It is the position of the National Association of School Nurses that the registered professional school nurse (herein after referred to as the school nurse) has the knowledge and expertise to promote the prevention of overweight and obesity and address the needs of overweight and obese youth in schools. The school nurse collaborates with students, families, school personnel, and health care providers to promote healthy weight and identify overweight and obese youth who may be at risk for health problems. The school nurse can refer and follow up with students who may need to see a health care provider. The school nurse also educates and advocates for changes in school and district policies that promote a healthy lifestyle for all students.
Overweight and obesity are an increasing problem in the United States that often begins in childhood. Overweight for children is defined as a BMI at or above the 85th and less than the 95th percentile, and obesity is defined as a BMI greater than the 95th percentile for age and gender (NIH, 2012). Obesity in children can lead to serious health concerns, once only seen in adults. The rates for overweight and obesity have doubled in children and tripled in adolescents in the past 30 years, and currently almost 32% of youth between 2 and 19 are overweight or obese, at or above the 85th percentile (CDC, 2013).
The etiology of overweight and obesity is not completely understood but thought to be complex and have multi-factorial contributing factors (Crawford et al., 2010; CDC, 2012). Contributing factors may include:
Children and adolescents who are overweight and obese are at higher risk for health concerns such as (CDC, 2013; Copstead-Kirkhorn & Banasik, 2009; United States Department of Health and Human Services [USDHHS], 2010):
Coronary heart disease
Hyperlipidemia (high cholesterol)
Hypertension (high blood pressure)
Bone and joint problems
Social and psychological problems
Stigmatization and poor self-esteem
Type 2 diabetes
Good quality nutrition and physical activity are essential for growth, development, and well-being. Schools and families should promote behaviors that encourage healthy nutrition, portion control, and physical activity early in childhood and continue throughout the life span. To maintain a healthy weight, children and families should incorporate nutritionally balanced eating patterns and daily physical activity of a moderate to vigorous level for 60 minutes or more each day. The Dietary Guidelines for Americans states that eating patterns established in youth often last into adulthood making early development of healthy nutrition and physical activity behaviors a priority (U.S. Department of Agriculture [USDA] & United States Department of Health and Human Services [USDHHS], 2010).
The Physical Activity Guidelines for Americans states that regular physical activity in youth promotes health and fitness and makes it less likely they will develop risk factors for chronic illnesses. Regular physical activity also makes it more likely that youth will continue as healthy adults (USDHHS, 2008, 2012).
Healthy People 2020 (USDHHS, 2011) identifies specific goals to achieve and promote maintenance of healthy body weights. Since most children spend a large portion of their day at school, the school is a key setting to implement strategies to address this issue. The school can provide a healthy environment that supports balanced nutrition and activity.
As school nurses are in a position to reach a large number of youth, they are able to address the potential serious health problems that result from overweight and obesity. School nurses can provide essential leadership in helping students maintain a healthy weight to prevent overweight and obesity, decrease the burden of illness, and increase the quality of life.
Preventing and treating overweight and obesity requires multiple strategies. A school nurse can influence a child and his/her family to make healthy lifestyle changes by:
Identifying students who may need further evaluation by conducting screenings (height, weight and body mass index [BMI]) and assessing students for possible risk factors associated with overweight and obesity (hypertension, acanthosis nigricans, risk for type 2 diabetes, and family history);
Making necessary referrals to health care providers for further assessment and treatment;
Developing individualized health plans that address elevated BMIs and the appropriate interventions for the school day and recommendations for modifications for lifestyle;
Identifying community resources for referral for overweight and obese students;
Providing education and information to parents and families about nutrition, physical activity and community resources;
Encouraging follow up for counseling and psychological support for students;
Promoting healthy messages that encourage the consumption of healthy foods and encourage physical activity in and after school;
Serve as a role model and encourage role modeling of healthy lifestyle choices by parents and teachers;
Promoting nutrition and activity assessment by the school to help the child and adolescent identify healthy behaviors and set goals; and
Educating the school community about evidence-based healthy lifestyle changes, daily physical activity requirements, and preventable health risks associated with overweight/obesity.
