Childhood Obesity: Causes, School Nutrition, and Policy Solutions

Introduction

The rates of childhood obesity in the United States and many other Western nations have been growing at an alarming pace. This topic is significant for several reasons. One key observation is that childhood obesity affects the developed world at a much higher rate than developing nations. As society grows more technologically advanced and relies on mass-produced foods, this trend opens many dietary challenges. Although food may be plentiful, the nutritional value is often poor in cheaper, processed, and packaged foods in the United States. For example, a variety of inexpensive packaged pastries and soda drinks are highly portable, inexpensive, and easily accessible, making them popular among many demographics. This analysis examines childhood obesity from multiple angles and attempts to develop strategies that can help mitigate this growing trend.

Childhood Obesity Risks

Many factors have been identified as contributors to childhood obesity in the United States. One significant factor is the lack of physical activity. Children in some U.S. demographics have increasingly adopted sedentary lifestyles that include computer use, tablet games, and video games. The development of more sedentary activities has consumed much of the time children previously spent on physical activities such as sports or playing outdoors with friends.

As a result of increased time in sedentary activities, children do not burn as many calories as the average child in previous generations or in the developing world. The lack of physical activity means that children will not burn as many calories throughout the day on average. Those children who consume high calorie intakes without engaging in sufficient physical activity will store these calories in their bodies as fat. Furthermore, if a child has a high calorie intake coupled with a sedentary lifestyle, this can compound the issue significantly.

Poor eating habits are also a primary factor contributing to childhood obesity. Children now consume more foods that are high in calories because much of the food available to them includes processed sugars such as high-fructose corn syrup, which is an energy-dense food additive. In addition, many eating habits have changed. For example, some children are more likely to eat during times when they are not actually hungry and snack frequently throughout the day. Children can develop habits such as snacking while watching television or playing video games.

There has also been a rise in portion sizes in meals served to children. For example, many fast food franchises have marketed larger or "supersized" meals to young children for years. In response to the obesity epidemic, many fast food retail chains have recently worked to integrate healthier foods into the fast food model (Lucadamo, 2011). However, even though the nutritional value in some meals has improved, much work remains to be done, and healthier fast food options still represent only a small portion of the total solution.

Unhealthy and calorie-dense foods come in many forms, and fast food is only one source. Processed foods found in supermarkets are also incredibly popular. These foods are convenient for families because they are easy to prepare, store, and consume. In many cases, busy families lack the time or knowledge to prepare home-cooked meals. Most families today consist of two working adults or a household with only one parent, leaving little time or energy to consider different dietary needs and prepare meals. Furthermore, preparing fresh food can be more expensive, making cheaper processed food even more attractive.

All of these factors have contributed to childhood obesity. Poor diets and lack of physical exercise ensure that children begin to accumulate excess body fat and can compromise their health in many ways. Diseases associated with obesity in adults include cardiovascular disease, cancer, high blood pressure, and diabetes. These conditions can also lead to other complications such as blindness, neuropathy (nerve damage), and even kidney failure in some extreme cases (Mokdad et al., 2001). Until recently, many of these conditions were typically found only in adults. However, with the rise of childhood obesity, these diseases are increasingly being found in young children.

A strong correlation between childhood obesity and childhood diseases has now been identified (Dietz & Bellizzi, 1999). A young individual is far more susceptible to certain diseases if their body fat is significantly higher than normal levels. Thus, obesity can represent a significant risk factor in the overall health of a child. This is especially troubling because young children do not fully understand or realize the risks they take by being overweight. It could be argued that when parents do not actively participate in their children's health, they are putting them at substantial risk for contracting diseases at a very early age. The prevalence of this trend has become a serious public health issue.

School Lunches and Nutrition Standards

One way to address the public health problems associated with childhood obesity is to examine school lunches. The role of school lunches in addressing childhood obesity is considered an important piece of an overall strategy to address the epidemic for several reasons. Research has shown that if students adopt healthy eating habits at an early age, they are far more likely to carry on these behaviors into adulthood. Yet many children are only exposed to the eating habits of their parents, which are commonly the primary source of children learning their dietary patterns and behaviors (Epstein, Gordy, Raynor, Beddome, & Paluch, 2001). One study indicated that when parents replaced unhealthy foods with a diet composed of a higher percentage of fruits and vegetables, this had a significant impact on a child's body fat in less than a one-year period (Epstein et al., 2001).

