Childhood Obesity Epidemic Terms Defined

¶ … Childhood Obesity Epidemic

Terms Defined

Preliminary Causes of Obesity: Energy Imbalances

BMI and Other Body Weight Assessments

Behavior and Environment as Causes for Obesity

Psychosocial and Physical Effects of Obesity

Genetics

Family Dynamics and Parenting

Nutrition and Dietary Intake

Participants Selected

Insights

This research study provides a qualitative examination of the physiological and psychological effects of obesity among American children. A comprehensive review of the literature available with regard to obesity research is combined with insight acquired through surveys with K-12 physical education instructors and personal observations. The study results sow that obesity and overweight conditions among adolescents are the results of multiple elements.

The results show that genetic influences may increase an individual's susceptibility to overweight or obese conditions, however do not guarantee obesity later in life. Environmental, behavioral and parental factors were found to contribute most significantly to youths overall health and wellness. The more support children receive, positive affirmations and the more physical activity and education available, the less likely children are to suffer the deleterious effects of obesity, which include poor health, low self-esteem and depression.

INTRODUCTION

The intent of this research study is an examination of the physiological and psychological effects of obesity among American children. The researcher via qualitative examination intends to observe what factors contribute to obesity, with particular emphasis on genetic, environmental and parental factors that may contribute to obesity. In addition the researcher intends to examine the nutritional and dietary habits of youths in order to determine what factors are most likely to contribute to the growing epidemic striking this nation's youth. In depth investigations will be made to determine what the effects are of obesity among children.

This research is relevant for a number or reasons. There is a growing body of evidence that suggests that young Americans are getting wider, to the point where their lives and their mental health are at stake (Crute, 2005). In fact, an epidemic has hit the states, with an alarming rise in childhood obesity a problem that actually may begin during the toddler years, as more and more children turn to TV rather than outdoor activity for fun (Tweedie, 2004).

Studies suggest that one in five toddlers is already overweight by the time they hit their fourth birthday (Tweedie, 2004). Overweight toddlers typically become overweight adolescents, with increased risks for strokes and heart disease, asthma, diabetes and even abnormalities of the foot structure as a result of excessive weight (Tweedie, 2004). Problems in adolescents include poor self-esteem, fears of being unpopular and unattractive, depression and by far the worst eating disorders (Tweedie, 2004).

Many studies have focused on single causes of obesity in children including bad dietary habits and inactivity (Tweedie, 2004). The intent of this research study is to provide a more comprehensive examination of the physiological and psychological factors that contribute to obesity in children. Secondary to this the researcher will identify what exactly the effects of obesity are in children both physiologically and psychologically.

Research Questions

In particular the researcher will attempt to answer the following research questions: (1) what combination of physiological and psychological factors are most likely to contribute to obesity, (2) what are the combined physiological and psychological effects of obesity in children. To answer these questions the research focuses on an investigational analysis of all the combined factors including genetic, environmental and parental that may contribute to obesity in youths. From the information gathered from the literature review and the field, the researcher intends to produce a theory grounded in research that not only explains but also helps provide avenues for ameliorating the epidemic that is killing this nation's children.

Significance of Study

Obesity rates among American youth have soared to crisis levels over the past ten years, and the impact is evident in homes across the nation. According to Blasi (2003) obesity is considered "the number one health risk for children in the United States today" (321). The number of children who are now classified as overweight has more than doubled in the last twenty to thirty years alone, with approximately one in five children defined as overweight by health standards (Blasi, 2003). Even though 20 to 30% of children can be classified as obese, the condition remains largely under diagnosed and under treated by many healthcare practitioners and families (Blasi, 2003). Some studies suggest that if a child is overweight by the time they reach the age of six, they are more than 50% likely to be obese when they reach adulthood (Blasi, 2003; Axmaker, 2001).

America's children are literally expanding each and every day. Young adolescents once possessed of small amounts of baby fat have been replaced by obese fifth graders. More and more middle and high school students are diagnosed with diabetes, increased risk factors for cancer, stroke and even heart disease (Crute, 2005; Tweedie, 2004). Health experts are calling it a national crisis, but epidemic is the correct word for the problem that is plaguing the nation's young people (Crute, 2005). Obesity is affecting children's education as well as their quality of life and their life expectancy. (Ogden, 2002).

The percentage of children and adolescents who are overweight and obese is now at its highest. Approximately 25% of children and adolescents are considered overweight, a figure which has doubled in the last 30 years. (American Obesity Association, 2000). Among adolescent boys between the ages of 6 and 11, obesity rates have tripled during the last two decades, and increased more than two and a half times for girls. Obesity is also associated with many adverse side affects including asthma, diabetes, hypertension, sleep apnea, psychosocial effects, and stigma increased risk of morbidity and mortality. (American Obesity Association, 2000).

