Educational Intervention on the Balance

¶ … Educational Intervention on the balance between Diet and Exercise

Energy Balance is the key to a healthy body

More and more people are becoming victims of obesity. While on one hand, the precise causes of this disease are still unclear, the general conclusion most scientists have agreed upon is the disparity between the energy consumed and the energy used. This is to say, obesity occurs when individual lifestyles lead towards excessive food consumption and little to no energy-utilization activities. Zakus (1982) in his study pointed out that certain ailments, namely, Frohlich's, Klinefelter's, Praeder Willi, Klein-Levin, Lawrence Mood Biedl, and Mauriac syndromes, are the underlying causes of childhood obesity. However, these cases, he points out, occur in less than 5% of children (Zakus, 1982).

Scientists have also explored the possibility of family genetics as a possible cause of obesity. A number of studies have examined the growth and development of twins in order to figure out this the obesity mystery. World Health Organization (1997) summarized a number of studies which pointed out that the approximately 25% to 40% of BMI is genetic in nature (World Health Organization, 1997). Stunkard et al. (1990) pointed out that twins that have been raised apart have a BMI of 0.7% (BMI of 1 is considered to be perfect); this is slightly lower than the BMI of twins who have been raised jointly (Stunkard, 1990). In addition, Bouchard et al. (1990) in his study used a sample of two twin-pairs. Both twin pairs had been subjected to overfeeding and it was assumed that the results would reveal gain in weight for both twin pairs. However, the results showed that the first twin-pair gained more weight than the second twin-pair (Bouchard et al., 1990). It is clear from the aforementioned studies that genetics play some role in weight gain. However, genetics do not change as drastically as the weight gain being witnessed amongst both children and adults all over the world. Therefore, while the study of genetics is important to explain certain obesity trends, variations in the energy balance (energy intake and energy used) has got to be the primary focus of researchers if they are to figure out the obesity mystery.

The amount of energy consumed and utilized is the key to sustaining a healthy weight. Birch and Deysher (1986) found that most children possess the natural tendency to balance their energy intake and energy expenditure. Fisher, Rolls, and Birch (2003) found that as children grow up they tend to loose this ability to external signs and signals, such as the amount and kind of food presented to them. Most research studies on the relationship between energy consumption/utilization and obesity have yielded consistent results. We will review some of these studies in order to connect the theoretical foundation of this study to the conceptual constructs.

Definitions and conceptualizations of three variables

Calorie (Energy Intake)

U.S. Department of Health and Human Services (1996) has defined calories as "a measure of energy from food." They further elaborate that 3500 calories amount to 1 kilocalorie. Kilocalorie is what consumers see on food labels (U.S. Department of Health and Human Services, 1996).

When studying energy or calorie in-take, researchers usually look at how much fast food consumers eat on average. Paeratukul (2003) along with his colleagues revealed that those people who consume fast food quite frequently are eating food with lesser nutritional value than normal food and therefore their propensity to gain weight is more than those who either do not consume fast food or eat very rarely (Paeratukul, 2003). However, their results were contradicted by other researchers who concluded that consuming more fast food does not result in obesity. Ebbeling et al. (2004) found that slim children who consume fast food, balance their energy intake with other physical activities; whereas obese children who also consume fast food do not balance their energy intake with physical activities (Ebbeling et al., 2004). However, Thompson et al. (2004) found that those slim-girls, between the ages of eight and twelve, who were subject to eating fast food at baseline at least twice a week, gained weight after a three-year follow up study (Thompson et al., 2004). These studies show the contradiction amid the researchers who have studied the casual relationship between energy intake and obesity.

Artificially-flavored juices and soft-drinks are another very popular subject for energy intake researchers. The common element between the conclusion of studies on fast food and beverages is that they both result in higher weight gain. On one hand, several researchers have found that higher consumption of soft-drinks is positively related to weight gain (Ludwig, Peterson, and Gortmaker, 2001; James et al., 2004; Troiano et al., 2000). On the other hand, the results emerging from artificially-flavored juices are somewhat mixed, with some researchers finding a strong link whereas others failing to do so (Dennison, Rockwell, and Baker, 1997; Skinner et al., 1999; Skinner and Carruth, 2001). Welsh et al. (2005) in their study found that sweet drinks increase obesity propensity and most obese individuals consumed large volumes of soft drinks and beverages including soda and juice (Welsh et al., 2005).

