It was while she was working as an emergency room nurse with adults who presented with acute heart attacks and strokes that Assistant Professor Andraea Van Hulst first became interested in studying childhood obesity. As she explains, “Cardiovascular disease risk factors start developing in childhood and obesity is actually the most prevalent risk factor in children.” Obesity is a chronic condition, which can begin early in life and persist into adulthood. Children with obesity are more likely to develop abnormal cholesterol, high blood pressure and diabetes, which are key risk factors for cardiovascular disease, as well as anxiety, depression and low self-esteem due to stigma associated with larger body sizes. “The children and youth we see in obesity management clinics often accumulate several of these comorbidities. It is important to treat these at an early age when cardiovascular damage may still be reversible and lifestyle behaviours are more malleable”.
Childhood obesity is caused by the complex interplay of biological and physiological factors such as genetics and hormones, lifestyle factors such as nutrition, physical activity and sedentary behaviour, and environmental factors such as the family and neighbourhood environment. Professor Van Hulst has a particular interest in what is referred to as the built environment – features of the neighbourhoods where children live, go to school and play, which make it easier or more difficult for children and their families to adopt and maintain healthy lifestyles. Like other chronic conditions, obesity intersects with socioeconomic factors such as income and area of residence. This research requires collaboration with health geographers, urban planners and community organizations.
How prevalent is childhood obesity in Canada? Between the 1980’s and early 2000’s, the prevalence of overweight and obesity doubled, reaching over a third of children aged 5-17. In the past decade, thanks to population-level interventions such as banning fast foods in school cafeterias and devoting additional hours to physical activity classes, a gradual decrease in prevalence has been observed with a current estimate of 27%. Early indications, however, are that these gains may have stalled and even reversed during the past two years of COVID with significant increases in screen time and decreases in physical activity among children and youth.
Professor Van Hulst takes an inter-professional approach to her research program, notably on obesity management interventions. For example, she conducted a study of a two-year healthy lifestyle program at Ste. Justine Hospital called Circuit. A team consisting of a kinesiologist, nutritionist and psycho-educator developed individualized programs for 106 children with obesity between the ages of 4 and 18. As co-author of a research paper published in Pediatrics and Child Health, Professor Van Hulst described how the program led to a decrease in body-mass-index, a reduction in the percentage of body fat and cholesterol levels, and an increase in overall fitness. However, the program had a 50% dropout rate which was highest among older teens and those with lower socio-economic status. These findings highlight the importance of obesity prevention and treatment early in childhood, and the importance of tailoring interventions to socio-economically marginalized groups. “Understanding the determinants of obesity, especially in more vulnerable populations is the first step in adapting interventions that address their concerns and priorities,” she says.
Treatment and prevention strategies should go hand-in-hand, according to Professor Van Hulst, who believes that nurses have an important role in encouraging the adoption and maintenance of healthy lifestyles throughout the life cycle. To that end, she gives a three-hour class on the prevention and management of childhood obesity to Master’s students in the Pediatric Nurse Practitioner Program, and created an inquiry-based learning scenario for undergraduate students in the BScN program to help them recognize and address childhood obesity when working with children and families. She continues to explore additional opportunities to include childhood obesity into the curriculum.
Professor Van Hulst remains optimistic. “Attitudes and perceptions around childhood obesity have been moving in the right direction in recent years. Removing the stigma, shame and guilt associated with this chronic condition, and continued inter-disciplinary research will help us develop effective prevention and management strategies to best address childhood obesity.”