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Childhood Obesity with the Rise of Social Media

Jessica Cadorette

University of South Florida

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Childhood Obesity with the Rise of Social Media

Manatee county is home to spectacular scenery and to some of the countrys most

beautiful beaches. It is a part of the United States where most people are drawn to take vacations

year-round. Taking a look at vacation city populations is always interesting to research. The

majority of the residents in this county are elderly and overall pretty active for their age.

However, when researching the younger generation, in particular those aged 11-14, childhood

obesity is pretty prevalent. In fact, this county has a higher rate for childhood obesity than the

state of Florida. Childhood obesity is on the rise due to the increase of social media, lack of

physical activity, and decrease in consumption of healthy foods. This paper explains different

interventions that can help Manatee County decrease the rate of children being diagnosed as

obese.

Overview of Manatee County

Manatee county is located along the west-central coast of Florida. It is located just south

of Hillsborough county, north of Sarasota county, east of Hardee county, and the Gulf of Mexico

is located to the west (Manatee County,2017). Anna Maria Island is a seven-mile island located

in Manatee County. There are four national protected locations in Manatee county which are: De

Soto National Memorial, Passage Key National Wildlife Refuge, Lake Manatee State Park, and

Myakka River State Park (Manatee County, 2017).

According to the 2015 estimated U.S Census, the population of Manatee county was

estimated at 322,833. Of the population, 81.9% were as white, Black or African America alone

was 8.7%, American Indian and Alaska Native alone was 0.3%, Asian alone was 1.6%, Native

Hawaiian and other Pacific Islander alone was 0.1%, two or more races was 2.0%, and Hispanic

or Latino was 14.9%. (U.S Census, 2015). Due to the high population, the majority of Manatee
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county is classified as an urban area. Myakka, located in the eastern part of Manatee county is

the only rural area of this county (Manatee County,2017). The top three employers in Manatee

county are as followed: Manatee County School District, Manatee County Government, and

Bealls Inc. (Bradenton Area Economic Development Corporation, 2017). Manatee Healthcare

System is the top healthcare system. This system includes Manatee Memorial Hospital and

Lakewood Ranch Medical Center. Manatee County represents approximately 1.8 percent of

Floridas total population and continues to grow each year (U.S Census,2015).

Comparison of Local vs. State populations

The socioeconomic indicators in Manatee county during the years 2011-2015 were very

close to those of the whole state of Florida. The percentage of the total families that was below

the poverty level in Manatee County was 10.2%, where as in the state of Florida it was 12.0%.

The percentage of the population aged twenty-five or older with a high school diploma in

Manatee county was 30.7% and state percent was 29.5%. Additionally, the population aged five

or older that do not speak English was 6.9% with the state rate listed as 11.7%. In Manatee

county, the rate of total licensed primary care providers is 15.0% and the state rate is 14.0%

(Health County Profile,2017).

Analysis and Interpretation of Data

Identified Strengths

Diabetes is a prevalent disease of this decade, however, even though it is discussed so

much, the amount of people who manage their diabetes properly is poor. With that being said,

Manatee county has a higher percentage of individuals who self-monitor their blood glucose

daily. According to the County Health Profile, in 2013, for the state of Florida the percent of
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individuals who self-monitor their blood glucose at least once a day was 61.8% and in Manatee

county it was 74.3%. This is a positive statistic for Manatee county because, with more

individuals monitoring their glucose daily, it will lead to fewer complications and

hospitalizations. Years prior Manatee county was below average in this area, therefore, the

information about daily self-monitoring is being heard and getting done.

In 2015, infant deaths rate from 0-364 days per 1,000 births in Manatee County was 5.3

and in the state of Florida the rate was 6.1 (County Health Profile,2017). This is a strength for

this county because a significant amount of women are not starting their prenatal care during the

first trimester. Prenatal care that began in the first trimester is below the state level by 6%.

(County Health Profile,2017).

In Manatee county, 19.7% of adults were recorded as sedentary and the state percent was

27.7% (County Health Profile,2017). This shows that adults in Manatee county are being active

and not staying inside all day doing nothing. This is especially significant because the population

of older adults is 5% greater in Manatee county than in the state of Florida. This is superb

because with the population being active it will lead to fewer health complications later in life.

