School Nurses May Be Crucial to Reducing Childhood Obesity

Rutgers-led training program in Newark led to steep increases in healthy eating

School nurses do much more than bandage scraped knees and take temperatures. A Rutgers study, published in the journal Pediatric Nursing, suggests they also may play a key role in reducing childhood obesity.

Elaine Elliott, a school nurse in Newark, teamed up with Cheryl Holly and the late Sallie Porter, professors at Rutgers University School of Nursing, to test a family-centered, school-based intervention using parents and teachers as role models for healthy eating and other behaviors.

“An important reason for the success of this program was the trust nurses have with parents and teachers,” said Elliott, who received her doctor of nursing practice degree from Rutgers in 2019. “I’ve developed a close relationship with the community that only a school nurse can have.”

Parents and teachers from a public preschool in Newark with high rates of obesity were invited to participate in the program. Thirty-seven parents, teachers and classroom aides representing 37 children ages 3 to 5 took part in the study, which included weekly 45-minute sessions over four weeks.

Modeled on a similar program in Maine called Let’s Go!, the course taught how to encourage children to eat at least five servings of vegetables; engage in, at most, two hours of screen time; do at least one hour of physical activity; and consume zero sugary drinks every day. For the second week of the program, participants were expected to implement what they learned by engaging children at home and in the classroom. Elliott, the school nurse, was available in person and online to provide additional support.

Based on pre- and post-survey data, children’s fruit and vegetable consumption increased from an average of one to five servings a day. The number of days children shared dinner and breakfast with their family rose sharply from an average of two to five days a week. Moreover, children stopped eating takeout food on average two days a week.

There also was a two-hour decline in the time children spent watching television or playing video games – from slightly more than three-and-a-half hours on average to one-and-a-half hours after the intervention.

The findings were significantly better than any previous study modeled after Maine’s program, said Holly. The researchers attributed the results to the presence of a school nurse leading the program and making herself available to answer questions.

“The significant results obtained, not seen in other studies using the Let’s Go! program, are postulated to be the result of the teaching and coordination of the program by someone familiar with the environment and the children and their families (the school nurse who lives in the area),” the researchers wrote. “The school nurse used a lay person’s vocabulary and culturally based food examples based on community available resources to demonstrate how to achieve health goals despite any socio-economic limitations.”

Despite the role school nurses play in establishing healthy habits, many schools are reducing nursing numbers. In 2017, a quarter of the country’s schools had no nurse, according to data from the National Association of School Nurses. The COVID-19 pandemic likely exacerbated these deficiencies, Holly said.

The New Jersey administrative code (6A:13A-4.5) requires one nurse per 300 preschool students. Yet, in some communities, nurses – even those with significant early childhood experience – are being reassigned to larger elementary schools and high schools to fill gaps. Future research should look at whether these changes are negatively affecting health of preschoolers, Elliot said.

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The co-authors wish to recognize the late Sallie Porter, an associate professor at Rutgers School of Nursing, and co-author of this study, who passed away on April 28, 2023. A passionate advocate for health equity, Dr. Porter’s contributions to advancing pediatric health and health care are immeasurable. Her research focus areas included social determinants of health, infants, neurodevelopment, and diaper need. Her work in genetics and maternal and child health has increased understanding and helped shape policy surrounding these complex issues.