Childhood Obesity in Kentucky Childhood overweight and obesity has grown at an alarming rate over the last decade. Obesity is linked to media advertising, environmental, social and psychological, food labeling, and parental factors. Causes of childhood obesity have been linked to sedentary lifestyles with limited or no physical activity and unhealthy eating of excessive fatty and sugary foods.

Body mass index (BMI) is a measure used to determine overweight and obesity using height, weight, age, and sex-specific percentile calculations. For children, overweight is defined as BMI between the 85th and 95th percentile for children of the same sex and age (Basics About Childhood Obesity, 2012). Obese is defined as BMI at the 95th percentile or above for children of the same sex and age.

Obese children are experiencing health problems that used to only be seen in adulthood. Overweight and obese children are at risk for cardiovascular disease factors, type 2 diabetes, breathing problems, joint problems, and liver disease, among others. Obesity places children at greater risks of social and psychological problems as well as greater risks of more serious conditions in adulthood. Communities must be more committed to address childhood obesity by promoting accountability in media and food labeling, healthcare programs designed to address all the factors of obesity, including cultural, and promotes professional collaboration, as well as community programs that are family based and include education on understanding food labels and nutrition with long-term approaches that contain continual monitoring and inspection for measurement as well as appropriate strategies to reduce and eliminate weight bias and stigma from the programs.

Literature Review

From 1971-74 to 2009-10 obesity increased from four percent to 18% in ages 6-11 and from 6.1% to 18.4% in ages 12-19 (Overweight in Children, 2014). According to (Russel, 2012), 15% of Kentucky adolescents were overweight with 17.6% being obese, with ages two to five 16% were overweight and 15.6% were obese. On a national level, (Ogden, 2012) found that nearly 17% of children, ages two to 19, were obese and a significant trend is reflecting an increase in BMI for males.

Risk factors for childhood obesity include lack of physical activity, unhealthy eating, sedentary lifestyle, and environmental factors (Nutrition, Physical Activity, and Obesity, 2011). Russell, E. (2012) found that only 21.4% of children were physically active with 75.8% consuming fruits or juices at least two times a day, 89.1% consuming vegetables at least three times a day, and 35.7% consuming sugar sweetened beverages at least once per day. Another factor includes societal ability to recognize childhood obesity where education as well as a parent's own weight and the weight of the child were determining factors in a parent recognizing obesity in their own children (Wareschburger, 2009).

Problems in children losing weight include media, environmental factors, social factors, misunderstanding in food labeling, and parental factors. Approximately 80% of advertising targeting children is toys, cereals, candies, and fast food restaurants (Wilcox, 2004). The majority of unhealthy food advertisements are shown during popular children viewing times and encompass cross promotions between food and entertainment to increase interest preferences (Termini, 2011). Convenience in food choices, decreased free time and physical activity in school programs, cultural attitudes, parental factors, role models, and biological relatives with poor weight management (Bishop, 2005), community safety and resources (A Growing Problem: What causes childhood obesity, 2013), (Bishop, 2005), are environmental issues that cause difficulty in losing weight. Weight bias and stigma (Washington, 2011, Aug 15), discrimination, feelings of inadequacies from too many failed attempts, and stereotyping are social issues that affect weight loss efforts. Marketing practices tend to cover up truths in product labeling concerning the nutritional value in products creating confusion with symbols, misunderstanding in daily value, and the level of nutrients (Bronell, 2011, June 23). Cultural beliefs, family perceptions, as well as available income can limit weight loss efforts.

The AMA has declared childhood obesity as a disease (Frelick, 2013). Understanding obesity in children is important because of being linked to health concerns (Ogden, 2012), (Overweight in Children, 2014), (Basics About Childhood Obesity, 2012). Understanding social and psychological factors of discrimination, poor self-image, and (Overweight in Children, 2014) negative effects of school performance, weight bias, and stigma will aid in determining better strategies to integrate into programs.