Exercise (Energy Expenditure)

U.S. Department of Health and Human Services (1996) defined exercise as "physical activity that is planned or structured. It involves repetitive bodily movement done to improve or maintain one or more of the components of physical fitness -- cardiorespiratory endurance (aerobic fitness), muscular strength, muscular endurance, flexibility, and body composition." Similarly they defined physical activity as "any bodily movement produced by skeletal muscles that result in an expenditure of energy (U.S. Department of Health and Human Services, 1996)."

Azar (1996) in their study found that exercise not only positively impacts the physical health; but it also helps keep the individual mentally strong. It reduces stress by normalizing the brain's response to stress therefore makes it easier for the individual to deal with stress (Azar, 1996). Greenough (1996) in his study found that exercise increases the flow of blood to our brains and therefore it makes both the body and mind stronger (Greenough, 1996). Similarly, Akande Wyk and Osagie (2000) pointed out that physical activity including exercises reduces the inclination towards obesity and keeps individuals in the best physical and mental shape (Akande Wyk and Osagie, 2000).Several other studies conclude the same results (Biddle, Akande, Vlachopoulos & Fox, 1996; Biddle & Bailey, 1985; Biddle, Akande, et al., 1996; Blair et al., 1989; Blumenthal et al., 1989; Boyle, 1985; Carlson, 1982, Charlesworth & Nathan, 1984, Danish, Petitpas & Hale, 1993; Howard, 1993; Jennett, 1996; Magill, Ash & Smoll, 1978; Pettijohn, 1992; Sarafino, 1990; Selye, 1985; Serfass & Gerberich, 1984; Sheridan & Radmacher, 1992; Van Raalte & Brewer, 1996).

Nutritional Knowledge

Nutritional knowledge can be defined as the awareness of foods that is healthy for one's health (the International Food Information Council Foundation, 1992). A number of studies have shown that parents' nutritional knowledge (or lack of) has a direct impact on their children's propensity to become obese (Alexander & Blank, 1988; Simic, 1983). If parents are not aware about the impact of food both in their house and in the market than it is highly unlikely they will be able to prevent their children from consuming unhealthy food. Bowers, Faulkner, and Michel (1979) in their study found that families having little to no nutritional knowledge end up taking meals haphazardly and the kind of food they eat has low nutritional value with high amount of calories (Bowers, Faulkner, and Michel, 1979). Price, Desmond, Ruppert, and Stelzer (1987) found that lack of proper nutritional knowledge and improper eating habits lead to obesity (Price, Desmond, Ruppert, and Stelzer, 1987). Similarly, Epstein, Masek, and Marshall (1978) in their study found that students who received nutritional knowledge were able to control their weight and remain healthy by consuming food with higher nutritional value (Epstein, Masek, and Marshall, 1978).

Chapter 2

This study offers a synthesis of the main findings on the literature of healthcare research related to obesity. This study used analysis of publications and reviews of research from 1980 to present, and refined these results into concise and clear findings that can be understood by the reader.

Inclusion and Exclusion Criteria

Four aspects had been taken into consideration when collecting the information. Only those scholarly books and peer-reviewed articles have been included which revealed:

1) the dilemma of obesity in United States;

2) the impact of energy intake on obesity;

3) the impact of energy output on obesity; and 4) the impact of nutritional knowledge on obesity

In order to answer these questions, the researcher did a meta-analysis of recent publications. The researcher reviewed articles from several books and articles published in magazines and journals (such as QUESTIA, CINAHL, PUBMED, MEDLINE, GOOGLE SCHOLAR, MSN, NIH, CDC) and analyzed information published in these sources to determine the types of patterns that are currently dominant in the obesity phenomenon in the U.S. Furthermore, the keywords used to search for information in these databases were: DIET, EXERCISE, OVERWEIGHT, OBESITY, WEIGHT Management, PHYSCIAL FITNESS, NUTRTION, EDUCATION.