School nurses initiate and lead the school community to influence policy and protocols related to wellness and can be the primary force in:
Development of youth-related wellness policies,
Promoting walk-to-school and bike-to-school programs, and
Community and school facilities to be available for physical activity for all people including after school and weekend times,
Research on the behavioral and biological causes of overweight and obesity,
Proper education to community youth organizations about the importance of making healthy food choices and obtaining the daily recommended amount of physical activity,
The importance of proper nutrition in enhancing learning and increasing brain function,
Nutritional school lunches,
Easy access to drinking water, and
Daily physical education at all schools.
The overweight and obesity problem in the United States has reached near epic proportions. School nurses are in a position to make a difference. School nurses recognize the impact of healthy eating and physical activity on academic success, promote healthy lifestyles for all students, and assist students who are overweight and obese work towards a healthy lifestyle. School nurses are in the prime position to influence the behavior of children and adolescents in developing good decision-making skills related to nutrition and physical activity to develop and achieve healthy lifestyles.
Centers for Disease Control (CDC). (2012). What causes overweight and obesity? Retrieved from http://www.cdc.gov/obesity/adult/causes/index.html
Centers for Disease Control (CDC). (2013). Childhood obesity facts. Retrieved from http://www.cdc.gov/HealthyYouth/obesity/facts.htm
Copstead-Kirkhorn, L.C. & Banasik, J.L. (2009). Alterations in metabolism and nutrition. Pathophysiology (4th ed.), pp. 969-981. St Louis: Elsevier, Inc.
Crawford, A. G., Cote, C., Couto, J., Dakinran, M., Gunnarsson, C., Haas, K., Haas, S., Nigam, S. C., & Schuette, R. (2010). Prevalence of obesity, type II diabetes mellitus, hyperlipidemia, and hypertension in the United States: Findings from the GE centricity electronic medical record database. Population Health Management, 13, 151-161. doi: 10.1089/pop.2009.0039
National Institutes of Health (NIH). (2012). How are overweight and obesity diagnosed? Retrieved from http://www.nhlbi.nih.gov/health/health-topics/topics/obe/diagnosis.html
U.S. Department of Agriculture and U.S. Department of Health and Human Services. (2010). Dietary guidelines for Americans (7th ed.). Washington, DC: U.S. Government Printing Office. Retrieved from http://www.health.gov/dietaryguidelines/dga2010/DietaryGuidelines2010.pdf
U.S. Department of Health and Human Services (USDHHS). (2008). 2008 physical activity guidelines for Americans. Rockville, MD: Author. Retrieved from www.health.gov/paguidelines
U.S. Department of Health and Human Services (USDHHS). (2010). The Surgeon General’s vision for a healthy and fit nation. Rockville, MD: U.S. Department of Health and Human Services, Office of the Surgeon General. http://www.surgeongeneral.gov/initiatives/healthy-fit-nation/obesityvision2010.pdf
U. S. Department of Health and Human Services (USDHHS). (2011). Healthy people 2020. Washington, DC: U.S. Government Printing Office.
U.S. Department of Health and Human Services (USDHHS). (2012). Physical activity guidelines for Americans midcourse report: Strategies to increase physical activity among youth. Retrieved from http://www.health.gov/paguidelines/midcourse/pag-mid-course-report-final.pdf
Acknowledgement of Authors:
Bobbi Shanks, MS, BSN, RN, NCSN
Julia Lechtenberg, MSN, RN, NCSN
Suzey Delger, MSN, FNP-c
2011 Position Statement Authors:
Melissa Mehrley, MSN/Ed, RN
Nancyruth Leibold, EdD, MSN, RN, PHN, LSN
Revised: June 2011, June 2013
All position statements from the National Association of School Nurses will automatically expire five years after publication unless reaffirmed, revised, or retired at or before that time.