This policy brief examines the role of parental influence in preventing childhood obesity and dental caries in Australia, two costly and largely preventable conditions. Drawing on Australian and international research, it outlines the prevalence, health consequences, and economic burden of both conditions, and reviews what the evidence says about how parental dietary and lifestyle choices shape child health outcomes. The brief highlights significant methodological limitations in the existing research base and argues that, in the absence of optimal evidence-based interventions, increased public investment in disease prevention research — particularly collaborative studies linking parental behavior to child BMI and dental health — represents the most actionable policy recommendation.
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Obesity represents a major health and economic threat to Australia, degrading the lives of countless citizens and costing the nation approximately $58.2 billion in 2010 alone (Crowle & Turner, 2010, p. 32–33). This reality has motivated Australian policymakers to increase funding allocated to researching this preventable condition by 5.4-fold between 2003 and 2011 (NHMRC, 2012). A related preventable disease, dental caries, causes untold suffering and represented 10% of all health care spending in 2004/2005 (RACP Paediatric and Child Health Policy Committee, 2013, p. 8). Both of these health issues have had a major impact on child health, which is the primary focus of this policy brief. Most of the research considered here concerns children and early adolescents. This issue is examined through the lens of parental influence — specifically, how parents can intervene to control and prevent overweight, obesity, and dental caries in their children.
Overweight and obese adults face an increased risk of physical and mental morbidity and mortality (NHMRC, 2013a, p. 27–29). Type 2 diabetes, heart disease, cancer, and mental illness represent the most common comorbidities in overweight or obese adults. The same comorbidities can affect overweight or obese children, in addition to a number of skeletal, hormonal, airway, and sleep problems manifesting during childhood or early adulthood. The economic burden of this condition for both adults and children was estimated at $56.6 billion in 2010, of which approximately $21 billion was attributable to direct medical costs (NHMRC, 2013b).
A closely related condition affecting overweight and obese children is dental caries. The prevalence of dental disease in children declined between the 1970s and the late 1990s but has since experienced an upswing (National Advisory Council on Dental Health, 2012) and has become the most common chronic childhood disease by far (Kagihara, Niederhauser, & Stark, 2009). Risk factors — aside from the immediate pain and cost of dental care — include developmental problems, speech disorders, permanent dental disfigurement, eating difficulties, and psychological problems.
World Health Organization (WHO, 2014a) recommendations for addressing these preventable childhood conditions include eating a healthy diet and increasing physical activity. Since the diet and physical activity levels of children are strongly influenced by the adults in their lives, the role of parental influence has received considerable attention (WHO, 2014b).
Based on 2007–2008 data, the Australian National Health and Medical Research Council estimated that 25% of children between the ages of 5 and 17 were overweight or obese (NHMRC, 2013, p. 9). Of these, 8% were obese, but the prevalence of obesity among boys was much higher (10%) than among girls (6%). The prevalence of childhood overweight and obesity began a dramatic upsurge in the 1970s and then stabilized towards the end of the twentieth century (Crowle & Turner, 2010, p. 9–10).
The short-term physical consequences of child obesity can include diabetes, high blood pressure, hyperlipidemia, accelerated development, hormonal irregularities, and diseased internal organs (NHMRC, 2013, p. 28–29). The psychosocial consequences include social discrimination, self-esteem problems, eating disorders, depression, and anxiety disorders (Crowle & Turner, 2010, p. 2). Longer-term consequences during childhood include constricted airways, sleep apnea, bowing of the legs, hip problems, fractures, asthma, hypoventilation syndrome, and heart failure (NHMRC, 2013, p. 28–29). Overweight and obese children also face an increased risk of adult obesity, premature mortality, diabetes, stroke, heart disease, high blood pressure, asthma, atopy, and disability.
The costs of childhood overweight and obesity are assumed to be comparable to those of other children, meaning the economic burden of this disease primarily manifests during adulthood (Crowle & Turner, 2010, p. 32–33). When the economic cost of obesity across all age groups was examined in 2008, the total cost was $58.2 billion annually. The majority was attributed to "loss of well-being" — a term intended to encompass disability and lost productivity, lower quality of life, and premature death.
A recent study examined the prevalence of decayed, missing, and filled teeth among Australian children aged 5–6 and 12 years (Australian Institute of Health and Welfare, 2011). A history of dental decay was found in 48.7% and 45.1% of children in the younger and older age groups, respectively. Importantly, the prevalence of dental disease was 70% higher for children in the lowest socioeconomic group compared to the highest. In addition to the pain, infections, and abscesses caused by untreated caries, the quality of a child's nutrition, development, sleep, self-esteem, verbal competence, and academic success can be negatively affected (RACP Paediatric and Child Health Policy Committee, 2013, p. 8). In the worst cases, facial disfigurement can occur. The economic impact of dental caries on society is equivalent to that of diabetes and heart disease, representing 10% of Australian health care spending in 2004–2005.
The relationship between diet and dental caries appears to be more complex than previously assumed. When Hooley and colleagues (2012a) examined published studies on this relationship, they found a U-shaped curve, such that dental caries was more prevalent among children at both extremes of the body mass index (BMI) continuum. This finding implies that excess calorie consumption resulting in overweight and obesity increases the risk of dental caries, but so does insufficient calorie intake. Accordingly, a normal BMI should be a target of any intervention designed to reduce the incidence of dental caries.
Overweight, obesity, and dental caries are preventable conditions and diseases. The WHO (2014a) characterizes overweight, obesity, and dental disease as natural outcomes of malnutrition due to dietary excess. Accordingly, parents can have a significant impact on these health issues by influencing the quality of a child's diet and the amount of physical activity engaged in (WHO, 2014b). Savage and colleagues (2007) offer a different perspective on the role parents can play in their children's health outcomes. In the not too distant past, the greatest threat to child health was a lack of food and infectious diseases; in contemporary developed nations, however, the greatest threat to a child's health is unlimited access to simple sugars and fats, combined with commercial marketing that promotes a lifestyle of habitual consumption. Their recommendation is to develop an intervention that would re-educate parents about this shift in health threats and promote an eat-when-hungry dietary approach for both parents and children. Unfortunately, an empirical knowledge base capable of serving as the foundation for such an evidence-based intervention does not yet exist (Skouteris et al., 2011). In addition, the scientific studies that have examined the impact of parental influence interventions have almost universally ignored objective measures of child health outcomes such as BMI.
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