Literature Review

1. The dilemma of Obesity

Mokdad et al., (1999) in his study found that the issue of unhealthy weight, overweight and obesity are perhaps one of the rising concerns for the Americans in the 21st century as more and more U.S. citizens become vulnerable to the circumstantial risks and dangers of the phenomenon (Mokdad et al., 1999). It is usually the body mass indexes (BMI) that indicate whether a person is actually overweight or not. The National Health and Nutrition Examination Survey (NHANES) carried out a study for the years 1999 to 2002 using the BMI phenomenon and concluded that about 65% of U.S. citizens in the adulthood years were categorized under the overweight group because of their BMI (Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, 2005).

To understand the phenomenon of obesity and its rise, it's important to understand the core meaning of the word. The most common and perhaps the most clear definition of obesity can be explained as the proportionate relation between body fat and the lean body mass; the higher the body fat difference in relation to the lean body mass, the higher the risks of being overweight (Office of Genomics and Disease Prevention, 2002). Furthermore, the effects of obesity amongst the adult population can vary from the elevated threat of chronic ailments that can also comprise of hypertension, coronary heart disease, diabetes mellitus and dyslipidemia (U.S. Department of Health and Human Services Publication, 1988). Olshansky et al. (2005) carried out a study on the growth rate of obesity within the United States and concluded that there was an obvious pattern of decreased infant life expectancy between 4-9 months due to the increase of obesity ratios. This is a more disturbing statistics then the one that exists for life expectancy ratios of road accidents (Olshansky et al. 2005).

A concise description of BMI

Body Mass Indexes or BMI as mentioned before is the main component to determine whether someone is overweight or obese. BMI is basically an arithmetical equation that divides an individual's overall weight (Kg) with the individual's overall height which is taken in meters. It is important to note here that BMI is heavily dependent on the overall fat percentage in the body and also depends upon the age as a decisive variable. The generalized consensus for an individual who is 18 years of age or older is that they are overweight if he/she has a BMI between 25.0 or 29.9 and is a victim of obesity if his/her BMI level rises above 30 (Division of Nutrition and Physical Activity, National Center for Chronic Disease Prevention and Health Promotion, 2005).

A concise description of Energy Balance

Energy Balance or EB is another arithmetical comparison between the energy that is used up during basal metabolism, specific dynamic action (S.D.A.) of food, bodily or mental exertions i.e. SPA with the energy levels that were built up or stored in the body due to the consumption of different foods. Basal metabolism is calculated using the Basal Metabolism Rate (BMR) and can be generally defined as the energy that is used up by a body to efficiently regulate its bodily functions like digesting, recollections, emotional drains, etc. (Whitney, Cataldo, & Roffes, 2002).

A concise description of Specific Dynamic Action

Specific Dynamic Action or S.D.A. Of food can be simply defined as the level of energy that is consumed by the body to execute the entire breaking down of the food which includes breaking it down, digesting, storing, dividing into different parts, etc. (Whitney et al., 2002). Usually, the energy used up during SDA can be measured by taking into account 10% of the total energy that's used up during the processes of SPA and basal metabolism (Guthrie, 1983). This is so because SPA and basal metabolism encompass basically all internal and external functions of the body that could require the distribution of the food nutrients to necessary parts as well as all bone or muscle movements (Whitney et al., 2002).

A concise description of energy consumption

Everyone understands that the more active you are, the more calories you end up burning. The objective on calculating energy levels follows the above statement as the energy that is used up during a bodily exertion will heavily depend on the extent, depth and rate of recurrence of the exertion. If all three i.e. extent, depth and rate of recurrence are high, then more calories will obviously be used up. A general consensus shows that the energy consumption levels are divided as: 10% for SDA, 30% for SPA and 60% for basal metabolism (Tam et al., 1996). It is important to note here that the main task of EB is to analyze, monitor and point out the weight changes in an individual's body, hence a steadily rising percentage of EB can lead an individual to be overweight and the opposite can lead an individual to be underweight (Groff, Gropper, & Hunt, 1995; Swinburn & Ravussin, 1994).

