Childhood Obesity No Child\'s Play

Childhood Obesity

NO CHILD'S PLAY

Childhood Obesity

Childhood Obesity Re-defined and Explained - the World Health Organization defines obesity as the condition when the body mass index of 25 kg/m^sup 2^ to 30 kg/m^sup 2^ (Risser and Murphy 2000). Gathered data suggested that 22% of children aged 12 to 17 were more than 120% heavier than their ideal body weight and, therefore, obese. This was not the same as being chubby, cute or a healthy eater. New growth charts were being revised according to these new standards. Children from age 2 should be tested for cardiovascular disease. The test should include a body mass index, blood pressure, an evaluation of physical and sedentary activities and typical daily diet (Risser and Murphy).

Childhood Obesity Incidence Alarming and Expanding

TV, Inactivity, Junk Foods and Video Games - the Culprits

The phenomenon has been increasing at an alarming rate (Monaco 2001). Experts attribute it mainly to inactivity. Children today prefer junk foods and watching TV or playing video games to playing outdoors and walking instead of riding. Technology has made things easier, requiring less physical exertion. Children imitate the ways of adults. They hurry with meals, consume fast foods and maintain busy schedules most of the day. Dr. Bruce Bagley of the American Academy of Family Physicians commented that the fat and salt contents of junk foods are much more than the body needs. This explains why these foods taste good. Furthermore, social interactions mostly center on eating (Monaco).

A published countrywide study conducted on the incidence of childhood obesity found that 17% of the children of school age were obese and 15% faced the risk of becoming obese (Pionkowski 2003). The study was conducted by the Health and Wellness Team at the Shawnee County. The team included health care professionals, educators and specialists in the field. The figures went way above the national average. Experts associated the phenomenon with physical inactivity and poor eating habits. These factors were also linked with adult obesity (Pionkowski).

Occurring Equally Among Low and High-Income Families

The largest survey and evaluation of public school students suggested that the situation could even be worse (Hellmich 2004). It found that 40% students among the respondents in Arkansas were overweight or too heavy. It also revealed that obesity among children was equally high among low and high-income families. Carden Johnston, president of the American Academy of Pediatrics, noted that the situation was not confined to Arkansas. He and pediatrician Joe Thompson, director of the Arkansan Center for Health Improvement, were of the opinion that obesity was reaching an epidemic level nationwide (Hellmich).

Arkansas was the only State, which required 450,000 students from kindergarten to the 12th grade to submit to a body mass index test (Hellmich 2004). The test measured height and weight in proportion to age and gender. It discovered that African-American and Hispanic students were more likely to be overweight or at a greater risk than white students. The research team advised the parents of overweight children to reduce the time these children watch TV, to increase their physical activity and to encourage them to drink low-caloric beverages (Hellmich).

Causes and Costs

Environmental Factors

The phenomenon has been an increasing public health problem in low and medium-income countries (Stettler 2004). A number of environmental factors have been associated with childhood obesity in the United States. These were too much television, low physical activity, lower socio-economic status among white adolescents, the consumption of sweet beverages, omitting breakfast, and irregularity of meals. American society has been described as a "toxic environment" as regards the incidence and development of childhood obesity. A cross-sectional study was conducted in 10 schools in Greater Zurich to determine if these factors were also applicable to Switzerland. It used 922 respondent-children in these schools. Their weights and body sizes and height were measured before noon. Interviews and questionnaires were administered. Highlights were the television programs regularly watched, time spent on electronic games, breakfast, television during meals and snacks. Findings established the link between obesity and the length of time playing electronic games and watching TV and lack of physical activity. The findings also drew a connection between obesity and smoking or mothers working outside the home. The study concluded that using electronic games increased the incidence of obesity two times by hour per day (Stettler 2004). Watching television also increased the incidence twice to thrice with every additional hour per day (Stettler).

Connection with Cardiovascular Disease

Obesity or overweight in a child is often overlooked or viewed only as the result of "healthy" eating but health experts recognize its association with cardiovascular disease (Buiten and Metzger 2000). The first National Health and Nutrition Examination survey in 1960 reported a 15% increase in the number of obese children aged 12 to 17. Obesity meant a body weight 120% greater than the ideal. Children at the greatest risk were those who had obese parents, from low-income families and of Hispanic stock. A 1977 report published in the New England Journal of Medicine said that almost 80% of children of obese parents would become obese themselves and 40%, if only one parent was obese. The research monitored the body mass index of 854 full-term infants and their parents until the infant reached age 21. It found that parental obesity was the greatest single predictor of a child's obesity in adulthood (Buiten and Metzger).

