Factors impacting population health: epidemiological and cultural perspectives

¶ … Population Health: Childhood Obesity

Of all of the current factors impacting population health, childhood obesity may be have the greatest threat for long-term damage, as well as being the one most highly linked to culture, socioeconomic status, and personal liberties. As a result, efforts to reduce childhood obesity have been met with ambivalence and, sometimes even hostility. Part of the reason for this hostility is that the two factors that contribute greatly to childhood obesity, junk food and a lack of exercise seem ubiquitous in modern society. It can be difficult for parents to avoid junk food, and, for those parents whose children do not struggle with weight issues, it can see unduly burdensome for them to have to avoid junk food (such as not taking birthday cupcakes to elementary school children) to cater to the health problems of other people's children. Likewise, it can be difficult for some to understand why children are so inactive, but unsafe neighborhoods and working parents can make it difficult for children to get exercise outside of a school setting.

Looking at childhood obesity through the lens of an epidemiologist, it is clear that tackling childhood obesity presents several challenges. The three most important issues related to the public health initiative are: the ethics of establishing weight guidelines, legal limits on food sizes or content, and regulating parenting choices that can contribute to obesity. The obesity and overweight epidemic is evident when one looks at today's children, but visual cues are not enough to document a health issue. Currently, health care practitioners use the BMI as a guide for overweight and obesity-related health issues. However, it is well-accepted among practitioners that BMI is, at best, an approximation for healthy weight and that some outliers in children will be overweight or obese according the BMI, but not overfat according to more accurate measures of body fat percentage. "Experts generally consider BMI for kids to be a good measure of body fat, at least among heavier children. But there are some cases in which BMI might be misleading. Athletic kids, in particular, may fall into the overweight category when they are actually muscular" (Benaroch, 2103). As a result, some people question whether it is ethical to use the BMI as a measure of obesity. When considered as a screening tool, BMI can be very helpful when identifying children with potential health problems, but it should not be considered a stand-alone diagnostic tool. One of the legal issues surrounding obesity is the regulation of high-calorie foods. For example, New York City had banned the sale of soft drinks above a certain size, but this ban was declared unconstitutional (Ax, 2013). Finally, because childhood obesity is epidemic and can have life-long health consequences for the impacted children, some have suggested that allowing a child to be morbidly obese is a form of child abuse. In fact, there have been cases where severely obese children have been removed from their parents. This is an interesting regulatory issue, because it would interfere in the parent-child relationship in a way, and leave otherwise good parents at risk of losing their children because of weight struggles.

Current health care legislation is likely to have a positive impact on ending childhood obesity. In the past, obesity was seen as a failure of self-control and not treated as a disease. However, understanding of obesity is evolving in today's society. Obesity is being seen as a disease, which opens up patient access to medical interventions. These interventions include nutritionists, dieticians, and even obesity specialists, such as bariatric surgeons. Though many interventions are not available for pre-pubescent children, the growing recognition of obesity as a disease has opened up the possibilities for insurance-paid treatment. However, current legislation that is not linked to healthcare, but is aimed at reducing the prevalence of obesity has faced some problems.

The Robert Wood Johnson Foundation (RWJF) has a six-point policy aimed at reducing childhood obesity. The goal of the program is to reverse the trend in childhood obesity by 2015. The program has six different foci: ensuring healthier choices in school foods and beverages; ensuring that healthy food is affordable; increasing physical activity at school; use pricing strategies to promote healthier food choices; increase physical activity in communities; and reduce marketing of junk foods to children (RWJF, 2013). More information about these policies can be found at: http://www.rwjf.org/content/rwjf/en/about-rwjf/program-areas/childhood-obesity/strategy.html.

The cultural, ethical, regulatory, and legal factors influencing the specified population health topic are very complex. For example, when First Lady Michelle Obama recommended that people drink more water, a recommendation that seems like it should be completely non-controversial; the suggestion was met with animosity. There is a feeling that the government being involved in food and nutrition choices is an overreaching. In addition, there has been tremendous resistance to efforts to legislate better health choices. Therefore, using pricing strategies, such as punitive taxes on junk food, to promote healthier choices may face opposition, not only from the manufacturers of junk food, but also from consumers. Many people struggling with poverty gravitate towards high-calorie, inexpensive food, and many of these food products would be targeted by punitive pricing or taxing schemes.