Because obesity is associated with chronic disease and adverse health outcomes, the growing incidence of obesity in the population has become a serious public health concern. This study is significant because it will contribute to the current body of research available aimed at overcoming this national crisis.

BACKGROUND

Obesity rates are rising among the nations youth due to a variety of complex factors. One of the more commonly cited factors that is contributing to the nations obesity epidemic is inadequate participation in active sports, both among female and male young children (Tweedie, 2004).

According to the National Association of State Boards of Education (2004) only 8% of elementary schools, 6% of middle schools, and 6% of high schools required daily physical education classes. There was a time in history when all children were required to actively participate in physical education. This is no longer the case. When children are encouraged to participate, they are infused with the idea that winning is ultimately the most important aspect of play, rather then fun, health and fitness.

The National Center for Health Statistics (2004) reported that nine million children over the age six are obese. Another 15% are overweight and borderline "at-risk." 2004 data from the Institute of Medicine reported 13% of Caucasian children ages 12 to 19 are overweight, 21% of African-American children ages 12 to 19 are overweight, and 23% of Mexican-American adolescents are overweight.

Environmental factors and genetics are two major factors contributing to childhood obesity although physical educators nationwide have also seen the results of individual behaviors and family dynamics resulting in poor nutrition choices and lack of exercise. The executive director of the National Board of Educators Association (NEA) Jerry Newberry was quoted in NEAToday (March, 2005) "If kids aren't healthy, their learning suffers." This statement suggests that learning is suffering across the nation.

Part of the problem may be the inordinate amount of fast food that young people consume. According to Moran (1999), "thirty-three percent of adolescents eat fast food everyday." Research shows that sedentary adolescents who eat high-sugar and, high-fat meals have poorer cognitive skills, higher anxiety levels, and problems with hyperactivity. Unhealthy adolescents also tend to miss school more.

NEAtoday (March 2005) found that schools in every state had reported that "tens of millions of dollars" were lost because of absenteeism caused by inactivity and poor nutrition (Crute, 2005). Interestingly enough despite this few researchers have examined what if any affects a nutritional education program might have on childhood behaviors.

There are emotional downsides to childhood obesity as well. As a physical educator of 12 years I have witnessed obese children who could not play sports, who could barely fit into their desks at school, and who could not get through a school day without being bullied by peers. "The psychological risks can be as great as the physical risks," says Ted Feinberg, assistant executive director of the National Association of School Psychologists. "Low self-esteem and depression can undermine children's learning, behavior, and well-being" (Moran, 1999).

The most immediate consequence of being overweight during childhood and adolescence are psychosocial (Dietz, 1998). The social implications of obesity are a major problem area that is often neglected. "The obese do less well academically, have poorer job prospects and lower self-esteem. The latter often caused by repeated failures at weight loss." (Dietz, 1998). Obese children are often taller than their non-overweight peers, and are apt to be viewed as more mature. This is an inappropriate expectation that may result in adverse effects on their socialization. (Dietz, 1998). Overweight children and adolescents report negative assumptions made about them by others, including being inactive or lazy, being strong or tougher than others, not having feelings and being unclean. (American Obesity Association, 2000).

This epidemic did not occur overnight. Obesity and overweight are chronic conditions.

Problem Statement

This study was concerned with genetics, family dynamics and parenting, and nutrition and dietary intake, all three of which contribute to childhood obesity. Specifically the researcher will attempt to determine what factors are contributing to the nations epidemic rises in obesity among children and what the effects are of the growing girth that is plaguing the nations children. The objective of the research study will be development of a concrete theory that clearly defines the effects of all contributing factors. The intent is to provide healthcare providers and researchers with new avenues for exploring the epidemic affecting this nation's children.

Purpose Statement

The purpose of this study was to sample 50 K-12 physical educators to determine their perceptions of the unintended physiological and psychological consequences of childhood obesity in their classrooms over their tenures from 3-30+ years. In doing so the researcher hopes to provide clear information that may help guide research in the future related to the subject of childhood obesity.

Terms Defined

Obesity - a state or condition present in the body that results in abnormal levels of fat in the body. Typically the term obesity is used for people that are more than 20 to 30% overweight for their combined sex, age and height (Crofton, 2005). Obesity may also be defined as being over 100 pounds the normal body weight. Obesity may be considered a level above overweight, and is typically associated with symptoms including fatigue, depression, problems with compulsive eating (Crofton, 2005).

Physiological - the biological effects of a given phenomena or substance.

Psychological - the emotional and mental effects of a given phenomena or substance.

Psychosocial -the combined social and emotional effects of a given phenomena. Relates to how individuals perceive themselves and their place in the world. Psychosocial factors can influence one's self-esteem. May include society's perceptions that overweight or obese people are lazy, inefficient and poor learners (Tweedie, 2004).