Identified Weakness

Childhood obesity is national health crisis in the United States. Manatee county middle

schoolers were estimated at 14.4% of having their Body Mass Index at being in the 95th

percentile or higher. Whereas, the state percentage was estimated at 11.1% (County Health

Profile,2017). A BMI in the 95th percentile is classified as obese. This is a priority health issue

in this county that needs to be resolved.

In Manatee county, the rate of total physicians is 208 per 100,000 people, while in the

state of Florida the rate is 249. With a lack physicians, the waiting time to see a physician
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increases, causing people not to go see their doctor and ultimately that may be the reason there is

a decline in overall physical health in this county. (County Health Profile, 2017).

In 2013-2015 the rate for Varicella for Manatee county was 4.7 and the state rate is 3.4.

The rate for hepatitis B was 2.6 while the state rate was 2.2. Meningococcal disease rate in

Manatee county was 0.7 and the state rate was 0.2. The Pertussis rate is listed as 4.4 and the state

rate was 3.0 (County Health Profile,2017). All of these rates for vaccine preventable diseases are

higher than the state rate in Florida, therefore, the population in Manatee county is not getting

vaccinated for these diseases, and people are getting infected with these particular diseases.

Identification of a Priority Health Issue

Healthy People 2020 (2017) stated obesity among children and adolescents aged two to

nineteen as a leading health indicator. In Manatee county, one health indicator that needs to be

improved is the percentage of middle schoolers who have a BMI at the 95th percentile or higher.

An individual ranked equal to or greater than the 95th percentile is classified as obese. The state

percentage for this is 11.1% but in Manatee county it is 14.4% (County Health Profile,2017).

This means that 14.4% of middle schoolers are classified as obese. This is a priority health issue

for this county because these children are at a higher risk for diabetes, heart disease, and

hypertension and they are only between the ages of 11-14! Not only does this affect them

physiologically, but also mentally. They are more likely to suffer from depression as well as a

low self-esteem (Pbert et al. 2014). Additionally, this particular county is above the state

percentage for individuals with hypertension, high cholesterol, adults who are overweight,

stroke, heart attacks, heart failure, and coronary artery disease (County Health Profile,2017).

Obesity is a comorbidity to the chronic diseases listed above. If there was a decrease in middle
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schoolers with a BMI in the 95th percentile and higher, there could be a decrease in chronic

diseases.

Discussion and Application of Community Health Models

Health models are beneficial for healthcare providers because they help understand

patients health behaviors which, helps promote health and disease prevention. Community

health models are essential to providing quality care because it allows for greater opportunity for

interventions. Determinants-of Health Model provides a wide range of factors that influence an

individuals health status. It includes biological, social, economic, and environmental factors.

(Savage, Kub, Groves, 2016). This model serves at the macrosocioecological level, which allows

providers to focus on an entire population rather than at an individual level within a community.

For instance, when analyzing where people are born, work, learn, grow, and play it allows

providers to see what makes someone healthy and others unhealthy; it allows providers to create

a community where quality of life is increased because this model is impacting all aspects of

health (Healthy People 2020). Therefore, determinants-of Heath Model are vital for every

community.

There are several factors that influence Manatee countys priority health issue.

Biologically, middle schoolers could be obese because they may have a family history of obesity.

According to Hill (2013), if both parents are obese the child has about an eighty percent chance

of being obese, a child has a fifty percent chance of being obese if only one parent is obese, and

if neither of the childs parents are obese then the child only has a ten percent chance of being

obese. Also, the CDC found that change in the MC4R gene can lead to obesity. MC4R encodes

for the melanocortin 4 receptor which if changed, causes children to feel very hungry leading to

overeating constantly (Genes and Obesity, n.d).

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Access to healthcare can affect Manatee counties priority health issue. Currently, twenty-

four percent of Manatee counties population is uninsured (Health Rankings, 2017). This may

impact middle schoolers who are obese because without insurance their parents are less likely to

bring them to their physicians for yearly physicals and delay emergent medical care. This

percentage of the population is likely to be uninsured due to the excessive cost of insurance. In

Manatee County half of the businesses have five or fewer employees, which may affect their

ability to offer healthcare benefits to their employees (Florida Department of Health in Manatee

County, 2013).

