Efforts to Reduce Childhood Obesity in America

Reducing Childhood Obesity in the USA

Introduction

Obesity among teenagers and younger children has exacerbated epidemic proportions in America, adversely impacting millions of lives. In the last thirty years, childhood obesity rates have increased threefold among teenagers and more than twofold among younger children (Hales et al., 2017). CDC (Centers for Disease Control and Prevention) discoveries stem from one of the gold-standard health surveys, measuring participants’ weight and height. The most recent surveys date back to 2017-18, with over 2,800 child participants (Hales et al., 2020). Survey results displayed that 19.3 percent of children between 2 and 19 years of age were obese, a somewhat higher percentage than the 2015-16 figure (18.5 percent). This growth may not be regarded as statistically significant; in other words, mathematically, the rates may not have risen. However, the figures display a rising trend since 2005-06, when obesity was reported among 15.4 percent of American children (Stobbe, 2020). CDC findings reveal that extremely obese children have consistently, and for many years, made up six percent of the American child population.

Various factors play a role in childhood obesity, such as consuming large quantities of sugared drinks and processed foods and physical inactivity (Sanyaolu et al., 2019). The latter factor is the present coronavirus crisis that has shut down schools and forced people to stay home.

Statement of the problem

Obesity probably impacts every area of teenage/child life, including though not restricted to their general physical, cardiovascular, and mental health (Dehghan, Akhtar-Danesh & Merchant, 2005). The relationship between morbidities and obesity has rendered it an element of public health concern for teenagers and younger children. Obesity seriously and adversely affects physical as well as mental health. As a result, it has been linked to numerous comorbidity conditions like hypertension, acute depression, diabetes mellitus, hyperlipidemia, sleep apnea, and a loss of self-esteem (Kelly et al., 2018). Furthermore, obesity among children that continues even into adult life increases the likelihood of contraction of digestive and cardiovascular illnesses. Lastly, increased body fat exposes them to greater risks of several cancer forms, including colon, kidney, esophageal, pancreatic, and breast cancers.

Purpose of the study

Considering the risks to health presented by childhood obesity, this research will ascertain the best available approach to reduce obesity among American children. Multiple strategies, interventions, and programs are being utilized by different stakeholders (parents/guardians, educational institutions, etc.) to decrease childhood obesity (Sanyaolu et al., 2019). But research reveals that to achieve an impact that is significant enough to constitute success, the interventions implemented ought to be multifaceted, involving all relevant stakeholders. Thus, this study will identify the key elements of a program targeted at decreasing childhood obesity and the main stakeholders involved in guaranteeing that the program succeeds. The study’s literature review will cover obesity in educational institutions, obesity interventions, and health education and awareness in educational institutions for gaining insights into the linkage between the above three elements. The literature review process, revolving around children between 5 and 18 years of age, will be performed in the spring of 2021.

Study significance

This study is significant because it will review research works in childhood/teenage obesity, thereby functioning as an aggregative review of the most recent findings on this subject. Research findings will prove to be an invaluable resource for parents, and social and educational institutions that deal with teenagers or younger children, providing an evidence-grounded background on the different aspects of a successful obesity reduction initiative focused on children. Furthermore, the study will define all relevant stakeholders who ought to participate to guarantee initiative success actively.

Research questions

1. What constitutes the ideal intervention to reduce childhood obesity?

2. What constitutes a successful childhood obesity decrease program?

3. Which key stakeholders ought to participate in a program for decreasing childhood obesity?

Literature review

Early childhood has been believed to offer unique opportunities for establishing lifestyle behaviors, including limiting sedentary time, engaging in physical activity, eating healthy, promoting good health, and minimizing obesity risks. To reinforce the above theory is the fact that, owing to such behaviors, obesity continues from childhood into adulthood: overweight preschoolers display a greater likelihood of being overweight in their adulthood when compared to normal-weight preschoolers (Evensen et al., 2017). Hence, interventions that promote healthy childhood behaviors function as a pivotal strategy for preventing obesity, as obesity treatment during adulthood has been more challenging than altering lifestyle habits early on in life (Baur & Garnett, 2019).

