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Preventing and Treating Childhood Obesity

The beginning of September means it's back-to-school time. Is your local school involved in projects to help fight the modern epidemic-childhood obesity? Recently, Swedish scientists reported the results of one such school-based obesity project: the Stockholm Obesity Prevention Program. The project was aimed to support the school staff in their efforts to increase physical activity and provide healthy food.


Ten schools within the Stockholm County area with children 6 to 10 years old were randomized, 5 to intervention (n = 1,538) and 5 to control (n = 1,300). Weight and height were measured every term between October 2001 and June 2005 until the children left the study at the age of 10 years. Body mass index scores were calculated and subjects were classified as normal, overweight, or obese. The proportion of overweight and obese children was compared. The intervention, based primarily on continuous encouragement of the school and after school center staff, was focused on increasing physical activity and providing healthier food (reducing the intake of fat and sugar in school lunches and in the afternoon snacks).


Results of the Stockholm Obesity Prevention Program were promising. In the intervention schools, overweight prevalence decreased from 18% to 13% and obesity from 4% to 3%. In control schools, a reversed pattern occurred with an increased prevalence of overweight and obese students: 13% to 14% (overweight) and 5% to 7% (obesity) (P < .001). The researchers concluded that small, long-term modifications of eating habits and physical activity in school and after school may affect obesity prevalence.


Obesity in the United States has reached epidemic levels with the number of overweight children doubling in the last 2 to 3 decades; currently, 1 child in 5 is overweight ( The increase is found in both children and adolescents and in all age, race, and gender groups. Obese children now have diseases, such as type 2 diabetes, which used to occur only in adults. Overweight children tend to become overweight adults, continuing to put them at greater risk for heart disease, high blood pressure, and stroke. But perhaps more devastating to an overweight child is the social discrimination; children who are teased about their weight may develop low self-esteem and depression.


There are many causes of obesity. Although there is no doubt genetics plays a role, genes alone cannot account for the huge increase in rates during the past few decades. The main culprits are the same as those for adult obesity: eating too much and too little physical activity. Almost half of children aged 8 to 16 years watch 3 to 5 hours of television a day. Kids who watch the most hours of television have the highest incidence of obesity.


Parents play a key role in creating a healthy-weight environment in the home. The Mayo Clinic provides the following tips for parents on their web site,


* Remove sugar-sweetened drinks from the home.


* Offer more whole-grain foods with meals and snacks.


* Reduce the number of meals eaten out at fast-food and other restaurants.


* Sit down together for family meals and have that meal last at least 30 minutes.


* Remove TVs and computers from children's bedrooms.


* Include children in active chores, such as washing the car or walking the dog.


* Be a positive role model by eating healthy, nutritious foods; controlling portion sizes; and being physically active every day!



Two prescription weight-loss drugs are available for adolescents: sibutramine (Meridia(R)) and orlistat (Xenical(R)). Sibutramine, which is approved for adolescents older than 16 years, alters the brain's chemistry to make the body feel fuller more quickly. Orlistat, which is approved for adolescents older than 12 years, prevents the absorption of fat in the intestines. Although available, these drugs are rarely prescribed to adolescents. The risks of taking the medications long term are still unknown, and their effect on weight loss and weight maintenance for adolescents is still questioned. Weight-loss drugs do not replace the need to adopt a healthy diet and exercise regimen.




Claude M. STOPP: Stockholm Obesity Prevention Program: Effect of a 4 year school-based randomized prevention study on overweight prevalence among children 6-10 years of age. Int J Obes. 2007;(suppl).


A Resource for Parents and PCNA Members Concerned About Childhood Obesity

In May 2007, the National Heart, Lung, and Blood Institute released an important resource for parents and families: We Can! (Ways to Enhance Children's Activity and Nutrition) Families Finding the Balance: A Parent Handbook. Parents can make a big difference in their child's health by making small lifestyle changes. Fun and practical tips in this colorful, easy-to-read handbook help families find the right balance of eating well and being physically active to maintain a healthy weight.


Several helpful tools in this booklet include a table on estimated daily energy requirements by age, sex, and activity level.


