Causes and effects of childhood obesity

Childhood Obesity

The problem of overweight children in the United States has increased dramatically in the last several years and some claim has reached near epidemic proportions. The problem has doubled in the past 20 years as the percentage of overweight children has increased from 6.5% in 1980 to 15.3% in the year 2000 (Centers for Disease Control, 2000). During the same period, the percentage of overweight adolescents tripled from 5% in 1980 to an alarming rated of 15.5% in 2000 (Centers for Disease Control, 2000). As will be discussed later in this paper, the consequences of this increase in obesity among children will have a significant impact on the health of these children not only presently but also as this generation of children age. Besides the life-threatening health problems that are directly addressed herein there are related other non-life threatening problems such as tooth decay or depression. Studies have been done that show that children who are substantially overweight throughout much of their childhood and adolescence have a higher incidence of depression that those who are not obese (Mustillo, 2003). Although these conditions are not life threatening, they are still significant and cost society millions of dollars every year to treat. Research has also shown a significant connection between obesity and decreased academic performance and an increase in the possibility of being bullied in school (Jannssen, 2004). Although not firmly established, it is believed that obese children, burdened with poor nutrition, inactivity, and related weight problems miss significantly more time from school and, thus, a correlated decrease in academic performance (Schwimmer, 1999). Current estimates have placed the percentage of overweight children at 16% of the total population. These numbers vary between various areas of the country but when examining the overall population obesity is a serious problem among individuals between the ages of 2 to 18 years of age. The problems associated with obesity are numerous and demand immediate attention. How this can best be done will be the purpose of this paper.

In examining the issue of obesity in children a variety of perspectives and disciplines were considered. Childhood obesity is not only a medical problem it is also a social problem with some unique legal overtones. The causes and effects of obesity have far reaching effects on society in general and for this reason the problem must be addressed but for the millions that must deal with the problem on a daily basis the immediacy of the problem is even more important. Every day spent being overweight is one too many and detracts from both the quality and quantity of life. It is not just a personal problem for those afflicted with the problem it is also a societal problem. Obesity reflects upon the type of society that we have created and begs for a solution. A solution grounded in healthy eating habits, proper exercise, and a respect for one another.

The responsibility for addressing the problem of childhood obesity is not the exclusive to parents. Because children spend nearly 2,000 hours a year in the classroom, educators share in this responsibility. It is incumbent on the schools to encourage physical activity and attempt to instill healthy nutritional habits in the students. Arguably, the schools are faced with obstacles such as a lack of resources, the demand for higher academic performances, and the availability of foods that comply with higher nutritional standards but such problems can be overcome with political pressure being applied.

Finding a lasting solution for obesity, particularly in children, will have far ranging effects across society as medical costs are lessened; life threatening diseases are eliminated; and the general health of society is enhanced. Turning the tide on this issue benefits everyone and to delay further hurts us all.

1. Problem Defined

Obesity at any age is a serious concern but when it involves children it takes on even more importance. One of the reasons why it takes on more importance in children is the fact that it has grown at an exponential rate in the last few decades. Presently the Center of Disease Control and Prevention has estimated that there are over 9 million overweight children in the United States and that this number has increased tripled in the past 30 years (Center for Disease Control and Prevention, 2011). The concern is that these overweight children will develop into overweight adults with estimates. Estimates from the United States Department of Health and Human Services are that 70% of overweight adolescents will become overweight adults. If one adds in the possibility that an overweight adolescent has one or both parents who are overweight and the percentage of an adolescent being overweight as an adult increases to 80% (U.S. Department of Health & Human Services, 2010).

Accompanying the rise in obesity is the rise in diabetes. Type 2 diabetes, like obesity, has increased at epidemic proportions in the United States and there are many who correlate the two conditions. The Institute of Medicine has estimated that 30% of all boys and 40% of all girls born in the United States in 2000 will develop Type 2 diabetes in their lifetime (Institute of Medicine, 2004). Similarly, these same children face an increased chance of also developing heart disease and, for the first time in our nation's history this group also faces the likelihood of having a lower life expectancy than their parents (Kraak, 2005).

