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Goals for NPs caring for children and adolescents with weight problems are early identification and referral to treatment in order to prevent the well-known adverse effects the diagnosis of eating disorders places on the child, adolescent, and family members-and, in time, the overall health of the adult population.
Ms. Nierengarten’s article ”When losing weight leads to eating disorders” in the latest issue of Contemporary Pediatrics recaps the American Academy of Pediatrics’ (AAP) brief but succinct eating behaviors update, which nurse practitioners (NPs) can apply directly to clinical practice. Goals for NPs caring for children and adolescents with weight problems are early identification and referral to treatment in order to prevent the well-known adverse effects the diagnosis of eating disorders places on the child, adolescent, and family members-and, in time, the overall health of the adult population.
All NPs need to recognize that obesity is also an eating disorder, with a direct relationship between overweight and obesity to other eating disorders such as anorexia nervosa, bulimia nervosa, and binge eating commonly seen in children and adolescents.
In addition to this latest AAP guidance on the subject, I encourage each NP to review the AAP’s 2010 clinical guideline on eating disorders, its 2015 guideline on the primary prevention of obesity, and its 2016 report on preventing obesity and eating disorders in adolescent in order to become well versed on identification and treatment planning to prevent obesity and eating disorders in children and adolescents.
To accomplish prevention goals for obesity and eating disorders, NPs must evaluate their clinical practices in both primary care and in acute care settings. The first question the NP must ask is: How are we addressing overweight, obesity, and eating disorders for every infant, child, and adolescent at every primary care visit? The answer is readily available in the electronic medical record (EMR) because aggregate statistical data on the number of children who are overweight, obese, and/or underweight in a practice can be abstracted from the EMR. The aggregate data will provide the percentage of children in the practice who are overweight, obese, or underweight. Once this percentage is known, the NPs can analyze individual data to identify the current practice parameters and address any issues that emerge.
For instance, a random review of individual records of children who are identified as overweight, obese, or underweight will reveal whether or not weight was addressed by the provider and what guidance was given to the parents and/or child. Based on the combination of analysis of the aggregate data and individual records, NPs and all providers in the practice setting can then determine the best ways to implement the AAP guidelines in the practice.
Parents, children, adolescents, and pediatric healthcare providers must work together to raise a healthier population of children and adolescents to achieve a reduction in the prevalence of adult cardiovascular and endocrine disorders that are directly linked to overweight, obesity, and underweight during the pediatric years.
If we commit to applying the AAP guidance in our daily interactions with our patients, we will be taking that crucial first step with them on their journey to a healthier tomorrow.