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Childhood Obesity in the Community

Tina Benedicto, John Horton, Jessica Keaton, Nicole Losey, Dalton McAnney, & Laura

Newcome

Old Dominion University School of Nursing

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Health Problem

Obesity and chronic diseases linked to it, particularly type 2 diabetes, became

increasingly prevalent in the United States around the mid ‘90s. These interrelated comorbidities,

in addition to the number of people who have uncontrolled blood pressure, has led scientists to

predict that the current generation of young people are likely to live shorter lives than their

parents (Chen, M., & Zhang, L., 2011). Children today represent three generations of eating

processed food; and men and women today eat the worst diets of any Western country in the

world. Our aggregate for this study focuses on 10-17-year-old children in the southeastern

Virginia region which has a childhood obesity rate of 24% (Community Health Survey, 2017). 

One meta-analysis of various studies aimed to synthesize current global literature

regarding the correlation of fast food consumption with increased obesity and incidence of

cardiovascular and metabolic diseases. Nutritionally, this type of processed food has shown to

have a marked amount of fat, carbohydrates, and additional sugar which contribute to a higher

energy density (Bahadoran, Mirmiran, & Azizi, 2015). Despite providing this increased energy

per gram of food, regular consumers were found to have an increased amount of intake. Due to

the increased amounts of fat contained in these foods, where saturated fat typically comprises

between a quarter to a half of total fat, an exponentially greater risk of chronic complications

exists for these individuals. In looking at these foods’ increased amounts of sugar, it has shown

that individuals who consume fast food at least once or more per week fall between a 27-150%

greater likelihood of developing type 2 diabetes (Bahadoran, Mirmiran, & Azizi, 2015). The

mounting research concerning such widespread consumption of processed fast foods and its
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correlation on one’s health has repeatedly detailed the detriment to both individual and

community wellbeing. Without proper intervention, these poor outcomes are doomed to persist.

Health Planning and Needs

A priority nursing diagnosis for our aggregate was identified as imbalanced nutrition -

more than body requirements related to poor dietary habits as evidenced by southeastern Virginia

childhood obesity rate of 24%. A study was conducted in the City of Portsmouth in collaboration

with the Portsmouth Health Department to identify ways to make Portsmouth healthier. Barriers

to obtaining optimum health are also assessed so that attempts can be made to overcome them.

Every five years data is collected via survey to assess the progress that has been made and what

changes need to be done around the community. In this survey, 66% of households reported

eating fast food once a week, 15% eat fast food five times a week, and 33% consume one sugary

drink per day (CHS, 2017). A Healthy People 2020 goal is to reduce the proportion of children

aged 6-11 years who are considered obese. The target goal for this objective is 15.7%- a far cry

from 24% (HP, 2020). A community health fair was planned at the Old Dominion University

Higher Education Building with an objective of half the participants to verbalize interest in

changing their diet habits by reducing intake of sugary drinks, increasing physical activity to

thirty minutes a day, and increasing their consumption of fresh fruits and vegetables.

Alternative Interventions

Evidence to support the impact of health teaching on childhood obesity can be seen

through its implementation in schools. One study aimed to research the efficacy of a school-

based educational program on the BMI of student participants grades 3-12 across multiple public

schools in a district (Cadzow, Chambers, & Sandell, 2015). Researchers implemented three-

pronged approach focusing on physical activity, nutrition, and health education over a three-year
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period. The intervention program not only called for investment into increasing exercise

equipment and altering the food available at these schools, but also ensured a continuing

comprehensive education focusing on bettering health. Student progression and intervention

efficacy were measured twice per year at school health screenings where participants were able

to discuss healthy behaviors as well as have their weights and BMIs recorded. Data from over

2,000 participants noted a 70.3% to 65.7% decrease in mean BMI percentiles, a statistically

significant finding (Cadzow, Chambers, & Sandell, 2015). Compared to the national decrease in

obesity rates being only ~0.5%, the experimental population experienced a decrease of 4%.

Intervention and education are paramount in combating the continuing progression of childhood

obesity. As this issue continues, many communities and organizations have supported various

interventional approaches at educating the youth about this issue.