Obesity rates amongst minority ethnic groups in America

Since high rates of coronary heart disease have been linked directly to obesity, it is important to here that the death ratio caused by coronary heart diseases is very high amongst the U.S. citizens e.g. It is 29% amongst the Hispanic-Americans and as high as 35% amongst the Asian-Americans (National Center for Health Statistics, Division of Vital Statistics, 2005). Furthermore, the ratio for the Asians and Hispanics to get Non-insulin-dependent diabetes (NIDDM, or Type II Diabetes) is two to six times higher than those of non-Hispanic white Americans within the U.S. (Carter, Pugh, & Monterrosa, 1996). The Asian-Americans and Hispanic-Americans Ratios are important to note here because they make up a majority of the U.S. minority population (Bureau of Census, U.S. Department of Commerce, 1982 & 1992). For case in point, a study conducted in 2003 for the student proportions with the California State University at Los Angeles (CSULA) showed that the Latinos (Hispanics) made up 52.4% of the student strength, the Asian-Americans/Pacific Islanders made up 22.1% of the student strength, while the white Americans made up 16.2% and African-Americans made up 9.2% of the student strength (Office of Institutional Research and Public Affairs, CSULA, 2003). This study and the proportions presented can be deemed as a micro representation of the overall population structure of Los Angeles as a whole.

Numerous studies have shown that for the minorities, the phenomenon of obesity is far more serious and effective then amongst the majorities. Studies have shown that the African and Mexican-Americans are more vulnerable to obesity than their white, non-Hispanic compatriots. The National Health and Nutrition Examination Survey (NHANES) that was carried out for the years 1999 to 2000 showed that within the last 10 years, both Mexican and African-Americans showed an amazing increase in the obesity ratio so much so that the percentage had doubled over the years. The study showed that the Mexican-Americans who were obese rose 13.8% in the ten years to have a total percentage of 23.4% while the African-Americans rose 13.4% in the ten years to have a total percentage of 23.6% who suffered form obesity (Ogden et al. 2002) while the overall percentage of white, non-Hispanic-Americans suffering from obesity are only a total of 12.7%.

Numerous studies have concentrated on the rate and the vulnerability of college students towards heart diseases (O'Connor, Gurbel, & Serebruany, 2000). There are a number of reasons for the higher rates of heart problems observed amongst students and they can vary from academic pressures to social differences, environmental adjustments or financial tensions amongst many (Ross, 1999). While some studies concentrated on the gender differences when dealing with dietary atherogenicities, energy balance, and the extent of bodily exertions (Tam et al., 1996) other studies concentrated on the combined impact of bodily exertions and dietary kcal configurations within the familial environment and how having parents and siblings with the same BMI, energy balances (EB) and specific physical activities (SPA) under the same roof affected the students entering adulthood.

Another study conducted by the National Institutes of Health concluded that if individuals 18 years of age or above have a BMI level of 25 or above then their risks towards suffering from related heart or other diseases is far more then those with a normal BMI and they have a higher tendency of increasing their overall BMI level above 30 (National Institutes of Health, 1998). The rising concern within the U.S. with regards to obesity and all related health risks is the reason why we have seen a steady and consistent rise in the promotion/marketing of maintaining a healthy diet and body weight throughout their lives with respect to their age and gender (U.S. Department of Agriculture & U.S. Department of Health and Human Services [USDA & USDHHS], 2005).

Origins of Obesity and the urban/suburban environment

As mentioned earlier, perhaps one of the biggest concerns that are rising in the United States is the phenomenon of obesity. This is especially a rising concern because obesity is striking both children and adults at the same steady and quick pace which is increasing the relative risks dramatically. One of the studies focused on this rise of phenomenon and concluded that when looking at the last 40 years, one can clearly identify a presence of obesity amongst newly born and young children. The study showed that overall the BMI amongst children was higher than the standard BMI of the 85th percentile and was annually growing 4 times on average (Ogden et al. 2002). The same study highlighted that now nearly 15% children were deemed overweight after their BMI had been calculated (Ogden et al. 2002). The main aim for most of the U.S. health agencies and the government is to not only identify and counter the origin of this phenomenon but also to reduce the overall infant obesity levels down to 5% or less as was the case 40 years ago in the 1970s. This particular aim was especially highlighted by the social group Healthy People 2010 in one of their meetings (U.S. Public Health Service 2000).