Syndrome X

In its sixth report, the Joint National Committee on the Prevention, Detection, Evaluation and Treatment of High Blood Pressure recognized 7 major risk factors to cardiovascular disease (Buiten and Metzger 2000). Overweight and a sedentary lifestyle were not among them. The factors listed were hypertension, smoking, dyslipidemia, diabetes mellitus, age over 50 years, gender and family history. The Framingham studies eventually recognized obesity as an independent risk factor. These argued that a decrease in body weight consistently and significantly contributed to a decrease in cardiovascular disease or CVD. Obesity has been connected with the metabolic disorder called Syndrome X Syndrome X has been estimated to occur among 25% of the general population. The current World Health Organization criteria for Syndrome X include obesity. A study conducted on 137 African-Americans from birth to 28 established the link between obesity in childhood the development of Syndrome X in adulthood. Finding showed that weight at age 14 significantly decreased the glucose-metabolizing ability of skeletal muscles in adulthood. This was linked with non-insulin-dependent diabetes mellitus. Other researchers also found the connection of children with high cholesterol intake and central abdominal fat distribution. Central abdominal obesity has been associated with insulin-resistance and Syndrome X (Buiten and Metzger).

The findings of studies of twins and pedigrees supported the generally accepted theories that genetic susceptibility and specific environmental factors together encourage higher disease incidence than non-genetic susceptibility (Buiten and Metzger 2000). The prototype for the link was the Pima Indians, who have nearly 76% heritability of body fat. Pima Indians are a people who live in Southwest U.S.. They are known for an unusually high prevalence of early non-insulin-dependent diabetes mellitus and obesity. The prevalence of diabetes reaches almost 50% before age 35. By age 5, Pimas children are visibly more obese than Caucasian children at the same age and with comparable physical activities (Buiten and Metzger).

Parents Generally Un-aware of the Condition

Another cause of the rise of childhood obesity was traced to parents' own failure to recognize their own children's weight problem (Etelson et al. 2003). This was the finding of a study conducted on 88 parents on their recognition of this problem, the health risks of obesity and basic knowledge of healthy eating behavior. Of these respondent-parents, 23% had overweight children but whose level of concern about the health risks of obesity and knowledge about health eating habits were comparable to those of other parents. They, however, differed in the accuracy of their perception about their children's overweight. Parents with overweight children always underestimated their children's condition at 59.4%. Only 10% perceived or acknowledged the problem accurately. Because eating habits and physical activity are largely established in childhood, parental practices tend to be very influential. Parents must recognize when their child is overweight. They must be made aware that obesity can pose health risks for their child. They should also know how to provide health and balanced meals to help their child to lose weight. Pediatricians should come up with strategies to help parents perceive and deal with this condition in their children (Etelson et al.).

Pediatric Obesity Exacts $127 million or more recent study on obesity among adults showed a 33% increase in medical expenses among both inpatients and outpatients and 77% on medications (Johnson 2006). Among children, the rise in hospital expenses was traced only to obesity and obesity-related conditions. The $127 million expenditure also reflected more than 300% increase in the last decade. The figure was, furthermore, only an estimated limited to hospital costs and excluded many obesity-related conditions. The study used data on children aged 4 to 17 from the 1998 Medical Expenditure Panel Survey, conducted by the Agency for Healthcare Research Quality (Johnson).

The study found that overweight children or those likely to be overweight tended to incur more medical expenses than non-overweight children (Johnson 2006). Socio-economic and demographic differences between them indicated the differences in expenses. In addition to genetics, TV viewing habits, exercises and family eating habits, economists also considered changes in food prices and the reduction of time in physical education in school and its effects. Overall, the risks of adult mortality and morbidity tended to increase on account of obesity in childhood. Overweight children tended to grow into overweight adults and develop poor health conditions. Adult obesity incurs large expenses, according to the study. These expenses did not include those needed for substance abuse and depression. Long-term consequences tended to become visible only in adulthood (Johnson).

Stigmatization

Obese children suffer much more from physical ailments and costs. They also lose self-esteem because of their condition. Studies conducted between 1961 and 1968 on 10-11-year-old children showed that obese children were viewed with the least respect and liking. The respondents were given drawings of children who were healthy, with disabilities and obese for ranking or preference (Latner 2003). The obese child was ranked last, even lower than those with serious physical disabilities. Those who did were children from various socio-economic and ethnic groups and those with physical disabilities and disfigurements themselves. Their responses indicated the degree of acceptance and disapproval of obesity. The study used 458 children in the 5th and 6th grades at a suburban middle school in an upper-middle income part of central New Jersey. They were 71% white, 12% Hispanic, 10% Asian, 3% African-American and 2% Native American. The highest or second ranking went to the healthy child at 74.9% and 70% ranked the obese child as the last or second to the last. Analysis of the study revealed strong bias towards the obese child. It recommended not only treatment of obesity but also education, prevention and intervention to decrease negative attitudes towards obese children (Latner).