Rev Your Bev is a statewide educational campaign that aims to reduce sugary drink

consumption and increase water consumption. This program was developed by the Consortium

for Infant and Child Health (CINCH) and includes information on how to read a nutrition label to

determine sugar content in drinks as well as various recipes using natural sugars from fruits to

flavor water. This is a free resource that can be downloaded and presented at community health

fairs. The lesson plan comes with a short story about the importance of water, a coloring activity,

a water taste testing station, games, recipe cards, and education for parents. The goal at the end

of the lesson is for children to identify water as the healthiest beverage, understand the

importance of keeping the body hydrated, and learn fun ways to drink water (RevYourBev). 

In 2018, CINCH received funding from the Virginia Foundation for Healthy Youth

targeting nutrition, obesity prevention, and tobacco use prevention (CINCH). The program,

Healthy Kids and Healthy Alternatives for Little Ones (HALO) will be implemented in day care
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and early learning centers in Hampton Roads for the next two to three years. The HALO

program uses an evidence-based approach to create a foundation necessary for making “healthy”

versus “harmful” choices while learning about important ways their bodies work and how

nutrition and physical activity affects the health of their organs. It has been shown to develop

self-discipline, an internal locus of control, problem-solving skills, and tolerance of people and

situations that are different from their own (HALO).

Implementation and Support

Our project focused on the primary level of intervention.  Primary health promotion

involves prevention of disease. This type of intervention is an important factor in improving

overall community health, and nurses play a key role in it (Clancy, Leahy-Warren, Day, &

Mulcahy, 2013).  We implemented our primary intervention by teaching the importance of

healthy lifestyle practices via a health fair. Health fairs are a low-cost way to provide screenings

and other services to a large number of community members in one convenient location, which

can be especially helpful for those who don’t regularly receive medical care (Murray, Liang,

Barnack-Tavlaris, & Navarro, 2014).

One station at our health fair provided education on reading nutrition labels, limiting

sugary/processed foods, and exercising for 60 minutes each day.  Healthy diet and exercise

practices have been proven to help prevent diseases such as obesity, heart disease, and diabetes

(CDC, 2019).  

Physical education in the K-12 school system needs to be enhanced to increase the

amount of time students spend engaged in moderate, or vigorous, intensity activity. Approaches

to achieving this goal include modifying games, substituting fewer active games with more

active games, and creation of physical education lesson plans that incorporate fitness and circuit
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training activities. Moderate to vigorous physical activity is associated with lower rates of

chronic health issues such as diabetes and obesity. Patterns of activity and inactivity can be

established during childhood and adolescence and carried on into adulthood. Schools serves a

suitable environment to promote moderate to vigorous physical activity, especially since physical

education is already part of the curriculum. The Self-determined Exercise and Learning for

FITness (SELF-FIT) intervention was designed based on the self-determination theory.

According to the self-determination theory, competence, autonomy, and relatedness are

important determinants of motivation, behaviors, and well-being. Motivation is categorized as

autonomous or controlled. The SELF-FIT intervention trains physical education teachers to

incorporate moderate to vigorous physical activity into lesson plans. Four follow up studies

showed that physical activity increased in adolescents on the weekends. Additional evidence

showed that participation in enhanced physical education was also associated with lower levels

of stress, lower levels of anxiety, increased concentration, increased memory, and increased

classroom behavior among adolescents (Ha, A. S., Lonsdale, C., Lubans, D. R., & Ng, J., 2017). 

The primary care setting has multiple advantages for the prevention of excess weight gain

due to the fact that pediatric practitioners are more trained in prevention of morbidity and

mortality, have an ongoing relationship with children, and are seen as a trusted source of health

information. Not surprisingly, the pediatric primary care setting is usually when excess weight

gain is first detected. A study was conducted to test if pediatric care providers can deliver an

intervention as part of their clinical practice similar to interventions successful in the research

setting with a goal to prevent increase in body mass index (BMI) compared to a control

intervention of the same intensity unrelated to weight. The theory-based, family-based, culturally

and developmentally appropriate intervention consisted of twelve 15-25-minute clinician, child,

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and at least one parent over a 12-month period. Children earned points based on attendance and

goal achievements which they could redeem for small prizes. Children were randomly placed

into one of three groups to receive information on: modifying beverages only; multiple behavior

interventions that included changes to diet, physical activity, and sedentary activity; and the

control group that focused on bullying prevention. There was a weight difference of about 1.5 kg

was observed between the combined obesity interventions and the control group. The findings of

the study suggest that trained, supported, and compensated pediatric primary care staff can

implement a theory-based behavioral intervention with sufficient impact on excess weight gain

among children. 