There are many factors in a childs environment that can affect their likelihood of

obesity. The home environment is a critical place where parents can influence their childrens

food choices. If parents have healthy eating habits, their children are likely to be motivated to

eat healthy. Vice versa, if parents are consuming food high in calories and fat, their child is

more likely to follow their unhealthy eating habits (Karnik and Kanekar, 2015). Also, children

spend the majority of their time at school therefore, schools need to promote healthy food habits

and physical activity. In Manatee county, they have incorporated a healthier lunch menu to

promote heathy eating habits. All Manatee county schools, offer the traditional menu items

which include least one vegetable and fruit. In addition, they always offer a variety of three

different salads and no longer have high sugar drinks, like soda and energy drinks, in their

vending machines. However, everyday students still have the option of pizza, hamburgers,

French fries, and crispy chicken sandwiches (Manatee County Childrens Services Annual Plan,

2016). Even though Manatee county offers healthier options, those healthy options are the most

expensive items. Many parents are unable to afford those healthy lunch items. Additionally,

kindergarten through eighth grade students must participate in gym class daily. Another
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environmental factor that affects childhood obesity is a communitys availability of facilities that

promote exercise outside of schools, such as parks, safe side walks, and bike paths. Manatee

county has twenty parks throughout the county and seven different bike trails (Manatee County

Parks and Natural Resources, 2016). A childs lifestyle can influence their health and can cause

obesity. Fewer children are playing outdoors outside of school due to the rise of social media

and apps such as Netflix and Hulu, which encourage binge watching. According to the U.S

Department of Health and Human Services (2016), children spend around four hours on social

media and two hours watching television during the weekdays. Weekends children spend an

average of six hours on social media and four hours watching television. A child who engages a

lifestyle glued to their devices will likely be impacted by childhood obesity.

Population Diagnosis

Middle schoolers in Manatee County are at an increased risk of having a BMI in the 95th

percentile or higher due to the rise of social media, decline of physical activity, and lack of

consumption of healthy foods. Sahoo et al. (2015) states, each hour spent using social media per

day results in lack of daily exercise and increase prevalence of obesity by two percent.

Additionally, children who eat fast food and high-fat and sugary snacks increase their chance of

obesity by four percent (Sahoo et al, 2015).

Community/ Population- based Interventions

Primary Level of Prevention

In Manatee county, students are allowed to use their cell phones in class upon the

teachers permission. In order to prevent childhood obesity, there must be a system- wide

restriction on cell phone usage during gym class. Lepp, Barley, Sanders, Rebold, and Gates
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(2013), stated that by taking away cellphones during physical exercise increased

cardiorespiratory fitness by twenty percent. This restriction would promote physical activity and

participation in class. Stakeholders involved in this intervention would be health care providers

and school board officials. Health care providers must inform school board officials the

importance of participation in gym class and how the hour of physical activity can help decrease

childhood obesity. School board officials must then implement a county-wide policy of no

phones during gym hour. The school board must then fund schools for more equipment to keep

the students interested and active during gym class. In developing this intervention, community

health nurses can express this issue to their providers and together they can discuss the best way

to implement their plan to the school board about positive steps to improve student participation

during gym. To carry this out the community health nurses need to meet with school board

officials and stress the importance of this issue.

Secondary level of Prevention

The entire community helps play a role in the healthy lifestyle of a child, therefore they

should be involved in the treatment of childhood obesity. One way the community can treat

obesity is by putting together events such as healthy food festivals or providing entertainment at

parks (Karnik and Kanekar, 2015). This would allow individuals to eat healthy foods and

encourage exercise. The community is a stakeholder in this because communities have the

resources to be able to provide social events that can promote healthy nutrition and physical

activity. Funding concerns related to this intervention may limit the community to only be able to

hold these social events monthly or bimonthly. Careful budgeting would need to take place in

order to hold these events weekly. Community health nurses can help develop these social events

by attending monthly community meetings to discuss the requirements that need to occur at each
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social event. For instance, the nurses can instruct what healthy foods to provide the community

with, and what physical activities they can incorporate at each event. To see if the events were a

success the community health nurses should follow up with the community at the following

meeting. In addition, the community health nurse should follow up with the patients that

attended the event and see how effective the event was toward their treatment.