REVIEW of the LITERATURE

There are a variety of factors and many theories that play a role in childhood obesity making it a complex issue to address. It is vital that researchers examine obesity and its impact on children from a variety of different perspectives in order to gain a clear and accurate picture of how and why the problem is occurring.

For the purpose of this paper, a concentrated focus of literature was researched focusing specifically on the following factors: the role of genetics, family dynamics and parenting and nutritional choices. The researcher assumes that all three of these inherently contribute to childhood obesity based on the preliminary data presented in this review.

Preliminary Causes of Obesity: Energy Imbalances

Studies from a variety of disciplines including pediatric nutrition and epidemiology demonstrate that childhood obesity is not caused by one thing; rather, "obesity has a multifactorial origin." (Gable & Lutz, 2000). Some of these factors include: genetic disposition, family demographics, parenting beliefs and practices, child television viewing and computer use, physical activity, "food as reward," increasing hectic family lifestyles and large portion, high fat foods in abundant supply.

One particular theory holds that obesity is a result of an imbalance of energy. "This epidemic is a result of energy imbalance over a long period of time" (Strauss, 2005). Energy balance is like a scale. When calories consumed are greater than the number of calories used weight gain results. Overweight conditions and obesity result from an energy imbalance thus, according to this theory. According to Richard S. Strauss, MD this scale is an example of energy balance and imbalance:

Weight gain:

Calories consumed > Calories used

Weight Loss:

Calories Consumed < Calories Used

No Weight Change:

Calories Consumed = Calories used

Weight gain involves eating too many calories and not getting enough physical activity (Strauss, 2005). The cause of energy imbalance for each individual may be due to a combination of several factors. "A persons body weight," according to Strauss (2005) "is the result of genes, metabolism, behavior, environment, culture, and socioeconomic status."

BMI and Other Body Weight Assessments

The most common method for determining whether adults or children are either overweight or obese is based on a measure called the body mass index (BMI). (Grantmakers in Health, 2001).

Body Mass index=

Weight in pounds x 703

Height in inches x Height in inches

Because the BMI for children is supposed to increase as they grow, an overweight classification cannot be based on a single number, rather the determination of whether a child is overweight is a function of age and sex specific percentiles based on the Growth Charts for the United States as issued by the Centers for Disease Control and Prevention (CDC) in May 2000 (Grantmakers in Health, 2001). Children with a BMI above the 95th percentile for their age and sex are considered overweight. Those between the 85th and 95th percentile for their age and sex are considered at risk of being overweight. Obese and overweight are often used interchangeably, but both refer to children who are above the 95th percentile (Grantmakers in Health, 2001).

The Office of Genetic and Disease Prevention (2005), has found fat stores are regulated over a long period of time by complex systems that involve input and feedback from fatty tissues, the brain, and the endocrine glands like the pancreas and the thyroid. Overweight and obesity can result from only a very small positive energy input imbalance over a long period of time (Office of Genetic and Disease Prevention, 2005).

Behavior and Environment as Causes for Obesity

Strauss writes that behavior and environment play a large role causing people to be overweight and obese. These are according to many researchers, the greatest areas for prevention and treatment actions (Strauss, 2005). "Genetics and the environment may increase the risk of personal weight gain. However, the choices a person makes in eating and physical activity also contributes to overweight and obesity" (Strauss, 2005). "Personal choices concerning calorie consumption and physical activity can increase a person's risk for gaining weight" (Strauss 2005).

There are many factors causing childhood obesity. "A person's bodyweight is regulated by numerous physiological mechanisms that maintain balance between energy intake and energy expenditure" (Strauss, 2005). Under normal conditions these systems are extraordinarily precise, for example, a positive energy balance of only 120 kcal per day (about one serving of a sugar sweetened soft-drink.) would produce a 50-kg. Increase in body mass over the next ten years. Therefore, any factor that raises energy intake or decreases energy expenditure by even a small amount will cause obesity in the long-term.

Bourbeau, Crawford, Freeman et. al, (2005) suggest that rapidly declining rates of sports participation among youths has contributed to the obesity epidemic that is affecting the young. The researchers examine several underlying trends which have contributed to the decline in sports participation, which they define as: (1) personnel issues, including how many teachers and coaches support intramural programs, (2) facility issues, including problems securing space to meet the demands of students interested in engaging in intramural sports and lastly (3) cultural issues, which either suggest that children play numerous competitive sports at once or do nothing (Bourbeau, Crawford & Freeman, 2005:11).

There are also many behaviors and amusements that children currently engage in that have contributed to youth obesity rates, including amusements for children that require no activity, such as video games, computer media, television use, MP3 players and even cell phones which all promote sedentary behaviors and obesity at a young age (Bourbeau, Crawford & Freeman, 2005).