A healthy eating chart categorizes food according to "Go, Slow, and Whoa" foods. Fruits and vegetables are considered "Go" foods (almost anytime), whereas white bread is considered a "Slow" food (sometimes), and fried foods and sweets are "Whoa" foods (once in a while).


This booklet is not just for parents; nurses who care for children and families in a variety of settings will find this booklet helpful in their daily practice and when addressing the public at events such as health fairs, PTA meetings, school wellness programs, community centers, and churches. To learn more about the We Can! program and/or download a copy of the booklet, go to


September Is Healthy Aging Month, Nurses Respond to the Challenge

Growth in the number and proportion of older adults in the United States is unprecedented. Two factors, longer life span and aging baby boomers, will combine to double the population of Americans 65 years and older during the next 25 years. By 2030, there will be 71 million older American adults accounting for roughly 20% of the US population. Improved medical care and prevention efforts have contributed to dramatic increases in life expectancy in the United States over the past century. They also have produced a major shift in the leading causes of death for all age groups, including older adults, from infectious diseases and acute illnesses to chronic diseases and degenerative illnesses. Currently, approximately 80% of older Americans are living with at least 1 chronic condition ( Moreover, people older than 65 years represent 60% of all ambulatory adult primary care visits, 80% of all home care visits, approximately 50% of inpatient care, and 85% of residents in nursing homes. As the baby boomers age, these percentages are only expected to rise.


Healthy Aging Month focuses national attention on the positive aspects of growing older, and nurses, who are central to the healthcare of all older adults, are responding to the challenge! Poor health and loss of independence are not inevitable consequences of aging. The following strategies have proven effective in improving the health of older adults.


* Healthy lifestyles. Research has shown that healthy lifestyle behaviors, such as being physically active, eating a healthy diet, and not smoking, are more influential than genetic factors in helping older people avoid the deterioration traditionally associated with aging.


* Early detection of diseases. Screening to detect chronic diseases early in their course, when they are most treatable, can save lives.


* Immunizations. Approximately 36,000 people 65 years or older die each year of influenza and invasive pneumococcal disease. Immunizations can reduce a person's risk for hospitalization and death from these diseases.


* Injury prevention. Falls are the most common cause of injuries to older adults. More than one third of adults 65 years or older fall each year, and of those who fall, 20% to 30% suffer moderate to severe injuries that decrease mobility and independence.


* Self-management techniques. Programs to teach older adults self-management techniques can improve health outcomes and reduce costs of chronic disease.



Figure. No caption a... - Click to enlarge in new windowFigure. No caption available., developed through the Nurse Competence in Aging initiative, is the official geriatric nursing web site of the American Nurses Association and of the John A. Hartford Foundation Institute for Geriatric Nursing. This web site provides the following:


* Evidence-based protocols for managing common geriatric syndromes and conditions.


* Linkage to specialty nursing associations' offerings in geriatric care and national geriatric web sites.


* The Try This Assessment tools series with 30 nationally recommended instruments for use with older adults.


* Hospital competencies for older adults for use in nurse orientation and evaluation.


* Opportunities to acquire continuing education contact hours, including topics such as Nutrition in the Elderly.


* An online course to prepare for the American Nurses Credentialing Center's gerontological certification.





Expanding the Cholesterol Challenge to Children

September is "National Cholesterol Education Month" and an appropriate time to examine how much progress is being made in the fight against hyperlipidemia. According to the American Heart Association, less than one half of qualifying adults receive treatment of dyslipidemia; less than one half of even the highest-risk persons with symptomatic coronary heart disease are receiving lipid-lowering treatment. And of those being treated, about one third are achieving their low-density lipoprotein goal, with less than 20% of coronary heart disease patients at their low-density lipoprotein goal. Over time, only 50% of people who were prescribed lipid-lowering drugs are still taking them six months later.


