Community DiagnosisBody image among girls between 13 to 17 years of age who are not comfortable with their appearance continues to increase; related to poor diet and nutrition; as evidenced by “third of teens (34.4%) in Santa Barbara County, California were overweight or obese in 2009” (Santa Barbara County Public Health Department, 2011).
Healthy People 2020 Objective NWS-10.3 states, “Reduce the proportion of adolescents aged 12 to 19 year who are considered obese. The baseline data is 17.9 percent of adolescents aged 12 to 19 years were considered obese in 2005-2008” (U.S. Department of Health and Human Services, 2012). Why this Diagnosis is a Health Problem
As our youth girls go through puberty, they become aware of peer acceptance and approval. Body image can be of great concern during this transition as more focus is placed upon physical appearance. When an adolescent has a negative perspective on body image, it can lead to low self-esteem, poor eating habits, dieting, depression, anxiety, and eating disorders (National Association of Social Workers, 2013).
The negative effects can lead to a decrease in grades and an increase in teasing and/or bullying. Being overweight can increase the risks of coronary heart disease, Type 2 Diabetes, cancers (endometrial, breast, and colon), hypertension, dyslipidemia, stroke, liver and gallbladder disease, sleep apnea and respiratory problems, osteoarthritis, gynecological problems (Weichselbaum and Buttriss, 2011).
Research has also shown that United States adolescents who perceive themselves as overweight tend to perform poorer academically compared to those who do not see themselves as overweight (Florin, Shults, & Stettler, 2011).
Current Nursing InterventionsSanta Barbara County Public Health Department has established a Healthy Weight Promotion & Obesity Prevention Plan.
There are seven types of interventions that are currently available which include:
“Prevention Education (kids, parents, and youth serving professionals), School Interventions (food services, PE, and health education), Physical Activity Opportunities (after-school sports, youth centers, and active technology), Community Planning (walkability, parks, safety, transportation, restaurant and market permits), Food Service Policies (menu labeling, banning unhealthy ingredients and proportions), Media Outreach (public service announcements), Medical Treatment (medical and behavioral interventions)” (Santa Barbara County Public Health Department, 2011).
One physical activity promotion strategy discussed is for medical providers to “monitor patient weight, and prescribe and support regular physical activity with exercise regimens, referrals, and follow-up” (Santa Barbara County Public Health Department, 2011). If the adolescent becomes teased or bullied because of their body image and suicide becomes an issue, there are many hotlines that an adolescent can utilize.
The National Hopeline Network (1-800-SUICIDE), National Suicide Prevention Lifeline (1-800-273-TALK), and the Santa Barbara County Family Service Agency (1-800-400-1572) are just a few hotlines that the adolescent could use (Melody Clark, 2012). To help tackle negative effects of body image, adolescents need information on consuming fruits and vegetables, physical activity, decreasing the amount of high fat/sugar foods and drinks, and reducing television/electronic time. Successful Interventions
One intervention that has shown to be effective is parental involvement. “Parental involvement leads to more favorable results in obesity prevention, as the family is thought to be key to developing a psychosocial environment that is conducive to healthy eating and physical activity” (Stice, Shaw, & Marti, 2006, p. 669). According to Stice et al. (2006), TV viewing and video game usage should also decrease the risk for future weight gain. These interventions can directly affect one’s weight which in return can enhance one’s body image and healthy nutrition. Unsuccessful Interventions
According to Pretlow (2011, pg. 295), a website was created in response to overweight teens and preteens. This website provided information such as healthy eating, portion control, and exercise, along with online peer support. However, most youth reported little or no change in weight loss.Planning
Plan Title: Education To Girls Between The Age Of 13-17 On Body Image And Healthful NutritionShort Term Goal: Through the implementation of educational sessions, adolescents 13-17 years of age who have a Body Mass Index of greater than 30, will lose at least 1% of their body weight within 3 months.