Psychosocial and Physical Effects of Obesity

The physical effects of obesity have been well documented. Children who are obese are more at risk for suffering lifelong health problems which include but are not limited to heart disease, stroke, high blood pressure, Type II diabetes and even orthopedic problems resulting from increased stress on the joints and bones in the body (Hoot, 2004; Blasi, 2003; Tweedie, 2004; Crute, 2000). More so than the physical complications or more devastating are the "psychosocial" effects of being overweight. Children who are overweight are more likely to suffer emotional consequences that are negative and damaging. Generally children tend to "develop negative attitudes about overweight peers" early on in life; such negative attitudes often result in stigmatization of overweight children (Hoot, 2004). Overweight children are more often thought of as "lazy, stupid, slow and self indulgent" (Hoot, 2004:70). In addition overweight children are more likely to be perceived by other children as less likeable, which typically results in them being excluded from "social development opportunities" including play (Hoot, 2004:70).

Studies have shown that obese children are more likely to experience depression and low self-esteem (Hoot, 2004; Blasi, 2003) and more likely to be socially withdrawn than other children (Hoot, 2004). These trends are noted in children as young as age 4 and 5 (Davison & Birch, 2001; Hoot, 2004).

Genetics

There is also a sufficient body of evidence that confirms a genetic influence on obesity rates. Bouchard (1990) points out that "not all children who eat non-nutritious foods, watch several hours of television daily, and are relatively inactive develop obesity. Genetics have recently been shown to influence fatness, regional fat distribution, and response to overfeeding."

Ebbeling, Ludwig, & Pawlak, (2002) point out that genetic factors can have a tremendous impact on an individual's predisposition for becoming obese or overweight. The Lancet journal published a story in 1997 about two massively obese Pakistani children who were found to have a mutation in the gene encoding Leptin; this is a hormone that is usually produced by adipocytes and secreted in proportion to body-fat mass (Ebbeling, Ludwig, Pawlak, 2002). Since this finding, "five genetic mutations that cause human obesity have been identified, all presenting in childhood" (Ebbeling, Ludwig & Pawlak 2002). "There are also many additional candidate alleles, such as those in the variable nucleotide tandem repeat region of the insulin gene, have been discovered that seem to affect the risk of early-onset obesity" (Ebbeling, Ludwig & Pawlak 2002). According to the Lancet journal, single gene defects account for a small fraction of human obesity. It is very rare for people to have single gene mutations causing severe obesity that starts in infancy, although according to the Office of Genetic and Disease Prevention, (2005) "studying these individuals is providing insight into the complex biological pathways that regulate the balance between energy input and energy expenditure" Ebbeling, Ludwig, & Pawlak (2002), discovered that predisposition to obesity seems to be caused by a complex interaction between at least 250 obesity-associated genes.

The Center on Disease and Control (CDC) labels obesity as a condition that results from an environment of caloric abundance and relative physical inactivity that is modulated by a susceptible genotype. There are some rare obesity syndromes caused by mutations in single genes that have been described by the CDC (2005). The CDC's findings were that the greatest proportion of obesity in humans is not due to single gene mutations. Genetic predisposition may not be health destiny, but studies indicate that inherited genetic variation is an important risk factor for obesity (CDC, 2005). Evidence from twin, adoption and family studies strongly suggests that biological relatives exhibit similarities in maintenance of body weight. Genetic factors are also being implicated in the degree of effectiveness of diet and physical activity interventions for weight reduction (CDC, 2005). Each genetic variation may contribute to a small amount of risk and may interact with environmental elements to produce the clinical condition of obesity. (CDC, 2005).

The Office of Genetics and Disease Prevention (2004) found that biological relatives tend to resemble each other in many ways, including body weight. Individuals with a family history of obesity may be predisposed that prevent obesity are especially important. Another finding indicates that individuals in an environment made of constant food intake and physical activity respond differently. Some people store more energy as fat in an environment of excess; others lose less fat in an environment of scarcity. The different responses are largely due to genetic variation between individuals (Office of Genetics and Disease Prevention, 2005).

Whitaker and Dietz (1998) suggest that prenatal over-nutrition might affect lifelong risk of obesity. Their hypothesis stated that maternal obesity increases transfer of nutrients across the placenta, inducing permanent changes in appetite, neuroendocrine functioning, or energy metabolism. Results of Whitaker and Dietz (1998) observational studies showed a direct relation between maternal obesity, birth weight, and obesity later in life; however, "the relative contributions of shared maternal genes vs. intrauterine factors are difficult to differentiate" (Ebbeling, Ludwig, & Pawlak 2002). Findings in animal studies indicate the long-term consequences of maternal obesity - the offspring of female rats with diet induced obesity were heavier than the offspring of rats with the same genotype but without obesity. These findings indicated that the obesity epidemic could accelerate through successive generations independent of further genetic or environmental factors (Ebbeling, Ludwig & Pawlak, 2002).

