SIOUX CITY | Research conducted by a Morningside College professor shows nursing students have negative views of children who are overweight, which could potentially affect the care these children receive.
Last year, Shar Georgesen, an associate professor of nursing at Morningside College, set out to investigate the attitudes bachelor of nursing students have toward obese children, their knowledge of childhood obesity and how they perceive their own ability to work effectively with families of overweight children.
Georgesen created an online survey featuring short little stories about a 5-year-old and a 15-year-old child. She varied the child's weight, the parent's weight and the child's activity level in the stories. Twenty-six schools in Iowa, Nebraska and South Dakota agreed to share an email containing a link to Georgesen's survey with their bachelor of nursing students. A total of 102 students completed the survey.
"When survey participants read vignettes about overweight adolescents who had an overweight parent, they viewed them negatively," said Georgesen, who will present her research, which was part of her doctoral dissertation, at the Midwest Nursing Research Society's 2017 Research Conference April 6-9 in Minneapolis.
The negative reactions nursing students had to children who were overweight was something Georgesen said she anticipated.
"In the Midwest there's a lot of strong emphasis on personal responsibility. If you have a problem you have to be responsible for it. I don't think that's true necessarily in all geographic regions of the country or within all populations," she said.
Several years ago, Georgesen had an encounter with a nursing student, who had recently returned to campus after having taken care of a child who was overweight, that shocked her. She said the student's comments about the child and the child's family were judgmental and stereotypical.
When Georgesen started graduate school at the University of Missouri-Columbia in 2011, she was initially interested in researching food insecurity. Recalling the earlier incident with her student, she instead decided to focus her research on examining whether nursing students know how to interact with overweight children and their families.
Even though the percentage of children with obesity in the United States has more than tripled since the 1970s, Georgesen said the resources to help overweight children lose excess pounds are limited in populated areas and even more scant in rural areas.
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"Obesity bias begins fairly early in childhood. There's evidence that says children as young as four and five respond differently to obese peers than normal weight peers," she said. "By the time students come to nursing school, those ideas are pretty well developed."
Survey participants were randomly assigned vignettes that varied, some included a normal weight child with an overweight parent, and others an overweight child with a normal weight parent. The nursing students were never told that the survey was specifically about childhood obesity.
Georgesen asked participants which health promotions -- the process of enabling people to increase control over and to improve their health -- would be important for the family, whether the child was overweight and the health risks an overweight child faced. Based on the child and the situation their family was facing, she also inquired about the nursing students' attitudes about the child and the parent. Participants typed their answers in text boxes.
Georgesen said participants responded that they would discuss the same topics -- nutrition, growth and development -- with both normal weight and overweight children. She said this finding was surprising considering other studies indicate that if a parent is overweight health care providers are less likely to discuss the child's weight, feeling that nothing they could say would make a difference.
"There is anecdotal evidence that says the parent could be offended and not return. If you lose that patient in your practice, it could be an economic issue as well," she said.
Georgesen said nursing students spend more time in the classroom learning about smoking and alcohol addiction than weight management, even though they're more likely to encounter a patient who is obese. She said the topic likely doesn't get the attention that it should because 40 percent of nurse educators are overweight. She said nurse educators may assign reading about weight management, but not feel comfortable standing up in front of the classroom and talking about it.
Today's nurses and nursing students are more likely to be overweight than those in the past. Poor diet, lack of physical activity, sleep deprivation and high stress levels are all contributing factors cited by those in the profession.
Georgesen said she has had nursing students in her classes who were overweight as children. While she said today's nursing students seem to have a greater awareness of childhood obesity's causes, she said that doesn't mean they're prepared to discuss a child's weight as a health problem with parents. In fact, some nursing students couldn't even identify if the child featured in the vignettes was overweight or not based on the child's body mass index (BMI).
The National Institutes of Health says children are considered overweight if their BMI is the 85th percentile to less than the 95th percentile and obese if their BMI is the 95th percentile and above.
About 10 percent of nursing students surveyed said their classes haven't prepared them to talk about weight as a health problem at all, while about 25 percent said they've been taught about the health risks associated with obesity, but not how to talk about obesity.
"If the child and the family are seeking care for something not related to obesity, I don't think it's going to matter that the child is overweight," Georgesen said. "I think if they seek out care for other growth and development things -- well-child care -- then I think it could matter, potentially. The bias certainly could be there."