Learner Objectives:1.By the end of the first hour of educational class, the participants will be able to list the benefits of losing weight and how it pertains to body image (cognitive domain).
2.By the end of the second hour of educational class, the participants will be able toidentify two coping strategies to deal with food cravings and unhealthy eating (affective domain).3. By the end of the third hour of educational class, the participants will be able to name at least six activities that they can partake in to help with weight loss (cognitive domain).
These supporting objectives signify all of the measures necessary to achieve the main objective of losing at least 1% of their body weight within 3 months.
These objectives are specific, behaviorally stated, and measureable over a period of time (Stanhope & Lancaster, 2010, pg. 228). Given the diversity of adolescents in the Santa Barbara County area, populations, demographics, socioeconomic status, and education level will be considered. Since most 13-year olds in California are in the 8th grade, a uniform content will be used and presented at a 6th grade level to ensure the information given is easy to comprehend by all participants.
Table 1Estimated Budget for Education on Body Image and Helpful Nutrition for 25 Participants Item| Price| Quantity| Total|Student Nurse Time| $15.00/hour| 36 hours| $540.00| Handout for participants (15 pages)| $2.41/presentation1| 25| $60.25| Pens for note taking| $11.99/pack of 501| 1| $11.99| Room| $0/to be held at school| 1| $0|
Pocket size retractable tape measure| $0.99| 25| $24.75| Portable weight scale| $19.992| 1| $19.99|Turbokick/Zumba Instructor as a guest| $0 (friend)| 1| $0| 24 pack of bottled water| $4.003| 2| $8.00|Total| | | $664.98|
1: Price subject to vary. Identified variable extracted from Staples.2: Price subject to vary. Identified variable extracted from Target.3: Price subject to vary. Identified variable extracted from Wal-Mart.
Interventions and EvaluationObjectives| Learning Domain| Topical Outlines for Objectives| Plan for Evaluation| 1. By the end of the first hour of educational class, the participants will be able to list the benefits of losing weight and how it pertains to body image.| Cognitive Domain| Timeline:
First Hour Teaching SessionUse of PowerPoints, Handouts, and DiscussionThe student nurse will provide a PowerPoint presentation that includes how obesity effects the body physically and mentally. Also the benefits of losing weight will be discussed. Data will be provided related to obesity.
The participants will partake in a discussion related to how obesity pertains to one’s body image.Primary InterventionsHealth education for 13-17 year olds who do not see the negative effects of obesity and how it effects body image.1. Educate participants about the negative effects of obesity, such as heart disease and diabetes.
2. Educate participants on the short-term and long-term benefits of losing weight.Secondary InterventionsHealth Screening to see how many participants already have negative effects of obesity.1. Ask participants about diabetes, low- self esteem, dieting, eating disorders and/or depression due to obesity.2. Use the weight scale to screen for elevated weight.| The student will start off by administering a short questionnaire before the start of the session.
The questionnaire will note if the participants see themselves as overweight. Then, they will be asked what negative effects they think being overweight has on the body and the person. This will help evaluate what the participants learned after the first session.
At the end of the first session, another questionnaire will be given to evaluate topics discussed and what the participants gained from the first session. The student nurse can compare the two questionnaires to ensure that the participants were able to list the benefits of losing weight and how it pertains to one’s body image.|
2. By the end of the second hour of educational class, the participants will be able to identify two coping strategies to deal with food cravings and unhealthy eating.| Affective Domain|
Timeline: Second Hour Teaching SessionUse of PowerPoint and Handouts The student nurse will provide a PowerPoint presentation including information successful interventions that have been shown to help reduce obesity. Also discussed will be coping strategies used to deal with being overweight and ways to increase healthy nutrition and eating habits.Primary InterventionsHealth education to 13-17 year olds on coping strategies and healthy nutrition.