In addition, infants born to overweight mothers have been found to be less active and to gain more weight by the age three months when compared with infants of normal weight mothers (Bouchard 1990).

The Lancet journal (2002), stated that under nutrition at important stages of fetal development could also induce permanent physiological changes that result in obesity. For this reason, the nutrition transition could place many children in developing nations at particularly high risk of obesity (Ebbeling, Ludwig & Pawlak, 2002). If these are the possibilities for obesity, than an opportune time to initiate prevention would be before conception.

Children who were bottle fed seem to be more at risk of obesity later in childhood than those who were breastfed" (Ebbeling, Ludwig & Pawlak, 2002). The Lancet journal explained this theory in relation to permanent physiological changes caused by some intrinsic factor unique to human milk or to psychological factors, such as locus of control over feeding rate (baby vs. parent) or taste preference. (Ebbeling, Ludwig & Pawlak, 2002).

Research has shown that during early childhood, Body Mass Index (BMI) normally decreases until age 5-6 years then increases throughout adolescence (Ebbeling, Ludwig & Pawlak, 2002). "The age at which this BMI redirection occurs has been termed the adiposity rebound" (Ebbeling, Ludwig & Pawlak 2002). Several observational studies have described an increased risk for obesity later in life in individuals who have early adiposity rebound. However, the biological importance and predictive value of this association remains a matter of debate. (Ebbeling, Ludwig, Pawlak, 2002). For children who are predisposed to gain weight, preventing obesity is the best course. (Office of Genetics and Disease Prevention, 2005). Predisposed persons may require individualized interventions and greater support to be successful in maintaining weight. Strauss (2005) points out that a child's genes are not necessarily his or her destiny. Obesity can be managed in many cases with a combination of diet, physical activity, and medication according to the Office of Genetics and Disease Prevention, (2005).

Children can't change their genes, but they can change their behavior. The public messages to prevent children from becoming overweight emphasize a nutritious diet and daily physical activity. Many who make the choice to follow this advice from the outset are able to maintain a healthy weight, even with genetic susceptibility to gain weight. However, these lifestyle interventions have a range of uptake and effectiveness, especially if obesity is already present. The public health interventions aimed at the general population are not a complete solution. (CDC, 2005).

Family Dynamics and Parenting

Of the many factors that are associated with overweight and obesity, studies suggest that parenting and family dynamics perhaps play the largest roll in a child's development and propensity for developing obesity. The ecosystems' model recognizes that there are relationships between and among individuals, families, psychosocial groups, institutions, and society, all of which may contribute to an individual's tendency toward obesity (Caple & Salicido, 1995). These interactions between or among these systems have a significant impact on human behavior and functioning. Gable & Lutz (2000) point out that "ecological theory posits that some of the potential risks factors that directly touch obese children are associated with aspects of the families dynamics."

For example, research indicates that food choices are related to demographic characteristics of the family. Single parent households and households in which both parents work full time have a tendency to favor the consumption of prepared foods, which tend to be high in sodium and fat (Crockett & Sims, 1995). Household income also indirectly influences children's eating habits and weight. "Between 1977-1978 and 1987-1988, lower income households reduced their vegetable consumption by twenty-two percent, as compared to twelve percent in high-income households" (Lutz, Blaylock & Smallwood 1993). These findings suggest that healthy foods are expensive and require more time to prepare. Dual-worker or single parent households may not have the time to prepare healthy meals and low-income families may not have reliable sources of income to regularly provide healthy foods. Thus, although food availability in the home sets the stage for food intake and eating habits, the availability of food is often affected by parents' time and parent's income levels (Lutz, Blaylock & Smallwood 1993).

Parent's beliefs about children's nutritional needs and their attitudes toward mealtimes can also make a difference in children's weight. A common response to a child's increasing weight is to restrict non-nutritious foods, or those foods we usually associate with poor nutritional quality, such as chips, cookies, and cake. Yet, when a child's intake is restricted, profound negative consequences result. Gingras (2000) shows that establishing food restrictions can actually have a detrimental affect on a child's natural ability to regulate food choices and feelings of satiety (Gingras, 2000). By enforcing rigid guidelines, parents alter their child's responsiveness to internal signals of hunger and satiety. When parents impose eating practices with few opportunities for children to learn self-control, children learn to depend on external signals, such as looking at a clock to determine hunger or overeating comfort foods as a way of coping with stress. Parents need to learn to trust their children to eat when they are hungry and to stop once they feel satisfied. It is a parents' responsibility however, to provide healthy food choices for children at appropriate times. Whether a child learns to appreciate the role of healthy foods in their own physical and emotional well-being and to recognize their body's signs of hunger and fullness is linked to the nutrition and mealtime environment created by parents (Gable & Lutz, 2000).