Reversing childhood obesity requires long-term approaches (Nutrition, Physical Activity, and Obesity, 2011), such as school, professional, and community efforts (Waters, 2011). School curriculums should include physical activities, promote healthy eating, contain education on body image, environmental, and cultural practices, as well as contain appropriate resources. Communities need high levels...

Promotions of better policies that govern advertising (Wilcox, 2004), food labeling (Bronell, 2011, June 23), and health policies can afford parents better understanding in the foods they purchase as well as more appropriate education on health benefits of physical activity.
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Media advertisements play a major role with deceptive practices that play on the cognitive abilities of children without full disclosure of ingredients and health benefits or hazards. Marketers use popular viewing times, cross promotions between food and entertainment, characters that promote thinness, and features, such as sound effects, animation, auditory changes, moving images, and audiovisual gimmicks to raise children's interest for products. Ads that target children focus on fun and happiness without providing information concerning health or safety factors. The intent of advertising is to create a need or interest to promote purchasing with the intent of building brand loyalty at early ages to reap economic benefits over the life of a child. Research indicates children below the ages of four to five do not consistently distinguish between program and commercial content, even with separation devices, children below seven to eight do not recognize the persuasive intent of advertising, and one exposure generates recall information that is strengthened with repeated exposure attempts over time (Wilcox, 2004). The number of commercials viewed by children each day has doubled from 20,000 in the 1970s to 40,000 in 2004 with a greater amount of unhealthy foods shown during popular viewing times and cross promotion (Termini, 2011) that creates a materialistic attitude (Wilcox, 2004). Two trends that promote advertising targeting children are the growth of advertising channels reaching children and the privatization of children's media use (TVs in bedrooms), and with greater amounts of content being viewed by children without parental monitoring and supervision marketers are allotted greater opportunities in expansions of marketing efforts to reach children. Where children have a significant influence on household spending and material possessions are a source of judgment, both by others and self-evaluation, marketers can create misconceptions concerning health and safety with products to promote future economic benefits. Children's media use also plays into environmental factors.

School and childcare programs, community safety, and socioeconomic status can create barriers to weight loss and weight management programs. School programs create inadequate physical activities due to competition in sports and decreased free time where childcare program nutrition and activities may not be regulated within all states. Levels of crime and community resources can create sedentary practices due to safety concerns as well as socioeconomic status creating barriers with discrimination, healthy food choices, parental work/life balance, weight bias, and stigma. It has been found that school, childcare, and community conditions coupled with negative relationships between socioeconomic statuses all create barriers with weight loss and management efforts. According to (Bishop, 2005), convenience is the main criteria for food choices, school and community limitation of resources creates barriers for physical activity, and heredity contributes five to 40% of risk for obesity. Inadequate funding of school activities and competition in school sports alienates less physically gifted students and diminishes the importance of physical activity (Ashton, 2004). Higher rates of sedentary lifestyles are created with limitations of available resources, such as competition of sports activities, a families ability to afford healthy foods and fast foods being cheaper in costs, as well as cultural attitudes of foods provided and work/life balance. Biological relatives who exhibit the same behaviors and attitudes of weight management affect food preference as well as work/life balances creating limited or no monitoring or supervision of social eating interaction patterns. Which, in turn, affect social factors associated with obesity patterns.

Societal perceptions and communications of emotional consequences creates barriers to weight loss and management efforts. Serious ethical problems arise when actions and policies exacerbate the consequences with the general belief that stigma and shame motivates change or personal failure is a result of inadequate self-discipline or insufficient will power. The American culture of valuing 'thinness' causes frequency in blaming the victim instead of addressing factors that contribute to the problem. Communications of shame and failure enhances low self-esteem and negative body image that brings on clinical depression and creates ethical issues in the way societal programs deliver services. "Weight bias can be defined as the inclination to form unreasonable judgments based on a person's weight" and "stigma is the social sign that is carried by a person who is a victim of prejudice and weight bias" with teasing and discrimination affecting…