Thus far, a large number of initiatives have been devised for preventing childhood obesity. Most of them revolve around intervention implementation at school (Nittari et al., 2019), as schools are regarded as a key setting concerning intervening in obesity-connected behaviors in children, for various reasons cited below: (i) Primary schooling is mandatory for every child in the majority of nations worldwide, thus reaching all children hailing from all backgrounds (ii) A considerable portion of a child’s day is spent at school, meaning they normally consume 1-2 meals there, every day; (iii) Physical education periods exist at schools, besides physical activity opportunities at recess time; (iv) schools provide a structured atmosphere facilitating easy adoption of interventions; (v) implementers will have access to a large number of children within a considerably short period through schools; and (vi) faculty may greatly facilitate and even participate in intervention delivery, thereby improving intervention sustainability (Goldthorpe et al., 2020). Despite the above advantages, school-based programs’ effect, on the whole, is questionable; one cannot easily extract generalizable recommendations from them.

Components of community-based interventions

The most effective community-centered initiatives aimed at preventing childhood obesity have several elements planned for and adopted based on local context. Thus, one cannot present a broad and all-encompassing list of elements that will likely constitute a community-centered initiative (World Health Organization, 2010). Rather, one important best-practice principle for community-focused initiatives is the community deciding on the aptest elements suited to their unique context while encouraging creativity and flexibility (King et al., 2011). The initiatives commonly target the following desirable behaviors:

· Consuming more fruits and vegetables;

· Decreased intake of sugary drinks (such as “soft” drinks);

· Lower intake of sugary, high-salt, and fatty (i.e., containing high levels of fat and saturated fat) foods;

· Reduced time spent before the TV and other “screens” (e.g., PCs, smartphones, etc.);

· Greater participation in non-competitive and competitive sports; and

· More active transport when going to school.

The above behaviors can be targeted using educational campaigns, modifying schools’ and other institutions’ policies, promotion initiatives, competitions, and activities, and involving a wide array of community stakeholders. Most of the studies on community-focused obesity prevention have been based in high-income nations. Lessons that they teach will probably prove valuable in the implementation of similar interventions within other settings.

Most activities geared at preventing obesity among children are centered on secondary and primary school settings (World Health Organization, 2009). Research efforts most commonly entail multi-component, all-inclusive programs using interventions based on the school setting, school room curriculum, and schools’ food services. Several interventions use a combination of physical activity and diet, encouraging parental participation. Numerous educational institution-based interventions reveal steady improvements in attitudes, behavior, knowledge, and tested clinical and physical outcomes (World Health Organization, 2009). From a recent literature review (Brown et al., 2019), the following ought to be adopted as a standard school practice:

· Incorporation of aspects such as eating healthy, maintaining body image, and physical activity in the mainstream curriculum;

· Incorporation of physical activity sessions and fundamental motor skills development into the routine school week;

· Close monitoring and improvement of school canteen foods’ nutritional quality for students’ benefit;

· Creation of culture and environment fostering healthy eating and physical activity all through the school day;

· Provision of support to faculty in the implementation of health promotion activities and approaches (including capacity-building and professional development activities); and

· Parental engagement in home-based support activities encourages children towards increased physical activity, healthy eating, and spending less sedentary time (especially before TV, computer, and mobile/tablet screens).

The WHO’s “School Policy Framework: Implementation of the Global Strategy on Diet, Physical Activity and Health” (Lagarde et al., 2008) guides member nations on implementing policies promoting physical activity and healthy eating at school using educational, environmental, and behavioral changes.

Out-of-school interventions

As in the case of school-focused initiatives, initiatives that are most effective within the community context (i.e., settings like primary healthcare organizations, sporting centers, and religious institutions) often comprise of various activities; that is, they frequently encompass the elements of physical exercise as well as diet, in addition to a sound educational element. But up until now, a very small number of initiatives have been assessed based on their sustainability and cost-effectiveness (World Health Organization, 2009).

Initiatives revolving around primary healthcare institutions are vastly diverse concerning their intensity as well as efficacy. Minimal contact interventions like health check-ups, information dissemination, and single-session counseling have largely proven ineffective. Initiatives of moderate-intensity, offering chronic non-communicable disease consultations follow-up via trained practitioners and targeted education, are usually more successful in risk factor modification (World Health Organization, 2009). But the time, money, and other resources linked to implementing interventions, like population-wide ones or those aimed at even large groups of the population, renders them unattractive. Moreover, this setting’s potential in the middle- and low-income nations are mostly not known.

