Addressing the primary care workforce: a study of nurse practitioner students' plans after graduation.

Primary care is a growing area, and nurse practitioners (NPs) hold promise for meeting the need for additional providers. This article reports on the future plans of more than 300 primary care NP students in family, adult, and adult gerontology programs. The sample was obtained through NP faculty, and data were collected via an online survey. Results indicated that although these students chose primary care, only 48% anticipated working in primary care; 26% planned to practice in rural areas, and 16% planned to work in an inner city. Reasons cited as important for pursuing a primary care position included the long-term patient relationship, faculty and preceptor mentors from the NP program, and clinical experiences as a student. Implications include providing more intensive faculty mentoring to increase the number of individuals seeking primary care positions after graduation and help with future career planning to meet personal career and nursing profession needs.

CE: The obesity epidemic, part 2: nursing assessment and intervention.

Although there are many gaps in our understanding of the mechanisms underlying obesity, several nursing strategies have proven effective in combating this public health crisis. This article, the second in a two-part series, presents a theoretical framework to guide nursing assessment of affected patients and their families, thereby informing intervention. The authors discuss the effects of stigma and bias on the treatment of obesity; how to conduct a thorough assessment of an obese patient; the effectiveness of the most common lifestyle, pharmacologic, and surgical interventions for obesity; and issues to consider in the treatment of obese children. Part 1, which appeared in last month's issue, provided background on the epidemic; defined terms used in obesity treatment; and described pathophysiologic, psychological, and social factors that influence weight control.

CE: The obesity epidemic, part 1: understanding the origins.

OVERVIEW: The obesity epidemic remains a significant health problem in the United States and worldwide, with multiple associated physical and societal costs. To contribute to obesity's treatment and prevention, nurses must be conversant in a wide range of theoretical and clinical perspectives on the problem. This article, the first in a two-part series, defines the terms used in the treatment of obesity and outlines pathophysiologic, psychological, and social factors that influence weight control. Part 2, which will appear in next month's issue, presents a theoretical framework that can be used to guide nursing assessment of both patient and family, thereby informing intervention.

Preparing practice scholars: teaching knowledge application in the Doctor of Nursing Practice curriculum.

PURPOSE: The purpose of this article is to explore the scholarship role of the Doctor of Nursing Practice (DNP) and the associated knowledge and skills required for success. DATA SOURCES: There are excellent competencies provided by national organizations that present guidelines for design and application of this practice scholar's contributions. Although evidence-based research translation is known to be essential for the DNP scholar, a consensus does not exist about the required research knowledge and skill levels that are needed. CONCLUSIONS: A model was developed to depict the scholarship roles of the DNP and the Doctor of Philosophy (PhD). This model indicates both DNP and PhD scholars are alike in their enactment of active scholarship but have different areas of expertise. They are different in their major roles that lead to the development of practice science; the DNP is the expert in knowledge application while the PhD is the expert in knowledge generation. IMPLICATIONS FOR PRACTICE: A nurse practice scholar needs to have a fundamental and strong understanding of research design and interpretation in order to appraise and implement research-based evidence into practice and conduct clinical projects.

Health care professionals' attitudes about obesity: an integrative review.

Stigma and discrimination against obese people are common and related to individual attitudes about obesity. Despite a robust field of study on attitudes related to obesity, no integrative review of health providers' beliefs exist. Fifteen studies (1990-2007) on various health care providers are examined along with practice implications. Analysis indicates that attitudes toward overweight patients, although primarily still negative, have improved over time. Findings indicate that care dispensed to obese patients is not as likely to be affected by health care providers' attitudes as in the past. Implications include the need for additional research, awareness education, and practice guidelines.

Exploring relationships among maternal BMI, family factors, and concern for child's weight.

PROBLEM: in an effort to better understand child obesity, this study examined the association between family living location, family function, mother's body mass index (BMI), and mothers' attitudes and behaviors concerning child feeding. Recent research on obesity has shown there is limited information on family influence and parental perceptions and attitudes. METHODS: a cross-sectional analysis was performed on data from 47 mothers of school-aged children. FINDINGS: urban African-American mothers had higher BMIs and were significantly more concerned about their child's weight status than rural white mothers. Additionally, maternal BMI was associated with the total number of individuals in the household. CONCLUSION: results suggest the importance in understanding the family and community and its influence on childhood obesity. Armed with knowledge about family factors and parents' beliefs and perceptions, nurses can develop interventions that can assist families and communities to focus on healthy children feeding and weight management.

Obesity stigma: a newly recognized barrier to comprehensive and effective type 2 diabetes management.

PURPOSE: The purpose of this article is to increase awareness regarding the social problem of obesity stigma and its effects on persons with type 2 diabetes mellitus (T2DM). In addition, practical strategies to dispel stigma and improve diabetes care that nurse practitioners (NPs) can integrate into practice will be introduced. DATA SOURCES: Thorough review of the literature was conducted including MEDLINE, PsycINFO and CINAHL, spanning the years 1994-2008. CONCLUSIONS: Obesity and diabetes are both epidemics that demand immediate attention; however, obesity stigma can act as a barrier to ongoing management of both conditions. Obese patients with T2DM may feel responsible not only for their weight but also their diabetes. Therefore, NPs can employ specific counseling strategies that may be beneficial with T2DM obese patients to improve continuity of care while decreasing weight-related stigmatization. IMPLICATIONS FOR PRACTICE: Negative attitudes toward obesity by healthcare professionals can act as a barrier to diabetes management. Primary care providers including NPs must begin through self-reflection to recognize their own attitudes regarding weight-stigma and how these attitudes may affect their patients. By implementing effective strategies to reduce weight bias, an environment conducive to diabetes and lifestyle modification management may prevent patients from forgoing care.

