CHILDHOOD OBESITY: A COMMUNITY HEALTH NURSING APPROACH

A Community Health Nursing Approach to Childhood Obesity in New York City

Name
Institutional affiliation

CHILDHOOD OBESITY: A COMMUNITY HEALTH NURSING APPROACH

Abstract
This is a paper on a community health nursing approach to childhood obesity. It contains three
sections. The first part assesses the community and describes it social demographic features as
well as how they affect community health nursing. The second part is on diagnosis; it introduces
the topic of obesity and discusses the community health nurses diagnosis of obesity. The third
and final part is on planning- it discusses a 6 week intervention plan to combat obesity. This
paper utilizes multiple online (internet) as well as offline (non-internet) sources in its
compilation.

CHILDHOOD OBESITY: A COMMUNITY HEALTH NURSING APPROACH

Assessment of the community
New York City is the most highly populated city in the United States. It had a record high
estimated population of 8,336,697 residents in 2012 as well as the highest immigration numbers
than any other city in the U.S. The city has a fast growing population, and demographers have
predicted that it will reach an estimated population of 9.2-9.5 million by 2030.
New York City is a multicultural community with a wide range of social and economic
representations. In 2010, the population was racially comprised as follows: 44% white, 28.6%
Hispanic, 25% African American (black) and 12.7% was Asian. An estimated 36% of New
Yorks population is foreign-born.
The city is remarkably ethnically diverse, especially within the metropolitan area.
Outside of Israel, New York contains the community of Jewish people. The metropolitan area
contains 20 enclaves of little India, 20% of the countrys Indian Americans and 15% of its
Korean Americans along with 4 Koreatowns. New York City is also home to the largest Russian
American, African American, Italian American and South American populations in the United
States. It is also home to the greatest Asian Indian population within the Western Hemisphere as
well as the second-largest Hispanic community in the United States. New York City is also home
to the largest Chinese community outside the Asian continent and is also home to the largest
general Asian community than any other city in the U. S. New York City's population is
ethnically diverse and no single foreign-born community can claim to be a majority in this city
(Roberts, 2011).
The metropolitan area of New York is home to an estimate community of 568,903
persons who identify themselves as gay, lesbian or bisexual. This is the largest such community

CHILDHOOD OBESITY: A COMMUNITY HEALTH NURSING APPROACH

in the United States. On the 24th of June in the year 2011, same sex marriages were legalized in
New York City and began to take place 30 days after this legalization. The community is mostly
contemporary and generally very permissive. Moral standards are not very high owing to a mix
of different cultures which led to the dilution of standard. In New York City, it may be said that
anything goes. This may impact community health nursing both positively and negatively;
positively because there is less discrimination therefore easier accessibility and negatively
because health concerns are ever on the rise within this community.

There is a high degree of disparity in income in New York City. The median household
income in 2005 was $188,697 in the wealthiest, while it was $8,320 in the poorest census. Such a
disparity is contributed to greatly by wage growth trends: high income brackets continue to grow
while those in middle to low income brackets have stagnated. The highest numbers of
billionaires have their home in New York.

According to the United States Department of Agriculture Economic Research Service

(USDA ERS) state fact sheets, the levels of education have been steadily rising from the year
1980. New York City, being an urban population has seen a decline in high school drop outs, an
increase in high school and college graduates. More and more people are going to college even
though some do not complete it. It is therefore observed that the education levels of the target
audience are generally high. Literacy levels are high among this population, and they possess
substantial education levels (usda.gov).
The New York City department of health and hygiene, the city is well prepared for any
public or community health emergency. The New York City Health Department has formed and
continues to form partnerships with community organizations to this effect. Their aim is to give

CHILDHOOD OBESITY: A COMMUNITY HEALTH NURSING APPROACH

the community the ability to effectively deal with any short or long term threats to the health of
the community.

Some of the various for-profit and nonprofit organizations with which the New York City
Health Department partners to fortify the resilience of the New York City community include:
civic organizations, places of worship, neighborhood block clubs, community groups and
centers, businesses and local schools. The department works with its partners to ensure people
receive accurate and prompt information during emergencies of public health. Some of the
potential threats to public health facing New York City are pandemic flu, chemical and
biological threats, extreme weather and of course, natural disasters (nyc.gov). These hazards are
the causes of frequent hospitalizations and many morbidities and even mortalities result from
their effects on the community.

Community Health Nursing Diagnosis of obesity

Obesity can be defined as having too much body fat.. It has become a serious problem in
recent years in the United States, and New York City has not been spared by this epidemic.
Today in the United States, one in every three children is considered obese or overweight. The
percentage of obese children in the country has increased to almost 18% in 2010 from 7% in
1980. One in every five children in kindergarten is obese- a staggering statistic to say the least.
This is such a serious problem because it predisposes these young children to diseases that were
formerly confined to the adult population.

In the community, community health nurses can diagnose obesity in children when a
child is well above the weight they are expected to be at their age and height. This is a simple but

CHILDHOOD OBESITY: A COMMUNITY HEALTH NURSING APPROACH

effective way to diagnose this epidemic as in the community it may not be possible to carry all
the necessary equipment to make s detailed diagnosis.

Planning

The interventions for this problem will be a multi-faceted process. As obesity is a silent
killer,, and is not recognized by many as a real threat, the first plan of action will be to educate
the community on how to recognize obesity as well as on the effects and dangers on health it
poses on the community. This education would be done in mass within elementary schools to
reach the target audience at its hub. The education process would entail the use of pictures of
obese children. It would begin by defining obesity; this would be illustrated by pictures and
charts. Statistics would be provided on the proportion of children who are currently obese.
According to Thorpe et al (2004), 1 in every 4 children in public elementary school in New York
City is obese.