One of the facts that needs to be understood about obesity is that if an individual has the tendency to be overweight or obese, then he is going to have these tendencies from childhood; hence obesity problems as a child can well indicate that the individual will be facing obesity problems as an adult as well (Dietz and Gortmaker 2001). This fact is scary for most of the cities in the U.S. As numerous studies saw a rising percentage of obese children. For case in point, 25% of kindergarteners were deemed overweight or obese in New York after the New York City Department of Health and Mental Hygiene carried out a nation-wide survey (New York City Department of Health and Mental Hygiene 2003).

The origin of this phenomenon is multidimensional which is what makes it difficult to counter it. Two of the most common preludes to overweight or obesity are lack of exercise combined with unhealthy and fattening diet. This combination is basically a result of the social or environmental factors that an individual grows up around. And even though the overall attitude or growth of phenomenon can change as the individual interacts in different environments, the bottom line is that the basic genetic structure will not change which is where this phenomenon originates from (Clement and Ferre 2003).

Even though obesity is the single most increased disease within the U.S. (Sturm 2002), the fact of the matter is that obesity itself might not be as serious as the relative risks that occur as a circumstance of the condition, which will also be needed to be dealt with eventually. One of these related risks in the type II diabetes which has risen dramatically amongst the American children simultaneously with the rise in obesity levels among children (Rocchini 2002). Of late, American Academy of Pediatrics (2003) found that some of the other risks that are related to or caused as circumstance of obesity include mental health concerns (like depression and/or low self-esteem), orthopedic disorders, hypertension, asthma, hyper-cholesterolemia and heart disease (American Academy of Pediatrics 2003).

One particular non-profit foundation that has been working for the environmental and health conditions of the children within the U.S. is the Environmental Health Perspectives and their main focus is to identify and promote those social and physical conditions that lead sound health and strong physical structure (World Health Organization (WHO) 2003). Even though, the general understanding that the overall social interaction between humans is very complicated, many research groups are not faltered by the complexity and are still trying hard to identify all factors, social and environmental, that affects children and leads to diseases like obesity.

The fact that the lack of healthy and sufficient food intake in the developing or underdeveloped countries is accounted mainly to their environmental conditions is not new; however, the fact that the imbalance in the developed countries where nutrition or food intake is at a very high rate can also cause problems is a relatively new phenomenon. For case in point, Weich et al. (2003) in their study found that all peripheral factors in a society like the availability or non-availability of housing, roads, density of the population, transportation networks, shops, markets impact obesity and physical health of individuals (Weich et al. 2003). Similarly, CDC (2003) and Jackson (2003) found that social and/or academic institutions, economy, violence, are all factors that can and very often have a very strong effect, negative and positive, on the child's mental and physical improvement (CDC 2003; Jackson 2003).

Numerous studies have further investigated the different conditions of the developed countries especially the U.S. To understand the dramatic rise in obesity levels. Hill along with her associates (2003) found that some of the most common features across the U.S. are the high dependence on vehicular transportation as opposed to walking, having mostly indoor entertainments like video games, TV, movies, etc. And popularity of junk foods amongst others (Hill et al. 2003). The technological advancements have made most of the developed countries rely heavily on their mind instead of having a balance between mental and physical activities and this is growing to be more of a worldwide crisis. Obesity has overtaken others diseases in its rapid increase so much so that in 2002 WHO had deemed it as the top 10 health related problems in the world and top 5 in the industrialized countries (WHO, 2002).

Efforts to control Obesity

Numerous studies have disagreed with the promoted cause of obesity to be the choices made by the individual. Many agree that this view is a micro or restricted view on the problem and emphasize that the choices that the individuals end up making are very strangely influenced by overall environmental, social or media structure that mainly promotes a more or less stationery everyday routine and unhealthy diets. According to Nestle and Jacobson (2000), the media and the industries play huge part in the formation of this structure of the society. Even the overall architecture of the cities is designed to support the use of vehicular transportation like cars or motorcycles as opposed to walking or using a bicycle (Frumkin 2002). Something needs to be done drastically to establish any form of control on the rising obesity levels within the U.S. And one of ways to do that would be to alter the centralized agricultural regulations, economic policies, tax inducements as well the WIC Program (Special Supplemental Food Program for Women, Infants, and Children) which could lead many people to re-think their food choices as a whole.

