What is the issue?

1 in 4 children aged 2 to 17 years in Australia are living with overweight or obesity.  The costs to the Australian healthcare system associated with overweight or obesity at aged 4-5 years are nearly $10 million.  Children with obesity are five times more likely to grow up into adults who have obesity.  Given the long-term health and economic impact of obesity, early prevention and treatment is important.  Nurses who work in child and family health, community nursing, health promotion, paediatrics and school health have established roles that can support early prevention, treatment and management of overweight and obesity.

What did we do?

We investigated the work of nurses, nationally and internationally, on where and how they work with infants, children and adolescents, by searching widely across five scientific databases.

We undertook a scoping review, which looks at a broad range of research, including published scientific research, government reports and research dissertations and theses from university students.

What did we find?

In 83 studies and over 100 research papers, we found:

• Nurses work in a variety of roles in primary health care, communities and schools to promote health, nutrition and physical activity. This includes:
  • Teaching nutrition and physical activity education in the school curriculum
  • Providing healthy lifestyle counselling, mentoring or coaching, across primary health care settings, such as clinics and school-based health centres
  • Educating parents and students on various topics such as nutrition, physical activity, sedentary behaviour, portion size, label reading, understanding media and advertising influences, social eating, managing stress, self-esteem and self-efficacy, behaviour change, goal setting, mindful eating, and parenting skills
  • Running practical cooking and physical activity sessions.
  • Undertaking home visiting programs for parents and infants
  • Supporting change through health advisory and consultant roles, such as program roll-outs or on school health boards
  • Supporting programs to promote healthy environments in childcare settings
• Health services infrastructure such as school-based health centres in the USA or UK are effective in providing accessible primary health care services to students but they are not available in Australia. School-based health centres, staffed by practitioners like nurses and nutritionists, can provide easy access to primary health care to students, just like accessing ‘a school library’.  Common services include prevention and screening services, case management, and immunisation.
• School nurses are only available in Victoria but not in other States and Territories in Australia. In the Victorian state, school nurses are employed in local regional offices to deliver health services through school visits, provide health information and advice, develop targeted health promotion plans, and deliver health education curricula.
• Programs implementation and sustainability are heavily reliant on external funding sources such as government and private business or charity grants or donations. Many programs also rely on nursing students and research nurses. While student nurses and nurse researchers have the skill to deliver programs with children, teenagers and their parents, their involvement is transient for the duration of their studies. Sustaining program implementation would require that it is embedded in existing services and nurses deliver the program as part of their core business.

What does this mean?

• Effective interventions to prevent or manage overweight and obesity in infants, children and adolescents are best embedded in existing nurse-led health services for efficiency and sustainability. Hence, nurses need to be supported to enable the delivery of overweight and obesity prevention and management interventions as part of their routine practice.
• Given that an embedded school nurses are only available in Victoria, it is important that school staff in other States and Territories are supported to promote healthy environments for students. Existing nutrition education curricula, such as from Edith Cowan University, ACT Health and Foodbank, can help support teachers in developing the school health curriculum.

The Australian College of Nursing is the national leader of the nursing profession.  These findings will inform the update of their position statement on nurse-led interventions in assessing and managing overweight and obesity in children and young people.  The current position statement can be accessed here.

Read the abstract of the paper here

For further queries, please contact Heilok Cheng.