THE BUILT ENVIRONMENT

A built environment is simply defined as the person’s human made or modified surroundings in which the
live, work,and partake in recreation(renalds et al,2010). This is the actual physical environment in which
children live and includes neigh borhood access to recreation opportunities,grocery stores, the home
environment and the consideration of general safety for children in their physical environments. A child’s
built environment is influential in the managing of risk factors for obesity amount and type of physical
activity ,risk for injuries and exposure to environmental toxins. Therefore, as nurses, assessing child’s
built environment provides a foundation for identifying interventions and education to promote health and
prevent injuries and diseases. (See Evidence-Based Practice box)
Obesity
Obesity rate in american children have risen to epidemic levels over the past few decades. These increases
are noted for all children aged 2 to 18 years regardless of gender or ethnicity. The CDC defines
overweight as a body mass index (BMI) at or above the 85 th percentile and lower than the 95th percentile,
and obesity is defined as a BMI at or above the 95th percentile for children of the same age and sex when
plotted on the cdc growth charts ( table 29-2) (CDC,2012b). recently, it has been recommended to
monitor the world health organization (WHO) growth standards for children younger than 2 years. Those
infants and toddlers who measure above the 97.7th preare considered high risk for obesity(ogden et
al,2014).
The 2011-2012 prevalence of the overweight and the obese combined is 23% in children ages 2 to
5 years, 35% for adolescent 12 to 19 years. The prevalence of obesity in children is approximately 8% for
ages 2 to 5 years, 35% for children ages 6 to 11 years. And 35% for adolescents 12 to 19 years. The
prevalence of obesity in children is approximately 8% for ages 2 to 5 years, 18% for ages 6 to 11 years,
and 21% for ages 12 to 19 years (ogden et al,2014) (figure29-3). Comparing these 2012 national health
and nutrition examination survey (NHANES) findings with 2004 NHANES results demonstrates that
prevalence rates for obesity have remained stable with a decrease(5.5%) for the 2 to 5 years age range
(ogden et al,2014). In addition, 8,1% of infants and toddlers had high weight for recumbent length,
indicating a substantial risk for obesity in childhood.
The physiological consequences of childhood obesity are extensive and significantly impact the
health status of American children. Research has clearly identified strong relationships between being
obese as a child and increased disease burden in the cardiovascular, metabolic, musculoskeletal,
respiratory, and renal system(May et al,2012; Papandreou et al,2012; papoutsakis et al,2013 ; Paulis et
al,2014; Morandi & Maffies, 2013). Another critical consequence for children is the negative
psychological and social impact of obesity with decreased self-esteem;higher incidence of depression,
sadness,and anxiety;problem with sosial relationship;and higher reports of being the victim of bullying
(pull et al, 2012; Ting et al, 2012 ; Griffiths et al,2010)
Multipe factors contribute to the likelihood that a child will become overweight or obese.
Genectics and genetic susceptibility are certainly contributing components, although the genetic
composition of the population has been stable over time, thereby failing to account for a sudden rise in
obesity in recent years (garver et al, 2013). Within the literature, there modifiable risk factor are screen
time ( including, television, computer/tablet, phone,and video game) physical activity engagement, and
dietary intake/eating behaviors (Hoel scher et al, 2013; Vollmer & Mobley, @013; Fakhouri et al, 2013)
A rising comorbidity for childhood obesity is type 2 diabetes mellitus (T2DM). Currently, about
151,000 U.S. Children and adolescents have T2DM (CDC,2013c). Children and adolescent diagnosed
wtuh type 2 diabetes are usually beetwen 10 and 19 years old , are obese with strong family history for
T2DM, and insulin resistence ( Springer et al,2013). Most children and adolescent with T2DM have poor
glycemic control with hemoglobin A1C levels beetwen 10% and 12%. T2DM affects all ethic groups but
occurs more frequently in on white groups with the highest prevalence in American indian youth
(CDC,2013c)
Screning for T2DM is recommended for children with a BMI of 85 th to 95th percentile with two
risk factor of family history of diabetes, belonging to a racial minitory group, or with signs of insulin
resistance; all children with a BMI above the 95th percentile; and at age 10 years or onset of puberty. In
addition, the children should be screened for hypercholesterolemia and hypertension, which are also
associated with childhood obesity (springer et al,2013). Nurses can be instrumental in the management of
T2DM in children by educating and counseling.