbows. That indicates insulin resistance, that they are eating more sugar than the body needs."

Successful treatment depends on helping a family understand it's not something they are doing to the child.

"Sometimes two children in the same family eat the same food and have the same physical activity but one is overweight," Shreve said.

The article is designed to present information in a way that providers won't feel overwhelmed, she said, and there's an emphasis on when to refer patients to other health-care providers.

It quotes research that found, of those children and adolescents identified as being obese, an adequate dietary history is documented about 70 percent of the time, while physical activity and sedentary behavior are documented in only 15 percent of patient records.

A flow chart in the article illustrates what types of history, behavioral habits and other information need to be gathered and what lab tests should be performed for an accurate assessment. A second table outlines guidelines for treatment, with simple information about what types of food and drinks to eliminate and what to increase, how much physical activity is recommended and what behavior to encourage from setting a timer on electronics to waiting 20 minutes before taking a second serving of food.

Task Force

Several faculty members of the U of A nursing school make up a Northwest Arkansas obesity task force that plans to work with clinics in the area to use Shreve's article as one way to educate providers. The task force also plans to work with school-based clinics.

"We are developing an initiative called 'Eat Better, Move More, Arkansas,' with the goals of prevention, education and treatment of pediatric obesity," she said. "It will focus less on obesity and instead on general health. When you feel better, you do better in school and risk factors for other health conditions go down."

The program will stress that the entire family must be involved and making changes; otherwise, an obese child will feel stigmatized, Shreve said.

"With kids it's not about weight loss," she said. "It's more about teaching them healthy habits for the long term so they are not obese adults."