Quality of Life

The most widespread consequences of childhood obesity could be psychosocial in nature, according to research (Schwimmer and Varni 2003). Obese children would tend to have a lower or poorer quality of life, according to findings. Children and adolescent respondents aged 5 to 18 were surveyed along with obese children. Among them were cancer patients undergoing chemotherapy. Results showed that obese children and adolescents suffered from impaired health-related quality of life than their healthy counterparts or those diagnosed with cancer. These suggested the need for physicians, parents and teachers to be informed about the risks and consequences of the health-relted quality of life of obese children to improve health conditions (Schwimmer and Varni).

Solutions

No Quick Fix

Experts from the National Academy of Sciences' Institute of Medicine said that there could be no "quick fix" to the problem of obesity in children because of its diverse causes (Consumer Comments 2004). But they emphasized the importance of parental involvement in effecting changes in these children's eating habits. The experts also stressed on the significance of the involvement of other sectors in those changes. The food industry must adjust its advertising to discourage poor eating habits. The government should insure safer streets for children's physical activity. Schools should provide more physical education to children. The experts noted that while the home is the most influential setting for children, it was also the least accessible to health intervention

Current lifestyles and lack of time for healthful meal preparation and lack of physical activity have been identified as causes of obesity in children. Attempts to cross these barriers without the need to preach to parents and stigmatize obese children have failed. And government approaches have been viewed as heavy-handed and, therefore, unproductive or even counterproductive in effecting eating habits in affected children (Consumer Comments).

Another group of more than 700 experts from diverse fields met in June 2005 to come out with environmental solutions to obesity in America's young people (Hood 2005). Non-governmental initiatives were presented and discussed. One of these was the Kaiser Permanente, which focused on prevention by training 1,000 pediatricians and family physicians who would promote physical activity and dietary change. It also linked up with other anti-obesity groups through its Health Eating, Active Living or HEAL program. Girls on the Run was a 12-week program for third to fifth-grade girls, which provided life skills development and lessons to help reduce or prevent obesity. One lesson was the five-kilometer run. Founded in 1996 by Molly Baker, the program at last counting had 50,000 girl participants and has been active in 120 U.S. And Canadian cities (Hood).

Pati Miller of the Children Now child advocacy organization pointed to interactive marketing in the media as the latest threat contributing to obesity in children (Hood 2005). The threat often comes in the form of "advergames," which are online games during TV shows promoting unhealthy foods as part of the games. The organization lobbied at the Communications Commission to ban this children's television programming. For its part, Sesame Street, a vastly popular children's show, launched Healthy Habits for Life. It was incorporated into all of its media outlets to promote healthy eating habits as critical to early development as learning to read and write. On the other hand, Pepsi Cola Bottling Company recognized the profitability of offering nutritious and healthful products. Ellen Taaffe, vice president of marketing for health and wellness, said that 40% of the company's portfolio consisted of health-oriented products. She mentioned the Smart Spot program as one of the company's initiatives aiming at instilling healthy food choices (Hood).

Stonyfield Farm, the largest producer of organic yogurt, launched the first organic and healthy vending machines for schools in collaboration with the schools themselves (Hood 2005). She added that there were 32 such machines in schools in seven States at that time and 930 in the waiting list. State efforts have also taken off in California and North Carolina through large-scale programs, like "Active Living." "Active Living" by Robert Wood Johnson Foundation was introduced in 25 cities to increase physical activity. Another program was "America on the Move," which encouraged people of all ages to increase the amount of walking and decrease caloric intake. This combination of approaches was aimed at preventing weight gain and improving overall health. A number of federal agencies, including the U.S. Department of Transportation, launched the "Safe Routes to School" program to insure safe walking and biking in school. New tools, new measures and new methods were introduced to more reliably evaluate the connection between the environment and obesity. These included the quality and availability of healthful foods and the types of food outlets in schools and neighborhoods. These steps were aimed at providing more data to evaluate the effectiveness of obesity treatment prevention programs. A major National Institute of Health initiative, "Ways to Enhance Children's Activity and Nutrition" or We Can!, was also launched. It was designed to encourage good food choices, increased physical activity and less television and computer games for children 8 to 13 years old. The message was that taking simple steps would be the best approach to treatment and prevention of the health problem. Those behind these programs were of the opinion that modifying certain aspects of the environment could at least reduce and at best eliminate the looming epidemic in 5 to 10 years (Hood).