While planning and implementing our health fair we noticed that there may exist some

barriers to our intervention. Firstly, when planning our event one barrier we ran into was not

knowing the exact age of our participants. We knew that the organization we were working with

included children of multiple age groups, however, we were not able to acquire and exact age

prior to the event. This barrier significantly affected the content that we would be able to cover,

language we would use to convey our message, and activities performed. Moreover, how we

decided to address this issue was by preparing for multiple age groups and having presentations

and activities that we could adjust to fit the groups age and knowledge. 

Secondly, when planning we took into consideration possible barriers to learning such as

unwillingness to participate or disinterest in the information. We examined how we could make

this information important to the audience so that we may increase interest and adherence to

health teachings. Therefore, we implemented techniques that would provide context to the

teachings that the participants could relate back to their everyday life (Watanabe-Crockett,

2018). For example, when implementing teachings about amounts of sugar contained in
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everyday foods we decided to choose food that where common among our target audience such

as Big Mac burgers, Mountain Dew, and Frosted Flakes. This way when the participants see

these foods in their everyday life they can recall the teachings and visual aids used in the health

fair. Another technique utilized to overcome learning barriers was to provide guidance but allow

the participants to find their own way through and activity. This idea of guiding but stepping

aside enhances learning by allowing the participant to struggle with a new task while providing

encouragement and direction (Watanabe-Crockett, 2018). For example, during the CPR training

we instructed the participants on the proper techniques of CPR first.  After instruction followed

the participants time to practice CPR on the mannequin. During this time our instructor

examined their technique and provided encouragement and constructive criticism. By not

interfering and simply guiding the participants we are able to break down learning barrier to a

difficult task.  

Finally, going forward we have examined some possible barriers for the future of this

intervention. For this intervention to be successful in its intended purpose future nursing students

and faculty must maintain a relationship with the UP organization and build new relationships

with other like-minded organizations. Students and faculty must maintain consistency in the

health knowledge that is being taught at the health fair each year while adding new information

as it becomes relevant. By providing information that is not consistent or faulty can lead to

anxiety, stress, and distrust by the participants and community partners (Unite For Sight. 2015).

Lastly, funding, transportation, and location may become an issue as attendance grows and more

people want to participate in the event. Typically, health fairs are associated with   Ultimately,

these barriers will become the responsibility of future nursing students and faculty if they decide

to continue the health fair.  

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Evaluation Plan

The objectives of our project were that 75% of participants will report the desire to

decrease their sugar intake, 50% of participants will report a desire to eat more fresh vegetables

and exercise regularly, and participants will demonstrate emergency medical services (EMS)

activation and cardiopulmonary resuscitation (CPR) technique. We evaluated using verbal

reflection, asking the participants about what they learned from the different health fair stations,

and having the participants perform CPR on mannequins. Because the participants were children

between the ages of 10 and 17, and given the relaxed environment of the health fair, we decided

that realistically it is more effective to have a conversation with participants about what they

learned. The teach back method of evaluating learning also allows an opportunity for the

participants to ask questions about anything they may feel was unclear during the health fair

presentations and to stimulate conversation about other health concerns the participants may

have. The teach back method is cited as the best way to “close the loop” in patient education, and

has been recognized by the National Quality Forum as the best method for validating

understanding (Miller & Cohen, 2016). 

Limitations

Though the teach back method is useful for evaluating the participants’ understanding of

what they learned during the health fair, we are limited in our ability to evaluate the participants’

ability to follow through on the desired changes. If future health fairs are held and participants

return, we could perform follow up evaluations to determine if they consume less sugar, more

fresh vegetables, exercise regularly, and if they are able to demonstrate EMS activation and

CPR.   

Recommendations
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Going forward, we feel that it is important to continue the relationship built between the UP

Organization and the Old Dominion School of Nursing. Having more health fairs in the future

and making them open to larger groups of participants would be beneficial to engage more of our

aggregate. It would also create an opportunity for follow up evaluation of teaching provided

during the health fair.  The adults who accompanied the youth were just as engaged and reported

learning new information as well. Future health fairs could increase their impact by including

information that is also targeted towards the adult attendees.       