Tertiary level of Prevention

Children who have been diagnosed as obese need to see their providers monthly in order

to monitor compliance. When a child is diagnosed as obese, providers must educate their

patients on losing weight and a proper diet with balanced macronutrients, so they can prevent the

child from further negative impact on their health. According to Kelishhadi and Azizi-Soleiman

(2014), that thirty-three percent of children who visit their providers monthly have an increase in

compliance with treatment and prevention of disease that follows obesity. The recipient on which

this intervention occurs would be at the individual level. This intervention would help children

who are obese maintain compliance with treatment and better monitor the effects of treatment.

Parents and the child are held responsible during this intervention because they must continue to

come to their providers monthly. Concerns with this intervention would be cost, due to the fact

that some insurers may not cover monthly visits. Another concern would be that the parents may

be unable to find the time each month to bring their child to the doctor. The role of a community

health nurse in this situation would be to continue to stress the importance of compliance and

how important it is to come visit each month. Additionally, the community nurse could help

coordinate a time each month that works with the providers, parents and childs schedule.

Development of Health Policy

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In general, effective health policies can significantly improve the population health.

Smith (2013) explains, that health polices can effectively improve community health by

decreasing or eliminating unhealthy conditions or by promoting healthy behaviors that will

improve the wellbeing of large groups of people. Childhood obesity should not be taken lightly

in Manatee County, due to the fact that the county percentage of children classified as obese is

higher than the state of Florida. One reason childhood obesity is prevalent in this county is

because schools allow students to use their cell phones in class with teacher approval. Manatee

county needs a health policy put into act that restricts the usage of cell phones in gym class. This

is based off a primary level of intervention. There should be a policy enacted that restricts this

phone use. This restriction would allow students to not be distracted by their phones and

actively participate in physical activity for the hour they have gym class. Since 14.4% of middle

schooler in Manatee county are classified as obese, there needs to be emphasis on physical

activity (County Health Profile,2017). The desired outcome of this policy would be an increase

of physical activity and a decline in the percentage of middle schoolers diagnosed as obese.

Stakeholder associated with this policy would be healthcare providers and public officials of the

school board of Manatee county. Health care providers support this policy because of potential

reduction in obesity.

Additionally, health care providers recognize the significance of further health care

complications when being diagnosed with obesity at such a young age. The American Medical

Association (2015) explains, that children who have a BMI in the 95th percentile of higher are

five and a half times more likely to have an impaired quality of life compared to healthy

children. Obese children are also at risk for depression and other mental health disorders.

Furthermore, health care providers support this policy because obesity causes a decrease quality
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of life at such a young age and there are ways to help prevent this from occurring. The school

board of Manatee county may oppose this health policy because they will then be pressured into

spending additional money on gym activities. By spending more money on gym equipment, they

will be forced to take funding away from something else, which in return cause havoc on the

board because of recent budget cuts.

An essential start to this plan would be to encourage health care providers in Manatee

county to help back this policy. With their help, together the community health nurse and health

care providers would put together all the statistics for childhood obesity and stress how crucial

cell phone usage impacts the decline of physical activity. To get this policy moving, the

community health nurse would first travel to each middle school in Manatee county, and have a

meeting with the gym teachers and instruct them on the increasing number of students with BMI

in the 95th percentile or higher. Then the community health nurse would ask each teacher if they

would allow cell phone usage to be restricted or eliminated during gym hour and enforce

participation in gym class activities. In addition, the community health nurse would sign up to

speak at the monthly school board members meeting. At those meetings, the community health

nurse would bring attention to the growing rate of childhood obesity in this county, and the need

for it to decline. That is where the community health nurse will talk about this health policy and

how this policy will help decrease the BMI in children. This health policy will impact Manatee

county because it will lead to an increase in physical activity, which in return would help

decrease the percentage of children with a BMI that classifies them as obese. It addresses the

needs of an underserved population because childhood obesity is such a prevalent illness in this

generation and people think of it as a norm now. People do not see the long-term damage

obesity causes on an individuals health. Decreasing the percentage of children with obesity will
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also not increase the percentage of adults who are obese. Lastly, since psychological damage,

mental health disorders and depression of obesity will decrease, Manatee countys population

will see an improvement of their overall health.

Conclusion

Manatee county has 14.4% of middle schoolers with a BMI equal to or greater than the

95th percentile. With the rise of social media, students are staying inside staring at their phones,

computer, and television screens instead of going outside and being active. The solution to this

problem would be implementing a policy of restricting or eliminating cell phones during gym

class at school. Resulting in children actively participating in their gym activities.