The rapid advancement of our society has systematically eliminated the need for physical exertion. "Children are spending more time at home watching television, sitting in front of computer screens, and playing video games drastically reducing the amount of time they spend actively engaged in physical activities" (the Henry J. Kaiser Foundation, 2004). During the same period in which childhood obesity has increased so dramatically, there has also been an explosion in media targeted to children. TV shows and videos, specialized cable networks video games, computer activities, and Internet web sites are now directed at children significantly more often than they have been in times of old (the Henry J. Kaiser Foundation, 2004). "Children today spend an average of five-and-a-half hours a day using media, the equivalent to a full time job, and more time they spend doing anything else besides sleeping" (the Henry J. Kaiser Foundation, 2004).

Research examining dual income and single family households suggests that single parents are under more stress and spend less time at home than two parent, single income families (Bianchi, 1995). These children spend more time than their peers on household tasks, implying greater maturity demands and responsibilities. Translating those differences to a child's health and nutrition could lead to poor nutrition choices and less physical activity. For example, these children may more frequently prepare their own meals which consist of prepared food items, or spend more time unsupervised allowing them to engage in sedentary activities (Bianchi, 1995).

Parental modeling is crucial to the eating behaviors of children as well as self-esteem and body image" (the Henry J. Kaiser Foundation, 2004). When parents cringe as they step on the scale, children learn that the body of the person they love and admire is somehow unacceptable. This could be a dangerous lesson. If parents cannot love themselves for who they are, how can children be expected to appreciate their own bodies?

Parents need to impart a sense of balance when it comes to food, weight, and self-esteem. Proponents of a family perspective contend that individuals develop a normal or distorted body image in the context of family life (Hawthorn-Hoeppner, 2000). As a mediator of culture, the family operates as an influence on identity, contributing to the formation of self-esteem. In homes where talk about weight is prominent, and where a focus on dieting is central, cultural attitudes that are misshapen tend to arise. Derogatory statements related to weight and nutrition can also negatively impact children in many ways. These types of homes serve as defining mechanisms for the construction of collective identity; it creates a common outlook on the value of being thin. Part of being in the family means embracing this attitude, which determines the status of insider vs. outsider (e.g. thin vs. fat). This discourse on weight can lead to dysfunctional consequences such as binge eating, food hiding, and eating disorders (Hawthorn-Hoeppner, 2000).

With many overweight children, it isn't the extra pounds but the parent reaction to the pounds that take the greatest emotional toll" (Hawthorn-Hoeppner, 2000). As a result, parents face a balancing act of helping the child without giving the impression to the child that they are not loved unconditionally. A useful model to explain parental influence on a child's behavior is the expectancy-value model of Eccles and Harold (1991). In this model, socialization behaviors are thought to be influenced jointly by parental expectation for the child's success in a given area and the value parents place on this success. Parents who expect that their child can be successful and who value the success in an area will be more likely to influence their children to pursue this behavior. (the Henry J. Kaiser Family Foundation, 2004).

Four different socialization variables influence physical activity behaviors in children according to Welk (1999): (a.) Parental Encouragement - Refers to obvious verbal and non-verbal forms of encouragement for a child. Parental efforts to build competence and a sense of mastery are likely to promote involvement. (b.) Parental Involvement- the parent provides direct assistance or involvement in the child's activity. This could include family walks, playing catch or practicing skills. This demonstrates to the child that the parent feels physical activity is important. (c.) Parental Facilitation - effort is made by the parents to make it easier for children to become more physically active. For example, providing access to facilities or programs or obtain equipment. (d.) Parent Role Modeling - Parent models an active lifestyle for their child. Modeling promotes self-efficacy and also informs the child of what is important or valued (Welk, 1999).

Nutrition and Dietary Intake

With regard to nutrition and dietary intake, the data currently available indicates that Americans are consuming more calories but are not compensating for them with increased physical activity. (Public Health Reports, 2000). According to the U.S. Department of agriculture (USDA), Americans in the 1990's were consuming more food and several hundred more calories per day than they did in the 1970's. Much of this observed increase can be associated with an increase in eating away from home. A study by McCrory and colleagues (1999) found that an increasing proportion of household food income was spent on food prepared away from home and that frequently eating restaurant food was associated with being overweight. In two-career families where there is no one at home to prepare healthy meals, warming up packaged foods, picking up fast food, or dining out has become the norm. (Grantmakers in Health, 2001). "Eating is also a form of entertainment and a forum for socializing, as the number and variety of restaurants has mushroomed in recent years." Grantmakers in Health (2001). As a result of this, the amount of meals eaten outside the home has almost doubled in the past few decades. According to the USDA, food prepared away from home provided 34% of total food consumption in 1995, up from 19% in the late 1970's. (Grantmakers in Health, 2001).

