Date of Award
Spring 5-22-2025
Document Type
Doctor of Nursing Practice Final Manuscript
Degree Name
Doctor of Nursing Practice
Department
Nursing
First Advisor
Andrea Bell, DNP, APRN, FNP-C, CPNP-PC
Abstract
Background: In the United States, the increasing prevalence of obesity has caused public health concerns. From 2017 to 2020, 14.7 million children ages 2 to 19 were considered obese. The main parameter for diagnosis is a body mass index (BMI) at or above the 95th percentile on the growth chart. Additionally, overweight is defined as a BMI between the 85th and 95th percentiles. At a pediatric primary care clinic in San Diego, CA, over a third of patients are considered overweight or obese. Obesity comorbidities can include type 2 diabetes, hypertension, and hyperlipidemia. Overweight adolescents have a 70% likelihood of becoming overweight or obese in adulthood. Adult patients with obesity pay on average $1,861 more annually for healthcare than a patient of a healthy weight.
Purpose of Project: The Family Nutrition and Physical Activity (FNPA) screening tool can be implemented in pediatric primary care clinics to address lifestyle habits and risk for childhood obesity. Using this tool will flag more obesogenic behaviors to the provider than the standard practice, enabling them to counsel the family on lifestyle changes. Ultimately, this will increase screening and allow earlier intervention for childhood obesity.
EBP Model/Frameworks: The Johns Hopkins Nursing Evidence-Based Practice model (JHNEBP) was used to critically analyze current research and translate it into practice. This model has a standardized problem-solving approach to evidence-based project (EBP) that is user-friendly, regularly updated, and aims to incorporate new ideas into practice quickly.
Evidence Based Interventions: Thirty-three families with children aged 4 to 18 presenting for their well-child visits filled out the FNPA tool and the standard 5210 Healthy Habits Questionnaire. Motivational interviewing (MI) techniques were used to counsel the family on areas of potential improvement and set a specific, measurable, achievable, relevant, and time-bound (SMART) goal. After three months, families were contacted to fill out the FNPA tool again. Height, weight, and BMI of each patient were collected and de-identified for data analysis purposes.
Evaluation of Results: After three months, 27 families participated in a follow-up via phone call. Twenty-five participants’ FNPA scores improved, signifying that family lifestyle changes were implemented. A paired sample t-test showed that scores significantly increased from the pre-intervention score (mean = 64.67, SD = 5.903) to the post-intervention score (mean = 70.67, SD = 5.407); t(26) = -7.109, p< 0.001. Additionally, this tool flagged more obesogenic behaviors to the primary care provider than the usual 5210 Healthy Habits Questionnaire. This helped providers identify patients at risk earlier than the standard of care.
Implications for Clinical Practice: In using the FNPA screening tool, the provider can better counsel and intervene towards a family’s lifestyle behaviors when compared to the 5210 Healthy Habits Questionnaire. Increased screening has the potential to identify more children at risk and begin weight management interventions. Improved lifestyle behaviors can potentially minimize the risk for childhood obesity. In turn, reduced rates of childhood obesity will likely have large cost savings.
Conclusions: Families that were screened using the FNPA tool and counseled with MI techniques had a mean improvement of 9% (six points) in their score and demonstrated improved lifestyle behaviors over three months. Future studies may be necessary to follow-up with families for a longer period after intervention to see long-term lifestyle changes.
Digital USD Citation
Mak, Michelle J., "Beyond the BMI: An Educational, Family-Centered Approach to Identifying Risk for Childhood Obesity" (2025). Doctor of Nursing Practice Final Manuscripts. 313.
https://digital.sandiego.edu/dnp/313
Copyright
Copyright held by the author