Outside the home, most children eat meals provided by their schools. The school lunch and cafeteria environment represent another opportunity for students to learn healthy eating behaviors. For many children, this is their only opportunity to learn about proper diet and nutrition. One study found that children who eat unhealthy school lunches are more likely to become obese than peers who bring their own lunches to school, even when considering obesity rates at kindergarten entry (Schanzenbach, 2008). The study also identified an income factor correlated with childhood obesity: students eligible for income assistance for school lunches showed higher rates of obesity than children who paid for the same meals.

In 2008, an Institute of Medicine committee comprising 14 child-nutrition experts examined data on school lunch content in the United States. Their findings, reported after the passage of the Hunger-Free Kids Act in 2010 that established new nutritional standards for schools, indicated that (Baidal & Taveras, 2014):

• Children ate strikingly few fruits and vegetables, with little variety
• Potatoes accounted for one-third of vegetable consumption
• Intake of refined grains was high
• Almost 80 percent of children consumed more saturated fat than recommended, and sodium intake was excessive in all age groups
• Children ate more than 500 excess calories from solid fats and added sugars per day

These findings highlight ongoing nutritional challenges in school meals. Furthermore, there is some risk that the new standards could be challenged by new legislation that would return standards to previous levels.

Legislation and Public Health Advocacy

The government's role in promoting health and nutrition in various parts of society has remained a controversial topic. Some cities have experimented with ways to address various public health problems. One example has been bans to limit sugar intake based on a model used to help reduce smoking prevalence. Many sugary drinks and foods are strongly correlated with childhood obesity and adult obesity, and as a consequence of their overconsumption, have received enormous negative publicity. Some legislation introduced in response to obesity includes measures by the former mayor of New York City, Michael Bloomberg, who introduced legislation limiting the sale of large sugary drinks to sixteen ounces (Reimer, 2012).

While this may seem like common sense to some, there was a dramatized response in the media. Powerful industries that profit from the sale of unhealthy foods have voiced strong opposition. For example, the refined sugar industry has been vocal about the health aspects of refined sugar compared to high-fructose corn syrup (HFCS). Industry representatives have attempted to obscure their products' usage by asking the U.S. Food and Drug Administration to allow the name "corn sugar" as an alternative name for HFCS on food labels (Western Farm Press, 2011).

From a public health perspective, the government does have a role in mitigating confusion inherent in the labeling of different foods. The government can and should consider the obesity epidemic as a matter of public health that directly affects the overall healthcare system. The prevalence of obesity in the United States has strained the healthcare system in general, and this strain could be lessened with preventative measures.

Agricultural Subsidies and Food Policy

There is a paradox that lies in the United States agricultural system and the government's policy options available to mitigate obesity rates. On one hand, as noted by Michael Pollan, a professor, the federal government campaigns against the obesity epidemic while on the other hand it actually subsidizes it by "writing farmers a check for every bushel of corn they can grow" (Chicago Defender, 2003). Corn is processed into high-fructose corn syrup (HFCS), which is inexpensive and calorie-rich and is used as a chief ingredient in many lower-cost foods and sodas.

Because government subsidies make HFCS cheap and plentiful, it is a popular additive in many foods; however, it has many health risks associated with it. Concerns have been raised about the concurrent temporal trend between simple sugar intakes, especially of fructose or high-fructose corn syrup (HFCS), and rates of nonalcoholic fatty liver disease, obesity, and a multitude of different conditions (Chung et al., 2014). Some researchers even believe that HFCS might be a contributing factor in the decline of honeybee populations and have developed advanced analytical methods to study bees' exposure to HFCS (Chen, Collins, Tao, & Lu, 2013).

An effective public policy response to the obesity epidemic will undoubtedly include a comprehensive effort to change the diets of average Americans. In the case of smoking, the government effectively increased the price of tobacco products to increase the incentive for individuals to quit. However, regarding processed sugar, the government has done exactly the opposite by subsidizing this market. These subsidies have taken the form of direct payments, non-recourse loans, price support and purchases, and for several decades, trade restrictions such as tariffs, import duties, and quotas have effectively limited imports and stimulated domestic production (Williams & Bessler, 1997).

Conclusion

The rates of childhood obesity in the United States have grown steadily. Poor eating habits are one of the primary factors that contribute to childhood obesity. As society grows more technologically advanced and relies on mass-produced foods, this opens many dietary challenges. Although food may be plentiful, the nutritional value is often poor in cheaper, processed, and packaged foods in the United States. Children are significantly at risk for dietary problems because they cannot make their own diet decisions and depend upon others for sustenance.