OBESITY Childhood Obesity

Childhood obesity: An epidemiological overview

Community and population

Childhood obesity is an increasingly serious problem in America and around the world. Obesity in all demographic categories in the U.S. is increasing; however the increase in the rate of obesity for young people is particularly worrisome. The longer an individual is obese over the course of his or her lifetime, the greater the social and financial costs. Obese persons experience school and workplace harassment; have difficulty fully participating in the full range of physical activities needed for health and personal well-being because of joint-related issues such as osteoarthritis; and incur higher healthcare costs as a result of a greater risk of suffering from diabetes, heart disease, and certain kinds of cancer. The longer the person is obese, the greater these risks are compounded and today's generation of obese children may never have a memory of what it is like not to suffer from the condition. And obese children are more likely to grow up to be obese adults.

According to the Centers for Disease Control (CDC), over the past thirty years, childhood obesity has more than doubled in children and quadrupled in adolescents. Although obesity is a multifactorial illness and has genetic as well as social origins, the rapid increase of obesity cannot be explained by genetics alone. "The percentage of children aged 6 -- 11 years in the United States who were obese increased from 7% in 1980 to nearly 18% in 2012. Similarly, the percentage of adolescents aged 12 -- 19 years who were obese increased from 5% to nearly 21% over the same period" ("Childhood obesity facts," 2014). Quite simply, the population's genetic makeup has not changed rapidly enough to explain such an increase. Children who suffer from obesity are, like adults, more likely to exhibit chronic health conditions "such as high cholesterol or high blood pressure. In a population-based sample of 5- to 17-year-olds, 70% of obese youth had at least one risk factor for cardiovascular disease" and "obese adolescents are more likely to have prediabetes, a condition in which blood glucose levels indicate a high risk for development of diabetes" ("Childhood obesity facts," 2014).

However, not all groups are equally affected by obesity, once again underlining the cultural component of the disorder. "Among children, Black adolescent girls (29%) and Mexican-American adolescent boys (27%) are most affected" (Johnson 2012). Nonwhite children and adolescents as a whole are disproportionately affected by obesity. Poverty also increases one's risk.

Healthy People 2020

Given the serious national implications of a generation that may be sicker than its parents due to the obesity crisis, the national government has set standards to promote healthy weight loss. One specific objective as outlined in Healthy People 2020 is "NWS-2.2 Increase the proportion of school districts that require schools to make fruits or vegetables available whenever other food is offered or sold" ("Healthier food access" 2014). At present, only 6.6% of school districts are required schools to make fruits or vegetables available whenever other foods are offered or served and the 2020 objective is to increase that to 18. 6%. Children who eat more fruits and vegetables are less likely to suffer from obesity and offering them a greater variety of healthy foods expands their palates at a young age to healthier foods. Poor and minority children (again, the demographic groups more likely to suffer from obesity) are more likely to rely upon school lunches for the bulk of their daily calories. Competing unhealthy foods in cafeterias can also increase sugar consumption.

Federal, state, and local agencies tasked with addressing and managing this issue

On a federal level, the CDC, the Department of Health and Human Services and the First Lady Michelle Obama have been major proponents of anti-childhood obesity efforts. Campaigns such as "Let's Move" encourage young people to engage in healthy movement and to consume fewer highly processed, obesegenic, low-nutrition foods. On a state level, state health and education authorities can be extremely influential in encouraging, for example, PE in schools (or discouraging it in lieu of focusing more time devoted to academics). Unfortunately, "gym classes are being sacrificed across the country to save money and satisfy federal mandates stressing test scores in math and reading" and "little more than half of students nationwide are enrolled in a physical education class, and by high school only a third take gym class daily, according to the National Association for Sport and Physical Education" (Sealey 2013). Once again, poor and minority children tend to suffer more as a result because they have less safe space to play outside after school hours and fewer financial resources for physical extracurricular activities.

On a local level, schools themselves can promote physical activity and healthy eating but the evidence is that few...

2011) of low income districts in Chicago "barriers included budgetary constraints leading to low prioritization of health initiatives; availability of unhealthy competitive foods; and perceptions that students would not eat healthy foods." Highly stressed school districts were unwilling to prioritize nutrition as an important objective for students. Additionally, schools were afraid of wasting money on healthy foods, despite the fact that there is evidence that inevitably there is 'food waste' in the trial period as students slowly transition over to expecting more healthy foods. However, some schools on a local level did make a difference, provided they had a clear change plan. "Schools had made improvements to foods and increased nutrition education. Support from administrators, teamwork among staff, and acknowledging student preferences facilitated positive changes. Schools with a key set of characteristics, (presence of a coordinated school health team, nutrition policies, and a school health champion) made more improvements" (Lucarelli 2014).
Models and systems used to determine and analyze this issue

One of the most common methods of conceptualizing addictive behavior, including obesity, is the trans-theoretical model of change which includes the pre-contemplation stage, the contemplation stage, the preparation stage, and the action stage. A necessary shift from the pre-contemplation stage, in which the individual is unaware of the need for change, to the contemplation stage is the sense of urgency about change which distinguishes both stages (Zimmerman, Olsen, & Bosworth 2000). This is one reason why providing more information about childhood obesity has been deemed so essential. On a federal level, the CDC continues to track demographic patterns, including the rise in childhood obesity. Other advocacy groups for good nutrition have noted more subtle differences in population groups in terms of the extent to which they suffer obesity.

As well as keeping track of obesity numbers, however, there have also been attempts to keep track of correlating issues which could explain the rise in obesity. For example, "the per capita consumption of high fructose corn syrup -- the mainstay of soft drinks and other sweetened beverages -- has increased from 38.2 pounds in 1980 to 868 pounds in 1998" (Johnson 2012). This was around the time the obesity epidemic began to increase. Also, physical activity has decreased: fewer and fewer children walk or bike to school, partially due to safety concerns. "The U.S. turned into a nation of drivers; only 1% of all trips are on bicycles and 9% are on foot. Approximately 25% of all U.S. trips are less than one mile but 75% of these are by car" (Johnson 2012).

Community and targeted population

Encouraging physical education and healthy eating targets all young people. This has been somewhat controversial as a general strategy, however, amongst some anti-obesity advocates. They argue that ignoring the economics behind obesity is dangerous. Obesity is not just an education problem or problem of personal will they believe; it is also a poverty problem. Others focus on the difficulties of behavioral change regarding food-related matters: "Empirical evidence indicates that when behaviors are underpinned by habits, they are automatically enacted by the presence of cues or internal drive states. When aiming at changing these behaviors, the intentions need to be powerful enough to override the existing habits" (Raman, Smith, Hay 2013).

Epidemiologic surveillance systems

The CDC continues to keep track of childhood obesity statistics on a state-by-state basis, as well as based upon demographic categories. Age, obesity (versus overweight) and the prevalence of chronic diseases associated with obesity are all monitored. Correlates between healthy eating habits and physical activity are also tracked on the federal level.

Epidemiology tools

However, in addition to the CDC, independent researchers have also noted correlates between other changes in American society, such as the explosion of sedentary leisure that offers a shift in focus away from more physical activity, suggesting that limiting television and computer time could decrease obesity (Johnson 2012). Studies have also supported that physical education during the school day enhances rather than limits academic performance in school and even on standardized tests, contrary to conventional wisdom (Johnson 2012). Tracking of less conventional associations with obesity in children can also help to create a more effective plan to combat it and ultimately reduce the prevalence of chronic diseases.