I want to spend my nursing career in Manatee county primarily focusing on the pediatric

population. Therefore, this paper is relevant to my future practice as a nurse. As a pediatric

nurse, I am going to encounter children who are obese, therefore I am going to have to be able to

implement solutions to help these children reach a healthy weight.

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References

America Medical Association. (2015). Childhood Obesity. Retrieved from

http://jamanetwork.com/journals/jama/fullarticle/2429716

Bradenton Area Economic Development Corporation. (2017). Retrieved from

http://www.bradentonareaedc.com/largest-employees/

County Health Profile. (2017). Retrieved from

https://countyhealthrankings.org/app/florida/2013/rankings/manatee/county/outcomes/ov

erall/snapshot

Florida Department of Health in Manatee County. (2013). Retrieved from

http://manatee.floridahealth.gov/programs-and-services/wellness-programs/data-and-

reports/_documents/manatee-cha-chip-09-09-13.pdf

Genes and Obesity. (n.d.). Center for Disease Control Prevention. Retrieved from

http://www.cdc.gov/genomics/resources/disease/obesity/obesedit.htm

Healthy People 2020. (2017). Nutrition, Physical Activity, and Obesity. Retrieved from

https://www.healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Nutrition-

Physical-Activity-and-Obesity

Healthy People 2020. (n.d). Retrieved from https://

www.healthypeople.gov/2020/about/foundation-health-measures/Determinants-of-Health

Hill, J. (2013). Eating Disorders. Detroit, MI: Lucent Books. doi:10.1007/978-1-4613-8300-0_6

Karnik, S., Kanekar, A., (2015). Childhood Obesity: A Global Public Health Crisis. School

Nutrition and Activity.3(1),7-9.doi:10.1201/b18227-3

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Kelishandi, R., Azizi-Soleiman, F. (2014). Controlling Childhood obesity: A Systematic Review

on Strategies and Challenges. Journal of Research in Medical Sciences. 19(10), 993-995.

Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4274579/

Lepp, A., Barkley, J., Sanders, G., Rebold, M., Gates, P. (2013). The Relationship between Cell

Phones Use, Physical and Sedentary Activity. International Journal of Behavioral

Nutrition and Physical Activity. 10(1), 79. doi: 10.1186/1479-5868-10-78

Manatee County. (2017). Welcome to Manatee County. Retrieved from

https://www.mymanatee.org/home.html

Manatee County Childrens Services Annual Plan. (2016). Retrieved from

http://mymanatee.org/published/December%208,%202015%20%20Work%20Session%2

0on%20Tuesday,%20December%2008,%202015/32D1CFCD3-2FC7-445F-AA62-

A5E60856AFDC.pdf

Manatee County Parks and Natural Resources. (2016). Retrieved from

https://www.mymanatee.org/home/government/departments/parks-and-

recreation/parks.html

Pbert. L., Druker, S., Gapinski, M.A., Gellar, L., Magner, R., Reed, G., Osganian, S., (2013). A

School Nurse- Delivered Intervention for Overweight and Obese Adolescents. Journal of

School Health. 83(3), 182-193. doi:10.1111/ 5674.12014

Sahoo, K., Sahoo, B., Choudhury, A., Sofi, N., Kumar, R., Bhadoria, A. (2015). Childhood

Obesity: Causes and Consequences. Journal of Family Medicine. 4(2), 187-192. doi:

10.4103/2249-4863.154628

Savage, C., Kub, J., Groves, S. (2016). Public Health Science and Nursing Practice: Caring for

Populations. Philadelphia: F.A. Davis Company

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Smith, M. (2013). Public Policy. Johns Hopkins Bloomberg School of Public Health. Retrieved

from http://jhsph.edu/research/centers-and-institutes/jogns-hopkins-center-to-eliminate-

cardiovascular-health-disparities/about/influences_on_health/public_policy.html

United States Census Bureau. (2015). Quick Facts. Retrieved from

https://www.census.gov/quickfacts/table/RHI125215/12081.00

U.S. Department of Health and Human Services. (2016). Retrieved form

https://www.hhs.gov/ash/oah/facts-and-stats/day-in-the-life/index.html