Effects of family nutrition and physical activity screening for obesity risk in school-age children

Abstract

Purpose: An obesogenic home environment is a major contributor to overeating and sedentariness in school-aged children, as children have less autonomy during this phase of development and are influenced by family environmental cues. The purpose of this study was to implement a screening tool at a low socioeconomic elementary school clinic to identify children at risk of developing obesity and provide standardization for practitioners on educating parents regarding child obesity risk factors.

Design and methods: An evidence-based practice design utilizing the Family Nutrition and Physical Activity (FNPA) tool was completed at all visits of patients ages 4 to 11. Parents completed the 20-item screening tool related to 10 factors (family meal patterns, family eating habits, food choices, beverage choices, restriction/reward, screen time behavior and monitoring, healthy environment, family activity involvement, child activity involvement, family routine). The nurse practitioner (NP) provided parents with education regarding healthy home practices based on American Academy of Pediatrics (AAP) recommendations. Level of obesity risk (low, moderate, and high) was determined based on the FNPA score and body mass index (BMI) of the patient. Patients identified as at-risk were scheduled for a 2-month follow-up and rescreened to determine if lifestyle modifications were made.

Results: Twenty-seven children were screened using the FNPA tool, with an initial mean FNPA score of 64. Ninety-three percent were classified as a moderate or high risk for obesity (BMI percentile 85th or greater and/or moderate-high risk FNPA scores). Seven percent had a healthy BMI and low-risk FNPA scores and did not require follow-up intervention. Sixty-seven percent of patients scores improved at follow-up, with an average FNPA score of 70. Effect size stratified by risk category was low-risk score 0.07 and moderate-risk score 1.49 with a standard deviation of 5.36.

Practice implications: Implementation of the FNPA tool at a school-based clinic is a feasible opportunity to identify children at risk for obesity and allows for anticipatory guidance by the NP to increase awareness of parental influence as role models for healthy lifestyle behaviors.

Keywords: childhood obesity; elementary school; family environment; screening tool.