Addressing the childhood obesity crisis: a call to action.

The prevalence of childhood obesity is increasing in the United States and globally. Associated with numerous comorbid conditions, childhood obesity is also recognized as a risk factor for multiple chronic conditions and premature mortality in adult life. Children and adolescents, particularly those from ethnic minorities and rural low income populations, bear an excess burden of obesity and its attendant comorbidities. A major contributor to childhood obesity is a physical and social environment that promotes foods high in fat and calories and minimizes the opportunities for physical activity. Despite the strong environmental influences that encourage overeating and sedentary behavior, weight maintenance is viewed as a personal responsibility. Addressing the obesity crisis requires a paradigm shift away from blaming individuals for the lack of will power to control their eating and physical activity to one of recognizing the "toxic" or "obesigenic" environment as a primary determinant. This article addresses the obesity crisis from individual, family, local community, and public policy perspectives. Emphasis is placed on the role of nurses and nursing, acting to promote change with individuals and families and acting as advocates for multilevel policy initiatives, in reversing the epidemic and improving the health of future generations.

Weight loss in obese African American and Caucasian adolescents: secondary analysis of a randomized clinical trial of behavioral therapy plus sibutramine.

BACKGROUND: Obesity, a major risk factor for cardiovascular disease, is more prevalent in African American adolescents than in their Caucasian counterparts. Effective weight loss treatment options are required to aid in the reduction of this health disparity. The purpose of this study, a secondary analysis of data collected as part of a double-blind, randomized clinical trial of behavioral and pharmacologic weight loss, was to examine and compare changes in weight loss and cardiometabolic risk factors in African American and Caucasian adolescents. METHODS: Analysis included 34 African American and 45 Caucasian obese boys and postmenarcheal girls. The participants were randomized to family-based behavioral therapy plus placebo or family-based behavioral therapy plus sibutramine. Changes in weight, body mass index, % body mass index, fasting glucose, insulin, homeostatically assessed insulin resistance, and lipid levels were measured at baseline and month 6. RESULTS: Mean age was 14.1 years (range 13-17 years). Average body mass index was 37.8 kg/m (32-44). Retention was 88.2% for African American adolescents and 91% for Caucasian adolescents. At baseline, African American adolescents had lower waist circumferences, triglycerides, serum glucose, and higher high-density lipoprotein cholesterol levels. At month 6, percent change in body mass index and weight loss was significantly greater in the Caucasian drug group than in placebo, whereas the weight loss for African Americans in the drug group versus those in the placebo group was not significant but had a medium effect size (Cohen d = 0.64). Irrespective of treatment group, those losing >5% of initial BMI had significant reductions in waist circumference. Caucasians had significant reductions in triglycerides, high-density lipoprotein cholesterol, glucose, insulin, and homeostatically assessed insulin resistance levels; African American responders had significant reductions in triglycerides, insulin, and homeostatically assessed insulin resistance. CONCLUSION: Sibutramine impacted reductions in weight loss in both African American and Caucasian teens. Weight loss, whether by behavioral therapy alone or in combination with pharmacotherapy, produced beneficial changes in cardiometabolic risk factors in adolescents from both racial groups. Limitations included a small sample size. Longer-term obesity intervention studies addressing retention, acceptability, safety, and treatment effect on cardiometabolic risk are critical to reducing health disparities.

School-based obesity prevention: Research, challenges, and recommendations.

Childhood overweight is one of the most serious problems currently affecting individual and public health. Schools represent a logical site for prevention because children spend 6-8 hours a day there during most of the year. Although reports of school-based overweight or obesity prevention programs exist, there are no summaries specifying which interventions are effective in preventing weight gain in the school environment. Researchers generally consider randomized controlled trials to be the most reliable and valid findings; so, naturally they are the best for providing evidence on which to base curriculum and policy guidelines. Consequently, the purpose of this paper is to provide an overview of school-based randomized controlled studies intended to prevent increases in schoolchildren's body weight or body mass index. This paper addresses the successes and other positive health outcomes, as well as the limitations of the school-based research. The goal of this paper is to assist school health administrators with curriculum decisions related to overweight or obesity prevention in schools. Following the critique, the challenges of childhood overweight or obesity prevention are discussed, and recommendations for further research, school activities, and policy changes are made.

Childhood obesity: determinants, prevention, and treatment.

The prevalence of child and adolescent obesity has increased dramatically in the last 20 years and has led to a rise in cardiovascular-related comorbidities, including type 2 diabetes, in children and youth. The American Heart Association (AHA) issued a scientific statement with available evidence and guidance for health professionals involved in the prevention and management of childhood obesity. The scientific statement was ranked as 1 of the Top 10 Research Advances of 2005 by the AHA. This article builds on the scientific statement, presents multilevel determinants, and emphasizes individual and population-based approaches to prevention. Treatment of child and youth obesity, along with the implications for nurses and other health professionals, is also included.