Reducing Childhood Obesity in the USA: Interventions and Strategies

Introduction

Obesity among teenagers and younger children has reached epidemic proportions in America, adversely affecting millions of lives. Over the last thirty years, childhood obesity rates have increased threefold among teenagers and more than twofold among younger children (Hales et al., 2017). These findings stem from one of the gold-standard health surveys conducted by the Centers for Disease Control and Prevention (CDC), which measures participants' weight and height. The most recent surveys date to 2017–18, with over 2,800 child participants (Hales et al., 2020). Survey results showed that 19.3 percent of children between 2 and 19 years of age were obese, a figure slightly higher than the 2015–16 figure of 18.5 percent. This growth may not be regarded as statistically significant; 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 also reveal that extremely obese children have consistently, and for many years, made up approximately six percent of the American child population.

Various factors contribute to childhood obesity, including the consumption of large quantities of sugared drinks and processed foods and physical inactivity (Sanyaolu et al., 2019). An additional contributing factor is the coronavirus crisis, which has shut down schools and confined people to their homes, further reducing opportunities for physical activity.

Statement of the Problem

Obesity likely affects every aspect of a teenager's or child's life, including but not limited to their general physical, cardiovascular, and mental health (Dehghan, Akhtar-Danesh, & Merchant, 2005). The relationship between obesity and associated morbidities has made it a significant public health concern for both teenagers and younger children. Obesity seriously and adversely affects physical as well as mental health. It has been linked to numerous comorbid conditions, including hypertension, acute depression, diabetes mellitus, hyperlipidemia, sleep apnea, and loss of self-esteem (Kelly et al., 2018). Furthermore, childhood obesity that persists into adult life increases the likelihood of developing digestive and cardiovascular illnesses. Increased body fat also exposes children to greater risk of several forms of cancer, including colon, kidney, esophageal, pancreatic, and breast cancers.

Purpose, Significance, and Research Questions

Given the health risks presented by childhood obesity, this research aims to ascertain the best available approach to reduce obesity among American children. Multiple strategies, interventions, and programs are being utilized by different stakeholders — including parents, guardians, and educational institutions — to decrease childhood obesity (Sanyaolu et al., 2019). Research reveals, however, that to achieve a meaningful impact, interventions ought to be multifaceted, involving all relevant stakeholders. This study will therefore identify the key elements of a program targeted at decreasing childhood obesity and the main stakeholders involved in ensuring program success. The literature review will cover obesity in educational institutions, obesity interventions, and health education and awareness in educational institutions, focusing on children between 5 and 18 years of age. The review will be conducted in spring 2021.

This study is significant because it will review research on childhood and teenage obesity, functioning as an aggregative review of the most recent findings on the subject. The findings will serve as an invaluable resource for parents and social and educational institutions that work with teenagers or younger children, providing an evidence-based background on the different aspects of a successful obesity reduction initiative. The study will also define all relevant stakeholders who should actively participate to ensure initiative success.

The study is guided by the following research questions:

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

2. What constitutes a successful childhood obesity reduction program?

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

Literature Review: School-Based and Community Interventions

Early childhood is widely regarded as offering unique opportunities for establishing healthy lifestyle behaviors, including limiting sedentary time, engaging in physical activity, eating healthily, and minimizing obesity risks. Supporting this view is the fact that obesity tends to persist from childhood into adulthood: overweight preschoolers are significantly more likely to be overweight in adulthood compared to normal-weight preschoolers (Evensen et al., 2017). As a result, interventions that promote healthy childhood behaviors serve as a pivotal strategy for preventing obesity, since treating obesity during adulthood is considerably more challenging than altering lifestyle habits early in life (Baur & Garnett, 2019).

A large number of initiatives have been developed for preventing childhood obesity. Most revolve around intervention implementation at school (Nittari et al., 2019), as schools are regarded as a key setting for addressing obesity-related behaviors in children for several reasons: (i) primary schooling is compulsory for every child in the majority of countries worldwide, thus reaching all children from all backgrounds; (ii) children spend a considerable portion of their day at school, typically consuming one to two meals there daily; (iii) schools offer physical education periods and physical activity opportunities during recess; (iv) the structured school environment facilitates easy adoption of interventions; (v) implementers can reach a large number of children within a short period; and (vi) faculty can facilitate and even participate in intervention delivery, thereby improving sustainability (Goldthorpe et al., 2020). Despite these advantages, the overall effect of school-based programs remains debatable, and it is not easy to extract broadly generalizable recommendations from them.

The most effective community-centered initiatives for preventing childhood obesity incorporate several elements planned and adopted based on local context. It is therefore not possible to present a single, all-encompassing list of elements that will suit every community-centered initiative (World Health Organization, 2010). One important best-practice principle for community-focused initiatives is that the community itself should decide on the most appropriate elements for its unique context, while creativity and flexibility are encouraged (King et al., 2011). These 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 high-fat foods;

• Reduced time spent before the television and other screens (e.g., computers, smartphones);

• Greater participation in both non-competitive and competitive sports; and

• More active transport when traveling to school.

These behaviors can be targeted through educational campaigns, modifications to school and institutional policies, promotion initiatives, competitions, and community engagement activities. Most studies on community-focused obesity prevention have been conducted in high-income nations. The lessons they offer will likely prove valuable in implementing similar interventions in other settings.

Most activities for preventing childhood obesity are centered on primary and secondary school settings (World Health Organization, 2009). Research efforts most commonly involve multi-component, comprehensive programs that combine school-based interventions, classroom curriculum, and school food services. Several interventions use a combination of physical activity and dietary changes, and also encourage parental participation. Numerous school-based interventions have demonstrated steady improvements in attitudes, behavior, knowledge, and clinical and physical outcomes (World Health Organization, 2009). Drawing from a recent literature review (Brown et al., 2019), the following practices should be adopted as standard school policy:

• Incorporation of healthy eating, positive body image, and physical activity into the mainstream curriculum;

• Integration of physical activity sessions and foundational motor skill development into the routine school week;

• Close monitoring and improvement of the nutritional quality of school canteen foods;

• Creation of a culture and environment that fosters healthy eating and physical activity throughout the school day;

• Provision of support to faculty for implementing health promotion activities and approaches, including professional development; and

• Parental engagement in home-based activities that encourage children toward increased physical activity, healthier eating, and less sedentary time — especially before television, computer, and mobile device 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 through educational, environmental, and behavioral changes.

Conclusion

Due to the serious health concerns associated with childhood obesity, the proposed study will determine the most efficient approach to decreasing childhood obesity in the United States. To this end, it will conduct a systematic review of different obesity interventions to identify the most effective one for reducing childhood obesity. The study will attempt to ascertain what makes a child-focused obesity reduction initiative successful and to identify the key stakeholders whose involvement is essential. Owing to the methodology adopted, very low financial costs will be associated with this proposed research, which the primary researchers can easily fund themselves. The research, estimated to take around nine weeks, will be performed in spring 2021.

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