When eating out, people tend to either eat more or eat higher calorie foods than they do at home. (Putnam, 1999). Food eaten outside the home, on average, is higher in fat and lower in micronutrients than food prepared at home. Lin, Frazzo, Guthrie (1999). According to Grantmakers in Health (2000) as people spend more time and money eating away from home, their expectations regarding volume and value have created a demand for portion sizes that are not healthy. In 1957, an average muffin was 1.5 ounces, compared to at least 5 ounces in 1997. A theatre serving of popcorn was 3 cups in 1957, compared to 16 cups in 1997. And the average size of soda was 8 ounces in 1957, compared to 32 ounces in 1997. (Putnam, 1999). When quoting Susan Zepeda, Ph.D., executive director of the Health Care Foundation for Orange County in Grantmakers in Health (2001) as saying "That the one factor driving the increases in portion sizes in restaurants is that it allows owners to justify price increases without adding much to their overall costs."

Another important contributing factor is the breeding of high-calorie, convenience foods. Americans are eating more fast foods and other foods that are high in fat and sugar content such as prepackaged foods, cookies, chips, candy, and soft drinks. These foods are extensively marketed, relatively low in price, and readily available in vending machines and convenience stores.

Massive efforts by food manufacturers and restaurant chains to encourage people to buy their brands must play a role. Promotions, pricing, packaging, and availability all encourage Americans to eat more food not less." Public Health Reports (2000). "The food industry spends about $11 billion annually on advertising and another $22 billion on trade shows, supermarket "slotting fees," incentives, and other consumer promotions." Gallo (1996). In 1998, according to the 44th annual: 100 leading advertisers (1999), promotion costs for popular candy bars were $10 million to $50 million, for soft drinks up to $115.5 million, and for the McDonald's restaurant chain just over a billion dollars. These figures dwarf the National Cancer Institutes $1 million annual investment in the educational component of its 5-a-day campaign to increase consumption of fruits and vegetables or the $1.5 million budget of the National Heart, Lung, Blood Institute's National Cholesterol Educational Campaign. (Cleeman, Lenfant, 1998). American children are bombarded daily with dozens of television commercials promoting fast foods, snack foods, and soft drinks. (Public Health Reports, 2000). These advertisements are even a commonplace at schools, thanks to channel-one. A private venture that provides free video equipment and a daily television "news" program in exchange for mandatory viewing of commercials by students, and school district contracts for exclusive marketing of one or another soft drink in vending machines and sport facilities. (Public Health Report, 2000). "Advertising directly affects the food choices of children, who now have far more disposable income than they had several decades ago and far greater influence on their parents buying habits." Putnam (1999).

These problems are compounded among residents of low-income neighborhoods where there are often few choices for grocery stores and limited access to fresh fruits and vegetables. Among the options that do exist, foods that are high in fat and sugar content tend to be relatively inexpensive compared to available healthy food choices. (Grantmakers in Health, 2001). Disparities are compounded when income is considered. The National Longitudinal Survey of Youth (2000), documents that the overweight prevalence among low-income African-Americans and Hispanics was 27.4% while the prevalence among high-income whites was only 8%. Also, according to Strauss and Pollack (2001), "The prevalence of obesity decreases as educational level increase. Among adults who have not completed high school, 26% are obese. For those who have completed college, the obesity rate is 15%."

The same factors and food supply issues that undermine adult health, for example, more fast food, more soda, the dissolution of family meals, and greater portion size, contribute to overweight in children. (Grantmakers in Health, 2001). A recent non-healthy trend is that unhealthy foods are becoming increasingly available at schools as school districts deal with fast food franchises and vending machine operators to make extra money. (Grantmakers in Health, 2001). Fast foods such as pizza, ice cream, and french fries are sold in about half of all public elementary schools and in three quarters of middle and high schools. Sales from vending machines in American schools generated $750 million in 1997. (California Food Policy Advocates, 1997). "They lure school kids with the promise of sweets, tempt administrators with the promise of money, and draw ire from health experts who see nothing but the promise of overweight kids." neatoday, (2005). "While many schools argue that these contracts have become a vital source of revenue, they may very well be undermining the health of the children the schools are serving" (Grantmakers in Health, 2001).

Overall, more than 60% of children and adolescents eat too much fat, and only one in five eats the recommended five daily servings of fruits and vegetables. Only slightly more adults, about one in four, eat the recommended fruits and vegetables (CDC, 2001).

METHODOLOGY

Research Design

Design for data collection within this study focused on a survey instrument, which was utilized to sample physical educators with from 3 to 30 years or more experience and their perceptions regarding childhood obesity and its affects within their classroom.