Apart from the promotions of the media, all dietary choices revolve around the accessibility to healthy and fresh food (Morland et al. 2002a). For example an urban area that has two or more supermarkets will have more competition which will lead to lower prices and higher quality so that the customers can be retained and increased with time. However that is not always the case for urban regions where an area does not have more then one major supermarket and limited choices, all the healthy food is priced high and hence attracts fewer customers which leads to an overall unhealthy diet (Morland et al. 2002b).

Aside from the food intake choices, the choices for exercising or physical activities are somewhat limited depending on the economic demography and social contexts of different regions. A good example of this is that there are urban regions within every state in America that are deficient of any sufficient form of physical education at the academic or institution level, there is limited to absolutely no contact to playgrounds or substantial sports activities. Also high violence rates make many parents of the urban regions to abstain from allowing their children to venture outdoors for physical activities as they fear their children will either become a victim to the violence or become a part of the criminal groups. Rise in the popularity of video games, and TV series are also factors that help in the growth of the phenomenon of obesity amongst children (Dietz and Gortmaker 1985). All of these conditions need to be countered if there is any hope to revive reduction in obesity levels within the U.S.

One of the other ways that obesity can be controlled is by increasing awareness of the nutritional value in different foods items and how the nutritional intake should be divided to get the maximum output. Numerous journals, articles and books have emerged within the U.S. In the last 10 years that have focused on the nutritional value in foods and how important it is to eat healthy and exercise in order to maintain a healthy lifestyle and a long life. This in turn will not only motivate people to have a healthier diet but will also allow them to control their own body weight and decrease the overall obesity levels as a whole (Alexander & Blank, 1988).

One of the other ways that the U.S. government can chip in to decrease the obesity ratio in the poorer urban districts is by establishing more recreational facilities where the people of the region can have access to a number of physical activities that they can not only enjoy but control their weight with. The fact is that those regions with a better overall socioeconomic growth have sufficient amount of recreational facilities (Sallis et al. 1990) however, the poorer regions don't share the same luxury and the recreational facilities that are present are not in the best of conditions which increases their vulnerability to fall victim to the phenomenon of obesity (MacIntyre et al. 1993).

Some studies have ventured into the realm of the likelihood of a chemical reaction in a food substance that upon consumption could very likely have a negative effect on the hormonal functions of the body and in turn negatively impact the operations of genetic, environmental, mental or bodily functions and lead to numerous problems like lowered brain activity or obesity (Bhathena and Velasquez 2002; Howdeshell et al. 1999; Rubin et al. 2001).

The market and media as a contributor towards increased obesity

There have been a number of studies conducted that focus on the contribution of the market and promotional firms on the overall dietary and inactive structure of the children in urban societies. They have focused on how the phenomenon of obesity could have been caused by what the markets chose to trade. However, this is more complicated then it seems, as upon investigation it becomes evident that there are innumerable factors that could have eventually influenced the range of products that were made available to the societies. A study conducted by James Hill along with his associates shows that the rise in obesity can happen as a result of extra intake of calories in small proportions on a daily basis. They gave facts that on average if a medium-sized person took 15 extra calories everyday then he could eventually have to face the problem of obesity and they explained that this could be the case with 90% of Americans if their intake of calories was amounted to 50 extra calories everyday (Hill et al., 2003). This means that every choice the individual makes not only on what he eats but how much he/she eats as well as how he/she exercises and how much he/she exercises could eventually lead to overweight and obesity which is why it is impossible to determine how and to what extent the promotional market activities had contributed to the obesity phenomenon.

The altered patterns of eating and related finances

An important fact that has been highlighted in numerous studies is that the reduction in the prices of food items is also a major contributor to the phenomenon of obesity. Upon further investigation, U.S. Bureau of Labor Statistics (2005) has found that during last two and a half decades the overall price of almost all food items has fallen by a drastic thirteen percent, which allows more and more food to be bought and consumed (U.S. Bureau of Labor Statistics, 2005). Lakdawalla and Philipson (2002) in their study have given a statistics and have made this reduction of process responsible for a whopping 40% of the increase in weight and obesity levels in recent years (Lakdawalla & Philipson 2002).

