Childhood Obesity: Causes, Effects, and Prevention Strategies

The intent of this research study is an examination of the physiological and psychological effects of obesity among American children. Through qualitative examination, the researcher observes what factors contribute to obesity, with particular emphasis on genetic, environmental, and parental factors. In addition, the researcher examines 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, with in-depth investigation into the effects of obesity among children.

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

Studies suggest that one in five toddlers is already overweight by the time they reach their fourth birthday (Tweedie, 2004). Overweight toddlers typically become overweight adolescents, facing increased risks for stroke, heart disease, asthma, diabetes, and even abnormalities of 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 — perhaps most seriously — eating disorders (Tweedie, 2004).

Many studies have focused on single causes of obesity in children, including poor 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 childhood obesity. The researcher also identifies what the effects of obesity are in children, both physiologically and psychologically.

Research Questions

The researcher addresses the following questions: (1) What combination of physiological and psychological factors is 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 combined factors — including genetic, environmental, and parental — that may contribute to obesity in youths. From the information gathered through the literature review and field research, the researcher intends to produce a theory grounded in research that not only explains but also helps provide avenues for addressing the epidemic affecting 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" (p. 321). The number of children classified as overweight has more than doubled in the last twenty to thirty years, 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 underdiagnosed and undertreated by many healthcare practitioners and families (Blasi, 2003). Some studies suggest that if a child is overweight by the time they reach age 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 carrying only small amounts of baby fat have been replaced by obese fifth graders. More and more middle and high school students are diagnosed with diabetes and increased risk factors for cancer, stroke, and heart disease (Crute, 2005; Tweedie, 2004). Health experts are calling it a national crisis; obesity is affecting children's education as well as their quality of life and life expectancy (Ogden, 2002).

The percentage of children and adolescents who are overweight or obese is now at its highest. Approximately 25% of children and adolescents are considered overweight, a figure that has doubled in the last 30 years (American Obesity Association, 2000). Among 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 health effects including asthma, diabetes, hypertension, sleep apnea, psychosocial consequences, and 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 contributes to the current body of research aimed at overcoming this national crisis.

Background

Obesity rates are rising among the nation's youth due to a variety of complex factors. One of the more commonly cited contributors to the obesity epidemic is inadequate participation in active sports, among both 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 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 often given the message that winning is ultimately the most important aspect of play, rather than fun, health, and fitness.

The National Center for Health Statistics (2004) reported that nine million children over the age of six are obese. Another 15% are overweight and borderline "at risk." Data from the Institute of Medicine (2004) reported that 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 contributors to childhood obesity, although physical educators nationwide have also observed the effects of individual behaviors and family dynamics resulting in poor nutrition choices and lack of exercise. Jerry Newberry, executive director of the National Education Association (NEA), was quoted in NEA Today (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 every day." 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 often.

NEA Today (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, despite this finding, few researchers have examined what effect, if any, a nutritional education program might have on childhood behaviors.

There are emotional downsides to childhood obesity as well. As a physical educator with 12 years of experience, the researcher has 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 is 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 is 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 — 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 attempts to determine what factors are contributing to the nation's epidemic rise in obesity among children, and what the effects are of the growing girth plaguing the nation's children. The objective of the research is the development of a concrete theory that clearly defines the effects of all contributing factors, with the intent of providing 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 survey 50 K–12 physical educators in order to determine their perceptions of the unintended physiological and psychological consequences of childhood obesity in their classrooms over tenures ranging from 3 to 30+ years. In doing so, the researcher aims to provide clear information that may help guide future research related to childhood obesity.

Terms Defined

Obesity — a state or condition present in the body resulting in abnormal levels of fat. The term is typically used for people who 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 above normal body weight. It is considered a level above overweight and is typically associated with symptoms including fatigue, depression, and problems with compulsive eating (Crofton, 2005).

Physiological — the biological effects of a given phenomenon or substance.

Psychological — the emotional and mental effects of a given phenomenon or substance.

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

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 review of literature was conducted 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 factors 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 any single 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," increasingly hectic family lifestyles, and the abundance of large-portion, high-fat foods.

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 functions like a scale: when calories consumed are greater than calories used, weight gain results. Overweight conditions and obesity result from this energy imbalance. According to Richard S. Strauss, MD, the relationship can be summarized as follows:

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 person's 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 overweight or obese is the body mass index (BMI) (Grantmakers in Health, 2001).

Body Mass Index = (Weight in pounds × 703) ÷ (Height in inches × Height in inches)

Because BMI for children is expected 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 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 are considered at risk of being overweight. The terms "obese" and "overweight" are often used interchangeably, but both refer to children above the 95th percentile (Grantmakers in Health, 2001).

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

Behavior and Environment as Causes of Obesity

Strauss notes that behavior and environment play a large role in causing people to become overweight or 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 contribute to overweight and obesity" (Strauss, 2005).

"A person's body weight 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 — approximately one serving of a sugar-sweetened soft drink — would produce a 50-kg increase in body mass over 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 have contributed to the obesity epidemic. The researchers identify several underlying trends contributing to this decline: (1) personnel issues, including the number of teachers and coaches supporting intramural programs; (2) facility issues, including problems securing space to meet student demand; and (3) cultural issues, which either pressure children to play numerous competitive sports at once or to do nothing at all (Bourbeau, Crawford & Freeman, 2005, p. 11).

There are also many behaviors and amusements that children currently engage in that have contributed to youth obesity rates, including sedentary entertainments such as video games, computer media, television, MP3 players, and cell phones — all of which promote inactivity at a young age (Bourbeau, Crawford & Freeman, 2005).