Approaches to Childhood Obesity Annotated Bibliography

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Parents of Obese Children and Charges of Child Abuse: What Is Our

Response? Pediatric Ethics, Issues, & Commentary, 337-342.

This article provides a discussion on the problems related to childhood obesity and the potential redresses that could be ethically used to help mitigate the growing trend. Some healthcare professionals have also argued that obesity in children is sufficient grounds for some parents to be prosecuted for a form of child abuse in extreme cases. Yet, there are many social and cultural barriers that are present that can prevent parents from being able to understand proper diets or have access to nutritious foods. Some researchers have noted the irony of a country that allows removing obese children from their homes but that does not support healthier children through controlled advertising, legislating a living wage, or making healthy foods affordable (Lang, 2012).

The article notes that states have a mandate to protect children from harm and a parent who lets their children become obese could be construed as a violation under child abuse laws by some. There are some cases where it seems as if it could be necessary to separate a child from their parents and their home environment; especially in the case in which the condition becomes life threatening. Some have even argued that this might be a better option than having the child have a bariatric surgery to help alleviate the symptoms. The idea of separating the child from the environment that is associated with them being overweight can make sense on many different levels and it is easy to see why some researchers might promote this policy as a reasonable solution to seriously overweight children.

However, it is a difficult issue because it is difficult to determine if the parents are intentionally imposing harm on their children or if there are other factors at play. For example, in many cases the parents themselves follow the same dietary habits as they expose their children to and are not intentionally doing any harm to their children. They may have a diet based on convenience foods or fast foods and may experience many of the risks and problems that their children do as well. Therefore, it is difficult to prosecute these parents on the basis of the harms that they are causing to others, when they are doing it to themselves as well. Many of these habits are unintentional and not actually meant to do any harm consciously. If this is the cas, then it would be difficult to label someone as a child abuser.

Childhood obesity: Can electronic medical records customized with clinical practice guidelines improve screening and diagnosis?

This paper represents a study that had a stated purpose of determining whether the customization of electronic medical records (EMR) has the potential of being intervened with the ability to monitor and collect data about children and adolescents who are significantly overweight. There are many advantages that the EMR system can offer over traditional record keeping. One such advantage is the ability to share records from patients quickly and easily from one office to another so that the current provider has ability to track the problem throughout the course of their lives. However, at the same time, the article also takes time to point out the fact that all of this figures were more a correlation and not causation by any means. Therefore, the methodology is certain suspect to limitations, at this one is, and a discussion of these specific limitations are illustrated later in the article.

The basic premise however is that having full access to things like body mass indexes over time could help a doctor or nurse see how the condition has transitioned over time. For example, if a patient is having difficulty and this patter has just recently begun, then the doctor could see what factors were present during that period and would consequently help them to give a better intervention that was customized based on their specific circumstances. Thus there would be the potential to identify improper coping measures that are used in stressful situations and the factors that are likely responsible for the improper diets or lack of physical activity. Once the child was identified as "at risk for overweight" or "overweight/obese" using these screening tools, the providers were prompted within the encounter note to indicate the appropriate diagnosis in the EMR and this information would be available for all future healthcare professionals to see (Savinon, Taylor, Canty-Mitchell, & Blood-Siegfried, 2012).

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There would also be the option to do universal screening to help catch children at the earliest possible stages in their personal weight gain and then evidence-based practices could be designed at these early stages of identification and intervention. The authors then claim that they have shown that customization of EMR in a primary care could help track childhood obesity with tools such as growth charts and with the scoring of risk questionnaires (Savinon, Taylor, Canty-Mitchell, & Blood-Siegfried, 2012). However, the authors also point to the fact that there will likely be something of a learning curve with the use of the technology in this setting and coding errors could occur at many different points in the process.

Hopkins, K. D., & Elliot, L. (2010). How can primary care providers manage pediatric obesity in the real world? Journal of the American Academy of Nurse Practitioners, 278-288.

Poor eating habits are suggested to be one of the primary factors that contribute to childhood obesity and the authors in this article begin by defining the terms and explaining the parameters for what is considered overweight and/or obese. The terms are typically defined by BMI and above the 85th percentile for age and gender is likely to correlate with the adult definition of overweight; a BMI above the 95th percentile correlates with the adult definition of obese (Hopkins & Elliot, 2010). The BMI measure is typically considered the benchmark for determining at risk individuals because it is fairly easy to calculate and it is also an accurate predictor.

There have been many factors that have prevented primary caregivers from diagnosing these conditions. These conditions are often not considered an illness by insurance companies and thus doctors cannot be compensated for treating the condition directly but are often reimbursed for other correlated illnesses. Therefore, in many cases there is no incentive for the doctor to try to address the obesity issue head on and therefore many providers do not consider these conditions to be a priority. In fact, from a financial standpoint, there might actually be a stronger incentive for the physician to not treat obesity because they will treat more comorbid conditions indefinitely into the future. However counterproductive this may seem, it is likely some have viewed the situation from this perspective.

The authors provide various interventional and management approaches in the healthy overweight and otherwise healthy obese child and these interventions are divided into three groups: nonpharmacological, pharmacological, and surgical approaches. The authors illustrate many of the related issues that children might face in response to comorbidity and then go on to develop a framework to intervention at different levels. The diet is the focus of the stage one procedure. Other factors that have been shown to correlate are environmental, such as lack of exercise, other sociocultural factors and there may even be some genetic predispositions that can influence the tendency toward obesity. Despite these related factors many believe that the most influential factors are diet because children on average are now consuming more foods that are high in calories.

These foods are energy rich because they include ingredients that have dense artificial sugars such as high fructose corn syrup among other ingredients. Since these foods are energy rich, or contain higher calories and sugar densities than non-processed foods, it makes it more difficult for children to burn these calories naturally and one part of an intervention is for children to consume five or more servings of fruits and vegetables daily (Hopkins & Elliot, 2010). This also has led to the development of other dietary recommendations that are lifespan-tailored for children, such as the Traffic Light Diet that breaks down food based on the colors of the traffic light. For example, healthy foods are labeled green and children are allowed to eat as much as they would like; however, energy rich foods would be in the red category and must be closely monitored. Furthermore, as the stages progressed, new strategies for balancing diet and activity are suggested through various strategies. There is currently one medication approved by the Food and Drug Administration (FDA) for the treatment of adolescent obesity and there is also bariatric surgery is to be judged on an individual basis according to associated comorbid conditions (Hopkins & Elliot, 2010). However, these treatments should only be considered in the most extreme cases and utilized only when all other options have failed......

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