In addition to the commonly known reasons why childhood obesity is a problem there are a number of lesser reasons. High blood pressure and elevated cholesterol are problems that are usually associated with much older individuals but obese children are also subject to suffering from both of these conditions. The collateral problems from high blood pressure and elevated cholesterol are life threatening and will only get worse as the overweight children get older.

Sleep apnea, which is the obstruction of the airway during sleep that results in a serous drop in blood oxygen levels) occurs with much greater frequency in obese children. This condition is often associated with nightly bedwetting, difficulty getting up in the morning, poor school performance, and generalized fatigue. This last side effect can further acerbate the situation by making the obese child less apt to be active as he or she lacks the necessary energy.

Beyond the physical problems that have definitely been attributed to obesity in children there are a variety of studies being conducted that suggest that there are a number of additional problems. Some of these studies are investigating the possibility of several bone and joint disorders that may be attributed to obesity. One such disorder is a condition known as "slipped capital femoral epiphysis" which is a slippage of the growth plate in hip bone. The condition can alter a child's growth and result in crippling effects later in life.

Studies are also being conducted relative to the effect that obesity may have on the development of liver and kidney disease, and even a possible increased risk of cancer.

Finally, there is the psychological effect of a child growing up obese. America society places a high value on personal appearance and children can be quite mean to those who are different in some way and obesity certainly characterizes someone as being different. Such characterization can damage one's self-esteem and confidence. Self-image develops when we are young and if one's self-image is of being obese it is difficult to alter this self-image as one grows older leading to continued obesity as one matures (Daniels, 2006).

The effect of obesity on life expectancy was briefly mentioned earlier but it deserves further attention because what it says about our society in general. Life expectancy has been used as a barometer of society's overall health for several centuries. It has been used as a way of our saying to ourselves, "we are progressing." With the rise of obesity, it is entirely possible that the present generation of children will become the first generation to actually live fewer years, on the average, than their parents. This possibility should raise concern among everyone.

There are some related societal problems that are related to obesity in children that deserve attention. The first such problem is the de-emphasis of physical education in our nation's schools. From its apex during the administration of President Kennedy in the early 60s, physical education programs in schools have been on a steady decline. Despite the cries of experts advocating that physical activity is vital for the well-being of school children and that such activity would serve to combat obesity physical education is afforded little consideration in school curriculums. School officials argue that the budgetary considerations make it impossible for them to increase the number of hours put aside for physical education and that it is more important for their schools to concentrate on a rigorous academic curriculum. Quite simply, there is enough time, not even an hour a week, to ensure that the physical health of the students is improved. Data from the Centers for Disease Control indicate that the overall, daily participation in physical education has decreased from 1991 to 2001.

Another issue is the fact that our nation's schools are failing to provide students with healthy foods in our in-school lunch programs. The school programs are making little effort to structure their menus so that the daily nutritional requirements as proscribed by the United States Department of Agriculture are being addressed. Again, funding is cited as the problem but a strong argument can be made that convenience is more properly the issue. Additionally, the placement of vending machines containing snack foods high in carbohydrates and soft drinks high in sugar and fructose is also contributing to the overall problem. The placement of these vending machines is the result of corporate sponsorships by some of the nation's leading food manufacturers and the schools benefit financially from these placements but at what price?

If obesity could have developed as a problem in less than a generation it can be solved in less than a generation as well. Whether it can done in time to save the health of today's generation of children is unknown but failing to take action virtually ensures that they will live shorter and less healthy lives. These statistics and trends explain why obesity in children needs to be addressed and needs to be address immediately. It is not a problem that we can delay addressing. A solution must be found now.

II. Risk Factors

Predicting what may cause a child to become obese is not an exact science but through careful study and analysis a clear set of risk factors have emerged (Butcher, 2006). These factors, usually working in combination, increase a child's chance of becoming obese. The simple explanation for childhood obesity is that children are consuming more calories from food than they are burning during the day but there are other factors that must be considered as well.