1. Educate participants on behavioral and cognitive coping strategies that can be used.2. Educate participants on healthy nutrition and how it can affect their eating habits.Secondary InterventionsDiscuss the different coping strategies and the healthy nutrition and eating habits that they would be willing to implement.1. Ask participants which coping strategies they will use when they are overweight.2. Ask participants which types of foods they will choose when making decisions on what types of foods to eat. | The student will administer a short questionnaire before the start of the second session.
The first question will note how much the participants thinks they are overweight in pounds. Next, the participants will be asked to list as many cognitive and behavioral coping strategies that come to mind. Next, the participants will be asked to list as many healthy foods that they can think of. At the end of the second session, another questionnaire will be given with the same questions, to evaluate what was learned during the session. The student nurse will compare the two questionnaires to evaluate the effectiveness of the session and what was learned.|
3. By the end of the third hour of educational class, the participants will be able to name at least six activities that they can partake in to help with weight loss.| Cognitive Domain| Timeline: Third Hour Teaching SessionUse of PowerPoint, Handouts, and Guest Turbokick/Zumba Instructor (Akane Roddy)
The student nurse will provide a PowerPoint presentation that includes local resources and support groups that can help youth with obesity and nutritional education. A handout will be provided that includes the resource information along with the contact information. The guest fitness instructor will present some exercises that can be done to help reduce weight and make the experience fun and a learning environment for the participants.Primary InterventionsHealth education for 13-17 year olds on local resources for obesity and nutritional education.
1. Educate participants on the importance of seeking others who are also faced with the same situation and the resources available.2. Provide contact information for at least two local fitness events and support groups.3. Provide first hand instructional exercises that can be used to help decrease weight through exercise.Secondary InterventionsDiscuss any other resources or support groups that the participants may be aware of .
1. Ask participants what kind of support systems they will need in order to tackle obesity and making healthy nutritional choices.
2. Ask the participants which resources they would be interested in choosing and contacting for more information.| The student nurse will direct a discussion on the local resources and support systems/groups that are available. After the discussion, the participants will name which resource they would like to contact for more information. A short questionnaire will be given to see what the participants learned from the guest fitness instructor and how those exercises can impact their overall health.|
ReferencesFlorin, T. A., Shults, J., & Stettler, N. (2011). Perception of Overweight Is Associated With Poor Academic Performance in US Adolescents. Journal Of School Health, 81(11), 663-670. doi:10.1111/j.1746-1561.2011.00642.x
Melody Clark. (2012). California Suicide and Crisis Hotlines. Retrieved from http://suicidehotlines.com/california.htmlNational Association of Social Workers. (2013). Adolescent Girls and Body Image. Retrieved from http://www.naswdc.org/practice/adolescent_health/ah0204.asp
Pretlow, R. A. (2011). Addiction to Highly Pleasurable Food as a Cause of the Childhood Obesity Epidemic: A Qualitative Internet Study. Eating Disorders, 19(4), 295-307. doi:10.1080/10640266.2011.584803
Santa Barbara County Public Health Department. (2011). Healthy Weight Promotion & Obesity Prevention Plan. Retrieved from http://www.countyofsb.org/phd/healthed.aspx?id=39606Stanhope, M., Lancaster, J. (2010). Foundations Of Nursing In The Community: Community-Oriented Practices. (3rd ed.). St. Louis, Missouri: Mosby Elsevier.
Stice, E., Shaw, H., & Marti, C. (2006). A meta-analytic review of obesity prevention programs for children and adolescents: The skinny on interventions that work. Psychological Bulletin, 132(5), 667-691. doi:10.1037/0033-2909.132.5.667
U.S. Department of Health and Human Services. (2012). Healthy People 2020: Nutrition and Weight Status. Retrieved from http://www.healthypeople.gov/2020/ topicsobjectives2020/objectiveslist.aspx?topicId=29
Weichselbaum, E. E., & Buttriss, J. J. (2011). Nutrition, health and schoolchildren. Nutrition Bulletin, 36(3), 295-355. doi:10.1111/j.1467-3010.2011.01910.x