Implications

     The impact of childhood obesity reaches into adulthood.  There are many factors that

contribute to obesity, and education is a simple intervention that can be very productive.  If

similar educational health fairs had as great an impact as reported, we could see an overall

decrease in the rates of childhood obesity in the region.  We noted that nearly all of the

participants reported that they learned something that gave them a desire to make lifestyle

changes. If this is similar for all members of our aggregate, then education can have a

tremendous impact.  

     Increased wellness and positive future health outcomes occur more often when healthy habits

are utilized.  The impact of education on population health will be seen as the affected children

grow and teach their own children healthy habits.  There are many costs associated with obesity,

such as medications and healthcare. A population that is of a healthy weight will benefit from

fewer health woes that interrupt life.   

     Obesity is shown to have a negative impact on mental health as well as physical health

(Sahoo et al., 2015).  Youth depression and suicide rates have increased along with obesity rates.

A potential impact of successful health education on population health is an increase in reported

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mental wellbeing.  An increase in mental health better equips individuals to care for their

physical health.

      The greatest implication for nurses is the fact that we must thoroughly educate our patients

on that which is ailing them.  Education, when properly provided, has the opportunity to increase

patient wellbeing and save lives. We must remain aware of the fact that we have a large

knowledge base that we use to understand health problems, and that many people do not possess

the same information.  Remaining aware of this will ensure that the nurse provides education that

can be understood by their target audience. Nurses ought to ensure that they are providing the

most current, evidence-based information when educating themselves and their patients. If we

are not able to provide the best information, we should do our best to obtain information from a

reliable resource.

Conclusion

Though this project was intended for individuals in our target age aggregate of 10-17-

year-old, the information can be adapted to all ages. In looking back at our findings, we have

learned the importance of providing effective nutrition, physical activity, and vital signs

education in relation to obesity. The participants were receptive to the teaching and their

engagement was apparent when applying the knowledge learned from the teaching into their

daily lives as evidenced by the positive responses received. Each participant learned something

new and was able to identify areas of their lives to apply this newfound information.

Being able to pilot this health fair with the Up organization taught us a valuable lesson in

the importance of actively engaging participants contextualizing concepts and. Each station in

the health fair was engineered with age-appropriate, active engagement in mind. Establishing a

strong engagement ensured that the participants were truly learning knowledge we were teaching
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them. Health teaching holds no value if participants are unable to apply their newfound

knowledge into their daily lives. Giving a proper context to concepts, such as the teens tangibly

seeing the amount of sugar in different foods or understanding the idea of a calorie through

actual physical exertion, creates a more stunning impact that the participants can more concretely

relate to their daily lives.

References

Bahadoran, Z., Mirmiran, P., & Azizi, F. (2015). Fast Food Pattern and Cardiometabolic 

Disorders: A Review of Current Studies. Health Promotion Perspectives, 5(4), 231–240. 

https://doi-org.proxy.lib.odu.edu/10.15171/hpp.2015.028 

Cadzow, R., Chambers, M., & Sandell, A. (2015). School-Based Obesity Intervention

Associated 

with Three Year Decrease in Student Weight Status in a Low-Income School District. 

Journal of Community Health, 40(4), 709–713. 

https://doi-org.proxy.lib.odu.edu/10.1007/s10900-015-9989-0

Miller, S., Lattanzio, M., & Cohen, S. (2016). “Teach-back” from a patient’s perspective.

Nursing, 46(2), 

63–64. https://doi-org.proxy.lib.odu.edu/10.1097/01.NURSE.0000476249.18503.f5 

Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015).
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Childhood obesity: causes and consequences. Journal of family medicine and primary

care, 4(2), 187–192. doi:10.4103/2249-4863.154628 

Unite For Sight. (2015). Retrieved from

http://www.uniteforsight.org/health-screenings/health-screenings.

Watanabe-Crockett, L. (2018). 5 Ways to Help Your Students With Overcoming Learning

Barriers. Retrieved from 

https://globaldigitalcitizen.org/5-ways-overcoming-learning-barriers/amp.

Honor Statement

I pledge to support the honor system of Old Dominion University. I will refrain from any form

of academic dishonesty or deception, such as cheating or plagiarism. I am aware that as a

member of the academic community it is my responsibility to turn in all suspected violations of

the Honor Code.

Tina Benedicto, John Horton, Jessica Keaton, Nicole Losey, Dalton McAnney, & Laura

Newcome
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