The elementary schools of target will be identified, after which the education sessions
would begin. The charts used would be colorful and full of pictures as opposed to words in order
to captivate the children's attention since they would be the target audience. Once obesity is
defined and pictures shown to ensure the point sinks home, we would then delve into the
negative effects of obesity. Negative health effects of obesity including cardiovascular disease,
diabetes, bone and joint problems, psychological problems such as stigmatization and low self
esteem would be discussed. Once again, the language used would be simplified and made easy
for the children to understand. Pictures will also be used to this effect. After the talk on obesity,
the children would then be allowed a question and answer session and encouraged to approach

CHILDHOOD OBESITY: A COMMUNITY HEALTH NURSING APPROACH

the team with their concerns at any time. They would also be discouraged from making fun of
and mocking those who are facing the problem of obesity as it is a disease just like any other.

Once the information session is over, we would go into the interventions and prevention
methods for combating obesity. The 5-2-1-0 plan adopted by Community Health Care
Association of New York State (CHCANYS) from the Maine Youth Overweight Collaborative
would be used. This plan utilizes a fun and easy to understand method of approach to changing
diets and lifestyle of children within New York in a bid to combat childhood obesity.

In this campaign, 5 stands for eat 5 or more fruits every day, 2 stands for cutting the
amount of screen time enjoyed daily by 2 hours, 1 stands for participation in moderate physical
activity for at last 1 hour daily while 0 stands for the restriction (elimination) of soda and other
sugar-sweetened soft drinks. This approach covers all areas that need tweaking in the life of
children if obesity is to be properly dealt with. It nips it in the bud before it develops and reverses
that which has already progressed into obesity.

The main goals/ objectives of this plan would be to change the diet- encourage more
consumption of fruits and vegetables and less of fatty foods, increasing physical activity among
the children by cutting down screen time and time spent indoors while increasing time spent
outdoors being up and about, and finally decreasing or altogether eliminating the mount of soft
and sugar filled drinks consumed by the children. The overall objective would be to reduce the
prevalence of obesity by treating children who are already obese and preventing new cases from
occurring. This multifaceted approach ensures that the root causes of obesity are dealt with as
opposed to simply treating its symptoms and manifestations.

CHILDHOOD OBESITY: A COMMUNITY HEALTH NURSING APPROACH

The education session will only take one day in each elementary school and the rest of
the days will be used for observation and follow up. It would be recommended that the schools
change the diet they avail to their students if possible by switching up the lunch menus. It would
also be encouraged that they replace those drinks identified as unhealthy from dispensing
machines.

A follow up session would be done where parents would be invited to participate. This
would be done so that more changes are made in the households rather than just within the
schools. It would be proposed to the parents not to give their children sugary treats to reward
them for good behavior, or at least to keep it at a minimum of once a week. Parents should also
be discouraged from forcing their children to always clear their plates, and encouraged instead,
to have the children eat only when they are hungry, more so for the already obese children.

In school, It would be proposed that gym sessions are made compulsory for everybody
with the exception of those with doctors orders. Gym sessions would also be made more diverse
such that more activities are offered to encourage the children to participate. The criteria for
deciding which activities to be added to the itinerary would be decided and approved by the gym
teacher, as long as they are getting the required exercise.

Follow up would be done every week within the schools chosen to ensure that the
program takes root and takes off as opposed to it ending at the education session. 5-2-1-0 charts
would be mounted on walls all around the school to keep reminding the children of the cause
being undertaken.

CHILDHOOD OBESITY: A COMMUNITY HEALTH NURSING APPROACH

If this plan is followed and applied appropriately, it is anticipated that the prevalence of
childhood obesity in New York will reduce, and that we will begin the long, painful journey
towards recovery and better health. Obesity and overweight is now among the two leading
causes of preventable death in America. How it became an epidemic is concernind and
disconcerting to say the least, but like Albert Einstein said, We cannot solve our problems with
the same thinking we used when we created them. We must change how we do things if we are
to achieve different results. Small changes when added up create a big change.

CHILDHOOD OBESITY: A COMMUNITY HEALTH NURSING APPROACH

References
Roberts S. (2011). "New York City's Population Barely Rose in the Last Decade, the Census
Finds". The New York Times.
Chisholm H. (1911). "New York City#Population". Encyclopdia Britannica 19 (11th ed.).
Cambridge University Press. p.617.
Thorpe E. L., List D. G., Marx T., May L., Helgerson S. D., Frieden T. R. (2004). Childhood
Obesity in New York City Elementary School Students..Am J Public Health. 94(9):
14961500.
Davison K. K., Birch L. L. (2001). Weight status, parent reaction, and self-concept in five-yearold girls. Pediatrics.;107(1):4653. [PubMed]
Centers for Disease Control. Prevalence of overweight among third- and sixth-grade children,
New York City, 1996. MMWR Morb Mortal Wkly Rept. 1998;47:980984. [PubMed]
Parker T. (2011) USDA Economic Research Service - State Data. Retrived from
http://www.ers.usda.gov/data-products/state-fact-sheets/statedata.aspx?StateFIPS=36&StateName=New%20York#.UYehQTfBmul
Ogden C. L., Carroll M. D., Kit B. K., Flegal K. M. (2012). Prevalence of obesity and trends in
body mass index among US children and adolescents, 1999-2010. Journal of the
American Medical Association; 307(5):483-490.

10