Presented at Creating Connections 2010
Renee Buchanan Porter, RN, CPNP, Obesity Nurse Coordinator, The Children’s Hospital, Denver
Shaun Ayon, BS, Manager, Continuing Medical Education, The Children’s Hospital, Denver
Sharon Braun, RD, CDE, Head Dietician for Pediatric Endocrinology, Childrens Hospital Los Angeles
Michelle Demeule, MS, RD, Manager, Weight Smart Program, Mt. Washington Pediatric Hospital, Inc., Baltimore
Megan Lipton, MA, Program Director, Childrens Hospital Los Angeles
Heather Paves, MS, RD, CD, Clinical Dietician, Seattle Children’s
Tom Peterson, MD, Medical Director, Helen DeVos Children’s Hospital, Grand Rapids, MI
Mo Pomietto, MN, RN, Clinical Nurse Specialist, Seattle Children’s
Stacy Stolzman, PT, Physical Therapist, Children’s Hospital of Wisconsin, Milwaukee
Karrie Stuhlsatz, RD, LD, Registered Dietician, Doernbecher Children’s Hospital – OHSU, Portland, OR
Karen Young, MD, Medical Director of Fitness Clinic, Arkansas Children’s Hospital, Little Rock
Currently about one third of children in the United States are overweight or obese1,2. To address the needs of this growing population the National Association of Children’s Hospitals and Related Institutions (NACHRI) convened a multi-disciplinary task force “FOCUS on a Fitter Future” in the fall of 2008. The goals of this task force are to examine and refine successful components of hospital-based clinical obesity programs. One of the subgroups of this task force was charged with creating standards of care to enable children’s hospitals to provide a safe and therapeutic environment for obese patients. We polled nineteen NACHRI member children’s hospitals about components of a healthy hospital environment that identify, support and treat obese patients and developed recommendations for best practices based on those results.
- To examine current practices in children’s hospitals that provide for a safe, healthy and supportive environment for obese patients.
- To provide guidelines for pediatric hospitals on appropriate resources required to provide a safe, comfortable experience for their obese patients.
Thirty-seven percent (7/19) of NACHRI member hospitals that were surveyed had a policy in place that identifies overweight and/or obese children and intervenes or treats these children. A majority of the hospitals surveyed (58%) do not have a policy in place to ensure the safety of overweight and/or obese patients. Although the majority of hospitals surveyed (89%) do promote physical activity (i.e., teen lounge, gardening, playrooms, music therapy), they also reported the barriers to the promotion of healthier nutrition options are that it is “too costly to implement” (91%) and “not profitable” (75%).
Children’s hospitals should be equipped to provide care for obese pediatric patients as their utilization rates of hospital services are increasing. Obese patients have unique needs in triage, specialized equipment, transportation, and training of hospital personnel, in addition to needing access to providers with expertise in childhood obesity and its complications. The survey results indicate that many children’s hospitals currently care for obese children but do not have policies in place or possess the equipment and capacity to adequately identify and/or care for the obese child or provide healthy nutrition in their institution. From this survey we identified three recommendations that we have expanded upon to provide specifics guidelines for children’s hospitals to improve their environment for the obese patient 1) Establish a safe hospital environment for the obese patient and family. 2) Identification and treatment of obesity should occur in all in-patient and out-patient settings in children’s hospitals. 3) Create a healthy hospital environment around wellness for patients and families. Our results indicate that hospital administrators have an opportunity to identify and address barriers to providing optimal care to obese patients. Barriers include financial and/or space constraints that limit procurement of adequate resources such as supplies, trained staff and absence of policies that promote a healthy hospital environment for patients, staff and visitors.