The first such risk is the child's diet. This may seem like an obvious factor but it must still be considered and examined. Children who regularly eat high-calorie foods such as those that one finds at fast-food restaurants and in vending machines can be expected to cause a child to gain weight. The drinking of soft drinks, candy, baked cooks and other desert items are also high on the list of food items that fall into this category. All these items are high in sugar content and fat and their caloric content is much higher than their residual nutritional value. This factor is likely the most common cause of obesity in children but it is not the only one.

Changes in society such as video games and television have also made their contribution to the obesity problem. Quite simply, children in today's society do not spend enough of their time exercising. The activities that occupy most of their time are not of the type that result in the burning of calories. Too many children today spend their days watching television or playing video games and, too often, drinking numerous soft drinks and snack foods at the same time. These are inactive activities that burn very few calories. Plus, there is the fact that American families due to their life-styles are eating out more often, consuming larger meals, eating high-fat foods, and too often putting taste and convenience ahead of nutrition considerations.

Studies have also demonstrated that the chances of a child becoming obese increase in the situation where one or more parent is overweight. Whether it is genetics, the household diet, or a lack of an emphasis on physical activity the fact is that such environment contributes to childhood obesity. As to the genetics aspect, this factor alone is not likely to contribute significantly to the obesity problem. During the last generation the rate of overweight American children has increased from 4% to 19%; a figure that cannot be explained through genetics alone.

An overlooked factor, but one that is found in a significant number of situations, is where children use food as a way of dealing with their emotions. These children whether because of stress, boredom, or depression utilize food as a method of providing them some form of relieve from these conditions. Often these forms of coping are learned from one's parents or peers but regardless of the cause the results can be devastating.

In the last few years another risk factor has emerged that is receiving considerable attention. Some experts are pointing to the fact that childhood obesity is a particular problem in low-income families. The reasons for this prevalence is still being studied but some of the reasons being proposed are the frequent reliance on fast-food restaurants by low-income families and corresponding high cost of eating healthy foods such as fresh vegetables and fruits (Roach, 2009).

III. Approaches to Treatment

There a wide variety of approaches to the treatment of obesity. These approaches differ based upon the intensity of the treatment, the cost, the nature of how the treatment is administered, and whether it is self-regulated or directed by health care professionals. The options are so varied and numerous that they can become confusing for those seeking treatment.

In beginning any assessment of the approaches to treating or finding a solution to obesity is necessary to recognize that even small changes in weight have consequential health benefits. Study after study indicate that a 5-10% loss in body weight can result in meaningful health improvements in the areas of cholesterol levels, hypertension and glucose metabolism (Wadden, 2003). Studies have also demonstrated that a loss in body weight can lower the risk of developing Type II diabetes. This parallel between obesity and Type II diabetes has been made consistently by experts in the area of nutrition and health and the approaches that these experts have recommended follow a consistent pattern of lifestyle modification, dietary intervention, behavioral therapy and increased physical activity.

A. Lifestyle modification

Changing the way that children lead their lives is essential to any long-term solution to the obesity problem (Weiss, 2009). Frequently, children and their parents may become engaged to suddenly address the problem and begin to diet and exercise in an effort to lose weight. Such an approach works well in the short-term but without an accompanying change in lifestyle that involves the entire family the results will be short-lived. The entire environment of the obese child must be changed. Healthy eating habits must be adopted. Regular exercise must be continued and the reason for undertaking these changes must be on the health benefits garnered and not on the cosmetic changes that might result. Although the physical changes may be the more obvious of the advantages it is the internal physical improvements that will last longer.

The entire family of the obese child must dedicate itself to providing a healthy environment. This means a curtailing of eating out particularly at fast-food restaurants. Preparing and eating healthy meals at home which include moderate portions of fresh vegetables and fruits is essential. The availability of cookies, cakes, pastries, and snack foods should be extremely limited. These types of foods have limited dietary value and add nothing but calories and fat to one's diet.