Apart from the process of the food, the overall salary proportion is also a factor that has been studied. Acemoglu (2002) in his study argued that if all other factors remain unchanged except for the salary of a person which increases, then that person would indulge in getting more high quality food which basically means more calorie intake then before. Furthermore, the person might also not want to cook for himself as much as he did before and save his time by either going out to eat or buying packaged food now that he can afford it. Also, this could also mean that since he has less time to cook, he might end up eating a lesser proportion of food that he did before (Acemoglu, 2002).

Numerous studies have of course taken the salary variable into account and have agreed that the overall increase in an individual's salary is a direct result of the overall educational degree that he has acquired and how he has put that academic knowledge to use practically. A good example of this can be found in the study where the salary ratios between high school graduates and drop outs was compared and stats confirmed that the graduates got paid consistently more then the dropouts whose salary ratios declined over time (Acemoglu, 2002). However, many researches like the one conducted by David Cutler, Edward Glaeser, and Jesse Shapiro proved that the people who were using more packaged foods were the larger percentage of the group of people who were suffering from overweight issues and obesity (Cutler, Glaeser & Shapiro 2003).

The overall employment field and its openness to allowing women to work professionally even after motherhood has been another aspect that has decreased the overall time spent cooking food in the house. In the last thirty years especially, the percentage of increase in the working mother who have children younger than 18 has been a whopping 72% from 47% before. Also, U.S. Department of Labor, Women in the Labor Force (2004) found that there has been a steady and elevated increase in the percentage of working women who have children younger then three years of age (U.S. Department of Labor, Women in the Labor Force, 2004). This could have directly resulted in the increase of eating out or eating processed foods. Another study, carried out by Anderson, Butcher & Levine (2003), takes this phenomenon into perspective and presents stats that show that the overall time spent at work by women, their increase percentage of salaries and their indulgence of processed food or eating out has been a factor that contributed to the increasing obesity amongst children making it rise from 12% to an overall 35% (Anderson, Butcher & Levine, 2003). In addition to that, Blank (2002) in his study highlighted that the U.S. Congress started a new socioeconomic policy for the overall benefit of the country where they gave benefits and packages to poor or single mothers to work and earn reasonable salaries from, which also further discouraged individuals and women to spend time on cooking (Blank, 2002).

One other element that has perhaps contributed to the rise in obesity and overweight is the price level of high-energy foods like oils and fat. Adam Drewnowski and S.E. Specter (2004) in their study have looked into this and have explained that the overall price ratio of high-energy food against low-energy foods, that include fruits and vegetables, has been more beneficiary for high-energy foods as their overall pricing is lower (Drewnowski & Specter, 2004). However, contrary to their claim, Bureau of Labor Statistics (2005) found that other studies that have looked at price comparisons have highlighted that during the time from January 1989 to January 2005, the overall ratio of price for the low-energy foods decreased by 33.1% while the price for the high-energy foods increased by 74.6%, so the overall consumer preference should be for the low-energy foods (Bureau of Labor Statistics, 2005). They argued that more research needs to be done on this phenomenon for more consistent and concrete results.

The changed preferences for eating food

According to a study carried out by Lin, Guthrie and Frazao (1999), the increase in wages, working women and reduced time given to cooking resulted in the following statistics from 1977 to 1995:

rise in the percentage of outdoor meals form 16% to 29%;

rise in the percentage of the total calories that were devoured in outdoor meals from 18% to 34%; and rise in finances used up for outdoor meals from 26 to 39% (Lin, Guthrie & Frazao 1999).

Another study presented the following statistics for the years 1994 through to 1996: the total calories devoured by children younger then 18 rose to an overall 4% from restaurants, 9% from schools, 10% from outdoor food outlets and 9% from other sources like parties and vendors amounting to a total of 32% calories devoured away from home. Yet another study presented the following statistics for the years from January 1980 to January 2005: finances spent on outdoor food had an overall reduction of 5.1% while overall finances used up for preparing food at home reduced to a whopping 16.2% in comparison (Bureau of Labor Statistics, 2005).