Local nurse practitioner enlisting Belen students on body image study

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“For the first time in American history, our current generation of children could live shorter lives than their parents.” — President Bill Clinton.

Mike Bush-News-Bulletin photo: Carolyn Jaramillo Montoya is conducting a study designed to study how children view their own bodies. Students in Belen Schools are participating in the study.

Carolyn Jaramillo Montoya, a clinical nurse for 30 years, doctoral candidate, and mother and grandmother, is worried.

She knows that nationwide, nearly 17 percent of 2 to 10 year olds are obese, a figure that is expected nearly to double by 2030. Moreover, almost a third of the nation’s kindergarten kids are obese or overweight.

And here in New Mexico, looking only at third-graders, one in every five Hispanics and one in three Native Americans are obese. This compares to one in eight non-Hispanic white third-graders.

Montoya, who lives in Belen, hopes to do something about it.

The certified pediatric nurse practitioner has designed a study to examine how kids view their own bodies, as well as what they see as the ideal body. She has enlisted the Belen Schools to help with the effort.

All public school children between the ages of 8 and 11 in the third, fourth and fifth grades are being asked to take home a packet of information in English and Spanish seeking their participation in a survey she calls Children’s Self-Perceptions Regarding Weight.

Montoya specifically chose the mid-age group to be sure her subjects would be old enough to be able to read and young enough to avoid teenage hormonal influences in their responses. Additionally, few studies focus on small-town or rural children, especially minority children.

According to a letter she sent to Belen school personnel, the purpose of the study is to compare how children “think they look with their actual weights. Several studies have asked parents what they think about their child’s weight; however, not many studies actually ask children what they think about their weight status.

“While this study may not produce any direct benefit to the children, hopefully it will help us understand what children think about their weight,” she said. “This type of information may be helpful in planning and implementing obesity prevention and intervention programs.”

The packets of information include a letter of introduction, a consent form explaining the methods to be used and purpose of the study, a child assent form and a child informational form. Before a child can participate in the study, the consent form and the child information form, both yellow, must be signed by a parent and returned.

Legally, children cannot consent to participate in a formal study. Montoya has therefore included the assent form so the kids can give their own OK to their participation. “It empowers them,” she explained.

The children in the study will be presented with a graphic depicting seven human child figures ranging from skinny to obese. Boys will receive pictures of boys, girls pictures of girls. Each child will be asked first to circle “the body figure that looks most like you,” then “the body figure that you would most like to have.”

Participants will then give their age and be weighed, measured for height, assigned a body mass index or “BMI” and percentile for that BMI.

Every child who takes part — participation is completely voluntary — is receiving a $10 gift card to Walmart, even if they don’t finish the survey or the measurements.

The only kids in the age group who cannot participate are those with a health condition that affects their weight, such as diabetes or heart disease, those taking medication for cancer, those taking an oral steroid medicine and those under treatment for obesity. Individual findings will be kept completely confidential.

“It’s very important, especially since we’ll be working with children, to make sure the process is vetted thoroughly so as not to infringe on anyone’s rights,” Montoya said.

The survey is supported by the Robert Wood Johnson Foundation and the Nurse Practitioner Healthcare Foundation.

In a recent interview, Montoya said her concerns about childhood obesity — which almost invariably leads to adult obesity and aggravated health problems — go back to when she began noticing kids being treated for high blood pressure, traditionally an ailment reserved for adults.

“We have children — children, children! — on hypertension medication,” she said with alarm. “That’s crazy.”

Besides high blood pressure, childhood obesity can lead to heart disease, cholesterol problems and diabetes. Moreover, obese children sometimes experience bullying and social isolation and could become depressed.

Montoya’s concerns are supported by a report by the state Department of Health, “The Weight of Our Children: 2011 New Mexico Childhood Obesity Report.”

Dr. Catherine Torres, New Mexico’s secretary of health, writes in an accompanying letter: “Unfortunately, the report tells us that we are facing a public health epidemic regarding children who fall into the overweight and obese categories.

“The report shows that 15 percent of kindergarten and 21.9 percent of third grade students were obese. We also found that obesity is occurring at very young ages among children, signifying that they are developing unhealthy eating habits earlier, which makes it more difficult for them to adopt a healthy lifestyle later.”

Technically, definitions of “overweight” and “obese” are based on a person’s BMI or weight in kilograms divided by height in meters squared.

“It’s really a proportion, a height to weight,” Montoya explained.

BMI measurements for children also take age and gender into consideration. Those who are “overweight” fall into the 85th to 95th percentile, while those considered “obese” are at or above the 95th percentile.

Montoya offers some advice for children and parents, an exercise she calls simply “five, two, one, zero.” Five is the number of servings of fruits and vegetables a child should eat daily; two represents the maximum number of hours a child should spend looking at TV, video game, smart phone or computer screens; one is the recommended minimum of an hour of daily exercise, and zero the number of sweet drinks— sodas, sports drinks and juices — recommended by dietary and health experts.

“Five, two, one, zero,” she repeated, “It’s easy to remember.”

She said she often sees children consuming sports drinks such as Gatorade, which was developed for the Florida Gators, adult male football players at the University of Florida,

“Kids are not football players,” she said. “They don’t need Gatorade.”

Montoya is hoping that a large percentage of the roughly 1,000 qualified children and their parents agree to participate in her survey. She started working to gain approval for the project last summer and hopes to be ready to present her findings before school ends in the spring.

She said she would like to present the results at a forum in Belen to parents, teachers and, perhaps, school children.

Her findings will be included in her doctoral dissertation. The project has been given a green light by the Human Research Review Committee at UNM’s Health Sciences Center.