29: Jack

You are on placement with the school nurse and are following up Jack, a 6 year old who was identified as being overweight whilst in the reception class last year, as part of the National Child Measurement Programme. Last year, Jack was noted to be on the 75% centile for weight and the 50% centile for his height, but today, you note that his weight has increased to the 98% centile, whilst his height remains on the 50% centile. His parents were notified of the concern last year and provided with healthy eating advice. His teacher reports that Jack has a packed lunch every day that consists of sandwiches, crisps and a chocolate biscuit snack with either a fruit squash or a carbonated drink. His teacher has also noticed that Jack is increasingly reluctant to join in with active games.

  • Why is Jack’s weight a concern?
  • How might you address these concerns with Jack’s parents?
  • What further support could the school nurse instigate?
  • Is Jack’s weight a safeguarding concern?
  • What are the long-term consequences of childhood obesity?
  • What simple changes to Jack’s packed lunch could be suggested to make it more healthy?

› Suggested answers

  • Why is Jack’s weight a concern?

Jack was identified as being overweight last year and his weight has continued to increase. Jack’s reluctance to join in with active games also suggests that his weight is impacting on his quality of life.

  • How might you address these concerns with Jack’s parents?

Contact Jack’s parents as follow up to the advice they received last year and ask how they have found putting that advice into practice. This would provide you with an opportunity to discuss things further with Jack’s parents. They may not realise the potential harm to Jack in the long term.

  • What further support could the school nurse instigate?

According to the UK healthy child programme 5–19, Jack’s family should be given appropriate information and signposting for further sources of support and advice, with referral to an appropriate weight management service as well as an assessment of any underlying health issues/co-morbidities, if appropriate. Jack’s family may be unaware of the potential harm.

  • Is Jack’s weight a safeguarding concern?

Yes, Jack’s weight is a potential safeguarding concern, particularly as his weight has increased since advice was given last year. The concern is that Jack’s health and wellbeing may be compromised in both the short and long term.

  • What are the long-term consequences of childhood obesity?

Children who are overweight are more likely to be overweight as adults and this predisposes them to a number of health problems, including type 2 diabetes, coronary heart disease, certain types of cancer and an increased risk of stroke.

  • What simple changes to Jack’s packed lunch could be suggested to make it more healthy?

Wholemeal bread instead of white bread

Low fat popcorn instead of crisps

Fruit instead of chocolate biscuit

No added sugar fruit squash or water instead of fruit squash/carbonated drink.

Jack’s family might also want to consider moving from a packed lunch to school dinners, as school dinners are required to meet statutory nutritional standards.