A comparison of findings within the study was described as aligned to the available literature. Internal validity was finally established by triangulating the literature, the data, and the findings.

Participants Selected

The participants selected for this study were 50 K-12 physical educators to determine their perceptions of the unintended physiological and psychological consequences of childhood obesity in their classrooms over their tenures from 3-30+ years.

Methods of Data Collection

Survey participants were able to provide information anonymously via an online or paper survey. The data collected online was integrated with data collected via paper survey. The information from the field research was combined with information gathered from the literature and compared. From each of these areas the researcher established validity and created a theory with regard to the obesity epidemic among the nations youth.

FINDINGS

The results from the survey questionnaire show that physical educators are aware of the increasing girth of America's adolescents. Part of the problem according to study participants was a lack of financing for sport related programs, as well as a lack of enthusiasm from students who are self proclaimed "tv and internet junkies."

Genetic - the findings from the literature review confirm that a genetic link may be associated with overweight and obese conditions among adolescent youths. However as Straus (2005) points out a persons genes do not necessarily control their destiny. Physical educators surveyed point out that obesity and overweight conditions can be overcome in students with proper education and training with regard to nutrition and fitness.

The results from observation and survey research suggest that families with obese role models tend to result in children with more disordered eating behaviors as well as a greater propensity to be overweight. This is intimately related to the information gathered from the literature review which reveals that trends in obesity tend to run in families (Hawthorn-Hoeppner, 2000). Of critical relevancy however is the need to teach children how to monitor their hunger signals and control their intake. Whitaker & Dietz (1998) point out that genetic predispositions for overweight and obesity related problems may begin as early as in utero, when a mothers nutritional habits can physiologically impact her baby permanently into adulthood.

Environmental/Behavioral - Environmental and behavioral influences play a significant role in obesity related behaviors. Strauss (2005) confirms that environment may play a primary role and influence a child's behavior substantially with regard to eating behaviors. As Bourbeau, Crawford, Freeman et. al, (2005) suggest, perhaps the biggest environmental factor contributing to the expanding girth of the nations youth is a decline in sports participation at all levels of education. This sentiment is confirmed and proved valid y information gathered from physical educators via survey, who report that children are less interested in participating in intramural sports than they are interested in purchasing the latest video game.

In addition to a lack of sports participation, a culture that promotes excessive TV watching, internet usage and video game playing has also contributed to the obesity epidemic (the Henry J. Kaiser Foundation, 2004).

Parental/Familial - of all the evidence collected parental and familial factors seem to have the most impact with regard to dietary an fitness behaviors among the nations youth. Studies confirm that young people growing up in alternative households where both parents work several hours or where a single parent is responsible for a child's upbringing, the risks for obesity and overweight rise significantly (Putnam, 1999). Findings also suggest that as educational level declines so too does fitness and nutrition oriented behaviors within the household. Families that tend to view food and dietary behaviors in a negative way typically produce children that have more eating disordered behaviors and negative food associations. Children who are obese are more likely to receive pressure from friends and family members to lose weight, which may actually backfire and contribute to more disordered behaviors.

Insights

The researcher also took the time to observe several schools during recess in K-12 classrooms in order to determine what if any activities were predominant among this age group. These observations revealed that while in a school setting, most students were likely to engage in active play including field games, dodge ball and group activities within the context of school 'recess' or physical education classes. This suggests that if schools were to promote physical education more aggressively, young students would be more likely to engage in vigorous activity on a daily basis. This also lends support to information gathered from the literature review, which suggests that familial factors as well as environment substantially influence the likelihood of sports participation and an active lifestyle among classrooms.

One thing that was clearly lacking with regard to curriculum were classes geared toward nutrition and wellness, at least at the K-12 level. An observation of the standard curriculum at most colleges and universities shows that there is adequate availability of nutrition and dietary classes that instruct students on health and wellness (Dupal, 2003). Further investigation into school-based health promotion suggests that multicomponent nutrition education programs can influence student knowledge and result in positive behavioral changes with regard to food selection and activity level among young students (Dupal, 2003).

Dupal (Blomhoffman & Dupal 2003) and several other researchers point out that activities that promote healthy lifestyles are the mainstay of adult well being, thus are indisputably critical at every educational level. Further Dupal suggests that school psychologists could potentially serve a number of vital roles with regard to health promotion including in the "development, implementation and outcome evaluation of prevention and health promotion programs (BlomHoffman & Dupal, 2003:263).

Blasi (2003) points out that obesity and overweight conditions in children are the leading cause of pediatric hypertension and Type II diabetes. Putting on weight during childhood also increases the risk for heart disease, may increase the risk for chronic health problems and may even contribute to sleep apnea (Blasi, 2003). Children are more often teased when they are overweight which can contribute to depression, and children are often the target for social discrimination through adulthood when obese as children (Blasi, 2003).