Some nonpharmacological management strategies for childhood obesity include the following lifestyle changes:

• Encourage healthy eating habits, including smaller portions. Provide plenty of fruits, vegetables and whole-grain foods. Incorporate low-fat or nonfat dairy products. Provide lean meats, poultry and seafood. Limit beverages sweetened with sugar. Provide healthy snacks like fruits or vegetables and limit fast foods.¹⁶

• Promote dining together as a family without the television.

• Discourage use of food as rewards; find appropriate alternatives.

• Increase physical activities by encouraging family outdoor activities, such as taking walks, or indoor activities, such as using exercise equipment or exercise videos.⁵

• Limit time spent watching TV or playing video games.¹

The role of the school is important; schools affect the physical activity and eating behaviors of children. Key strategies that can be used by schools include the following:

• Develop a coordinated school health program model that uses a systematic and scientific approach to address student health issues through assessment planning, implementing and evaluation.

• Designate a school health coordinator and active school health council to manage and coordinate programs and activities.

• Assess the school health policy to identify areas for opportunities for improvement.

• Set or strengthen the nutrition policy and physical activity policies of schools.

• Encourage health promotions for school staff who can serve as role models for students.

• Offer heath education courses that support healthy behaviors.

• Implement physical education courses as part of the school curriculum.

• Increase physical education opportunities for students to participate in, enjoy and benefit from.

• Implement quality meal programs. For more information, visit http://www.fns.usda.gov/tn and http://www.asfsa.org/.
• Offer healthy food and beverage choices in school by restricting high-fat or high-sugar choices of foods.¹⁷

Pharmacological Management

When lifestyle changes alone fail, pharmacological management options may be used alone or in conjunction. Drugs approved by the FDA for the treatment of childhood obesity include orlistat (Xenical) and sibutramine (Meridia). Xenical has been studied for safety and efficacy in the pediatric obese population ages 12-16.

Xenical works by blocking the absorption of fat. Because fat-soluble vitamin absorption also is affected, it is recommended patients take fat-soluble vitamins daily, namely vitamins A, D, E and K and beta-carotene.

Patients should take this vitamin supplement 2 hours before or 2 hours after taking Xenical. Side effects of this drug include gastrointestinal issues such as fatty loose stool, leaking oily stool, diarrhea and gas, which can interfere with patient compliance with the medication. The active ingredient in Xenical is also available as an over-the-counter product called Alli, but Alli is not approved for use in the pediatric population.

The other drug is Meridia, approved by the FDA for use in the pediatric population ages 16 and older. This drug works by burning fat while causing satiety in the patient. Side effects include increased blood pressure, increased heart rate, headache, dry mouth and constipation.

Surgery should be considered the last resort after all else fails. When obese adolescents present with diseases that are mainly seen in adults and are at a high risk for increased mortality, surgery may be the only way to treat these cases.^12,18,19

Looking to the Future

It is vital nurses understand childhood obesity and its root causes, health risks and management if they are to help curb this national epidemic that is predicted to continue to rise. Prevention during childhood is the most effective approach in dealing with this crisis.

Because children and adolescents who are overweight are at a greater risk of being overweight or obese as adults, it is imperative the concept of prevention is well understood to help resolve childhood obesity, which continues to have serious health consequences. Simply put, childhood obesity is an issue we cannot ignore.^7,10,18

The Secretary's Advisory Committee on National Health Promotion and Disease Prevention Objectives for 2020 has proposed information on Healthy People 2020 be made available so people can be armed with the knowledge and plan intervention strategies to improve the health of all groups.²⁰ The implication of childhood obesity is even reaching legislation. For example, in New York, a tax on all sweetened drinks has been proposed.

Ever since the goals of reducing childhood obesity were established, they do not seem to have been met. Resetting these goals to include implementing mandatory wellness programs in schools, improving health screenings in schools, and conducting mandatory checkups for school-age children may be reasonable and attainable.

Public service announcements may prove helpful in educating families; increased awareness of the Healthy People 2020 objectives is a must if they are to be successful.

Provisions supported by tax dollars have to be made for low-income, uninsured and underinsured families to participate in the primary prevention strategies to combat childhood obesity.

As a nation, we have to do more to counteract this epidemic, as the children of today will be the adults of tomorrow.

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Marlene Nelson is a clinical specialist at Broward General Medical Center, Fort Lauderdale, FL.