B. Dietary Intervention

There are an unlimited number of available diet options on the market today. Adults are free to try as many of these options as they please but when addressing the diet options available for obese children a much different approach must be considered. Maintaining a dietary content nutritionally balanced for the health of the child is essential. What is being attempted is not only a loss in weight but also a change in eating habits and the health of the child cannot be compromised for the sake of convenience. In adult dieting unusual approaches can be attempted but dieting in children is far more complex. The evidence suggests that everyone, but especially children, benefit most from diets containing low and moderate-fat, low calorie food items (Chaffin, 2001). Any attempt at adopting any of the trend diets should be heavily discouraged when managing the diets of children. Quick weight loss is not the goal. The purpose is to develop healthy eating habits along the way and allow a gradual weight loss of a pound or two a week. The process is slower but the results longer lasting.

C. Behavioral Therapy

The value of behavioral therapy in the process of controlling childhood obesity may be criticized by many but there is considerable evidence that incorporating such techniques has a positive effect on the outcome. By developing an understanding of why one chooses to eat unhealthily the obese individual is able to develop insights that can aid in the long-term battle against obesity. A good behavioral program can help the obese child to set realistic goals, understand why physical activity is important, learn how to control the impulses to eat, and to rebuild one's confidence and self-esteem. The behavioral therapy setting allows the obese child the venue for expressing how being overweight has affected him or her and an outlet for letting go of the frustrations.

D. Physical Activity

Physical activity, like the inclusion of a diet plan, seems to be an obvious ingredient in the approach of battling childhood obesity but the mere inclusion in a program is not sufficient. In order to be effective physical activity must be geared to the personality and abilities of the obese child. This may require the intervention of an exercise professional who can assess the child's needs and design a program that fulfills these needs. Getting a previously inactive child to do anything physical will have positive effects but involving the child in a program that he or she finds interesting and entertaining will result in the child's adopting long-range changes in the area of physical activity that will yield permanent changes.

Unfortunately, to date, the approaches being used to combat childhood obesity have been largely initiated and monitored by the families of the obese child. Until recently there has been little public recognition that childhood obesity is a public problem as opposed to a private one. This trend is now changing as across the nation, policymakers and health providers are attempting to involve themselves in reversing the trend toward increased childhood obesity.

Some of the new programs include the requirements by the Food and Drug Administration that food manufacturers provide accurate food guidelines and nutrition labels so that the public can evaluate the nutritional value of the food they buy; grants from the Department of Health and Human Services that fund community outreach programs that promote healthy food choices in schools, health education classes, and exercise instruction.

In the private sector there are also efforts to discourage childhood obesity. Lawsuits have been filed against a number of fast-food chains and food manufacturers in an effort to hold them responsible for the growing obesity epidemic (Brownell, 2009). To date, these efforts have met with mixed results but consumer groups and educational foundations are adamant in their dedication to pursuing this avenue of relief. Additionally, there are a number of professional organizations such as the Robert Wood Foundation, the America Academy of Pediatrics, and the Let's Move initiative that are organizing efforts throughout the nation to combat childhood obesity and to lobby on behalf of obese children in Congress and state legislatures.

First Lady Michelle Obama's efforts to bring the issue of childhood obesity before the national public have sparked new interest in the subject. She has advocated for new programs directed at funding health awareness, education directed at healthy eating, and the organization of new exercise opportunities. Her efforts are only a beginning but they do highlight a problem that needs all the attention it can get. In reality the solutions must come from the grass roots level which means the home in order to effectuate any long-term solution but bringing the problem onto the national stage can only serve to make this process much easier.

IV. Recommendations

The recommendations relative to resolving the issue of childhood obesity in America are not easy ones to implement and they require a concentrated effort by parents, teachers, physicians, children, and communities to unite behind a common goal. That common goal is a renewed effort to increase the overall health of our society and developing new and health approaches to diet and exercise.