An even bigger challenge for healthcare providers is the growing incidence of hyperlipidemia in children and adolescents. Pathology/ in vivo and epidemiologic evidence now demonstrate that the progressive atherosclerosis process begins in childhood, with hyperlipidemia being a significant contributor. The prevalence of lipid abnormalities in children is increasing, primarily due to the epidemic of obesity and metabolic syndrome that has expressed itself in the past decade. This warrants vigilant attention to cardiovascular risk factors at an early age. Two key scientific statements from the American Heart Association address this issue: Primary Prevention of Cardiovascular Disease in Nursing Practice: Focus on Children and Youth (Hayman et al, 2007) and Drug Therapy of High-Risk Lipid Abnormalities in Children and Adolescents (McCrindle et al, 2007). These statements underscore the need to reexamine current recommendations for assessment and management of the lipid profile in children and adolescents. Existing pediatric guidelines are based on the National Cholesterol Education Program 1992 Expert Panel on Blood Cholesterol Levels in Children and Adults. These guidelines recommend several approaches: a "population-based" approach aimed at identifying those children with elevated cholesterol levels and the "high-risk" individual approach that focuses on a screening algorithm using family history as an entry point for detection of lipid problems. Targeted screening of fasting lipids is suggested for children older than 2 years with family history of premature coronary heart disease, diabetes, and dyslipidemia. Lipid levels of concern include the following:


* Total cholesterol >170 mg/dL (borderline) and >200 mg/dL (elevated)


* Low-density lipoprotein cholesterol >110 mg/dL (borderline) and >130 mg/dL (elevated)


* Triglycerides >110 mg/dL


* High-density lipoprotein cholesterol <40 mg/dL



Several challenges to existing guidelines are posed by McCrindle et al. These challenges include focusing attention on multiple risk factor scoring and the need to individualize cut points based on sex, race, age, pubertal status, and other modifying factors. In addition, the original guidelines, which recommend the use of bile acid-binding resins in high-risk patients, have been shown over time to be poorly tolerated in this younger population. However, more recent studies have documented the preferential response to statin drug therapies in children and adolescents with familial or severe hypercholesterolemia. These drugs are recommended for high-risk individuals who have not responded to lifestyle modification. American Heart Association Guidelines (2007) include the revised drug therapies for selected lipid abnormalities in children and adolescents. Visit the Preventive Cardiovascular Nurses Association, American Heart Association, and National Heart, Lung, and Blood Institute web sites for educational information on cholesterol risks and treatment guides.




McCrindle et al. Drug therapy of high-risk lipid abnormalities in children and adolescents. Circulation. 2007;115: 1948-1967.


Hayman et al. Primary prevention of cardiovascular disease in nursing practice: focus on children and youth. Circulation. 2007;116:344-357.


PCNA Honors Excellence With Cardiovascular Disease Prevention Award

Congratulations to the winners of the 2007 PCNA Cardiovascular Disease Prevention Award. Nominees were students graduating from a Master's or Doctoral Program in nursing who have demonstrated a significant contribution to cardiovascular disease prevention through a practice initiative, publication, research, community project, or other prevention leadership effort. They likewise have the potential to contribute to cardiovascular disease prevention in their future career.


Each winner will receive a 1-year PCNA membership, educational materials, a subscription to the Journal of Cardiovascular Nursing, and a complimentary registration to the 2008 PCNA Annual Symposium. Congratulations to the winners: Sarah L. Szanton, BSN, MSN, CRNP (Johns Hopkins University School of Nursing, Baltimore, Md); Salima Hemani, RN, BSN, MSN (Loyola University, Chicago, Ill); and Deborah M. Greer, ARNP (University of South Florida, Tampa, Fla).


World Heart Day

World Heart Day is the World Heart Federation's (WHF) most important advocacy event. Its aims are to increase public awareness and to promote preventive measures to reduce cardiovascular disease.


The theme for this year's World Heart Day is "Healthy Families, Healthy Communities," and the slogan is "Team Up for Healthy Hearts!" It will take place on Sunday, September 30, 2007.


World Heart Federation members, comprising 195 cardiology societies and heart foundations in more than 100 countries, organize activities for World Heart Day. A large number of nonmembers, whether they are hospitals, heart clinics, universities, schools, individuals, or other organizations, also participate by organizing events. Activities include walks/runs, free risk factor screening, press conferences, art contests, talks by experts, and much more.


For more information on events near you, please contact the World Heart Federation at

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Section Description

The Journal of Cardiovascular Nursing is the official journal of the Preventive Cardiovascular Nurses Association. PCNA is the leading nursing organization dedicated to preventing cardiovascular disease through assessing risk, facilitating lifestyle changes, and guiding individuals to achieve treatment goals.