There is only a very small pool of evidence to indicate the efficacy of carrying out interventions for preventing childhood obesity within religious settings. Still, consistent evidence exists of favorable physical, psychosocial, and behavioral changes due to interventions carried out within this setting. Taking advantage of religious communities’ extant social framework seems to help change healthier living, particularly within socially-disadvantaged communities. Further, great cost-related advantages have been associated with such interventions, as spiritual members/leaders themselves assume responsibility for carrying out or promoting the intervention in the religious environment itself (World Health Organization, 2009).

Theoretical Framework

Every health promotion plan has the same objective: reducing disease/illness risks through influencing people’s health-connected behaviors. It has been extensively acknowledged that behavior determinants go far beyond individual persons to encompass broader social factors besides the community; additionally, health promotion endeavors ought to target the various levels as mentioned earlier (Pallan, 2011). As a result, an ecological approach has been considered the ideal fit for this research. Ecological models represent theoretical models covering various impacts on individual conduct, such as individual traits, community and societal influences, and broader social factors. McLeroy et al. (1988) came up with a health promotion-targeted ecological model based on the Ecological Systems theory of child development influences proposed by Bronfenbrenner (see Figure 1). This model displays five levels of individual influence: intrapersonal elements (knowledge, self-concept, capabilities, and so forth), interpersonal processes (such as social networks and family), organizational factors (including educational institutions and one’s place of work), public policy (national as well as local level), and community factors (which may be socially, geographically, or politically defined). One central ecological model facet is the interdependency between the above influence levels and the mutual, active link between different levels of factors (Ammerman et al., 2007).

Figure 1: An ecological perspective on health promotion programs 1988 (Adapted from McLeroy et al. 1988)

Methodology

This study aims at determining the ideal intervention to adopt to reduce childhood obesity; thus, the aptest methodology, in this case, will be a systematic review of the literature. The above technique is deemed apt for this study since it will facilitate an analysis of multiple interventions and explain interventions that will help decrease obesity among children.

Search strategy

A literature search will revolve around papers published in English-language peer-reviewed journals published between 2015 and January of 2020. Some of the search databases which will be utilized are PubMed//MEDLINE, Scopus, Web-of-Science, and CINAHL. Citations within reviews will be utilized as well. Table 1 outlines the PICO keywords which will be employed in the literature search.

Table 1: PICO keywords used on search phrases.

Population 1

Population 2

Intervention

Comparison

Outcome eating

Outcome Physical Activity (PA)

Activity Sedentary behavior (SB)

“children,” OR

“Childhood,” OR “school children,” OR “school-aged children.”

“parent” OR “caregiver.”

“Health promotion

The program,” OR “health promotion

Intervention,” OR “school

Based intervention,” OR “School-based obesity program.”

“food habits,” OR “dietary habits,” OR

“eating habits,” OR “food choices,” OR “fruits/vegetable,” OR “sugar

Sweetened,” OR “whole grains,” OR “unhealthy diet.”

“Total PA” OR “MVPA,” OR “VPA,” OR “sports,” OR “active transport,” OR “walking,” OR

“Aerobic exercise,” OR “outdoor play,” OR “exercise.”

“sedentary behavior,” OR “domestic

Activities,” OR “total

sedentary time,” OR

“video games,” OR “smartphone use,” OR “reading,” OR “television

Viewing.”

Selection criteria

Research works that are original, controlled, experimental researches involving educational institution-based initiatives for preventing obesity among primary school-goers from all nations, published from 2015 to December of 2020, in the English language will be included. Other conditions for inclusion will depend on the latest studies (Goldthorpe et al., 2020; Lambrinou et al., 2020) and will include: a) duration of at least six months or over one school year, b) familial participation through reaching out to parents using meetings or newsletters dispatched to them through their children, c) use of diet and physical activity combined, d) school staff implementation of school-based interventions (including educators and healthcare providers working at the school). The above conditions will be utilized to avoid repetition of proven successful approaches and add to the extant literature.