Obesity in the Modern World - Essay Example

OBESITY IN THE MODERN WORLD 2007 Introduction Obesity turned into one of the major public health concerns and one of the prevalent nutritional diseases in the US long time ago. Thus, already three decades ago The Lancet addressed obesity as "the most important nutritional disease in the affluent countries of the world" (Lancet, 1974). However, in the beginning of this century prevalence of obesity in adults, adolescents, and children has reached epidemic proportions (Henry & Royer, 2004). The growth of obese children population is especially disturbing. Obesity rates have doubled in children ages 2- 5 years and tripled in children ages 6-11 (IOM, 2004). The IOM notes 11% of children ages 2-11 years of age are obese. The National Health and Nutrition Examination Survey III (NHANES) indicate 21%-24% of children ages 6 to 8 years are overweight or obese (Yackel, 2003). Other data notes obese children weigh significantly more than obese children 30 years ago (IOM, 2004). Children from lower income families, southern United States, African American, Hispanic, and American Indian descent have a greater incidence of obesity (Betz, 2000). Definition and Diagnosis One of the most common scholarly definitions of obesity is the following: "obesity is a chronic condition that develops when energy intake exceeds energy expenditure, resulting in excessive body weight" (Kibbe, 2003: 1). Although other authors define the condition using slightly different terminology, the core problem contributing to obesity is commonly known: an excessive accumulation of body fat. While the most common way to define obesity is the well-known weight-for-height proportion, professionals normally use skin-fold measure to determine the amount of fat more accurately. Triceps, triceps and subscapular, triceps and calf, and calf alone are used to obtain skin-fold measure of fatness (Lohman, 1987: 101). Other methods of measuring the percentage of body fat include densitometry (underwater weighing), multi-frequency bioelectrical impedance analysis (BIA) and magnetic resonance imaging (MRI), body mass index (BMI) and waist circumference. Clearly, the latter two, together with skin-fold measuring, represent the least accurate methods, which, nevertheless, help effectively identify the risk of obesity (Dehghan et al, 2005). Etiology The mechanisms of obesity development still have to be studied, although majority of scholars believe that energy intake exceeding energy expenditures is the common cause for accumulation of excessive weight. A number of studies carried out in the US and abroad clearly demonstrate that contemporary society promotes sedentary life with levels of physical activity decreasing, as children grow older (Styne, 2005). Thus, they report a strong relation between time spent watching TV - arguably the most common sedentary behavior in the U.S. these days - and Body Mass Index (BMI) values (Ludwig & Gormaker, 2004). Despite apparent relationship between physical activity and obesity, this relationship is not a cause-and-effect one. The major problem is that scholars lack methods to adequately and reliably measure slight change in physical activity and nutrition. Therefore, the prevalent opinion is that etiologies of obesity are multiple, while any attempt to understand obesity by addressing a single etiology will hardly be successful. These multiple factors include genetic and familial influences, energy imbalance, nutrition factors, physical activity levels, sociocultural background and environment. Genetic factors Obese individuals often tend to accuse genetic factors of excessive weight accumulation. Twin studies prove that around 50 to 70 percent of obesity cases may be due to genetics. Obesity can be a result of leptin deficiency or inherited medical conditions such as hypothyroidism and growth hormone deficiency. Family studies also demonstrate that obesity is often inherited from parents or grandparent. For example, the well-known study of obesity carried out by S. Garn and D. Clark as early as in 1976 demonstrates that "if both parents are lean, the likelihood of a child becoming obese is just 9%. When both parents are obese, the likelihood of the child also being obese rises to 60-80%" (Garn & Clark, 1976: 452). However, the same studies always demonstrate that obesity and excessive weight is the result of combination of genetic and external factors. Unfortunately, the mechanisms of specific mechanisms responsible for interplay of genes and environment are not fully known (Kibbe, 2003). Although certain genes can really influence a person's predisposition to gain weight, the overall number of cases when genetics played the key role in development of obesity is too small (Farooqi & O'Rahilly, 2000). The fact that genetically stable individuals also accumulate excessive weight and become obese and overweight demonstrates genetics is only one of the many factors affecting obesity. Other factors, such as physical activity, family, dietary patterns or sociocultural influences also play an important role in proliferation of obesity in the U.S. and globally (Ebbeling et al, 2000). Energy imbalance and physical activity Proper balance between energy intake and energy expenditures is a very important factor in controlling excessive weight. Even a slight positive balance in energy intake compared to energy expenditures inevitably results in accumulation of weight and, possibly, obesity (MacKenzie, 2000). For example, "a positive balance of about 120 kcal per day (about one serving of a sugar-sweetened juice or soft drink) would produce a 50 kg increase in body mass over a 10-year period" (Kibbe, 2003: 5). The recent developments in life-style and nutrition demonstrate that situation when a person's energy intake substantially exceeds energy expenditures has gradually turned into a common phenomenon. Intensive proliferation of modern technologies and transportation means has made life, especially in highly industrialized countries like the US, more sedentary than ever. Thus, the average American child/adolescent spends at least several hours a day watching TV and/or playing computer games, while only several decades ago the same child might spent these several hours in a more physically active way. Some scholars estimate that contemporary children spend approximately 5 hours per day watching TV (this figure slightly varies depending upon social position of the child's family, race, age) (MacKenzie, 2000). Hundreds of studies conducted over the last 20 years have convincingly shown strong correlation between watching television and obesity among children and adolescents. For example, an interesting long-term study carried out by Tom Robinson at Stanford University six years left little doubt as for the relationship between excessive watching TV and childhood obesity. Two random samples of third- and fourth-grade students from two elementary schools participated in the study. One group received an 18-lesson course explaining why watching TV and playing computer games was harmful for children's health. After that course the intervention group demonstrated "statistically significant decreases in BMI, waist circumference, triceps skinfold thickness, and decreases in children's reported TV viewing and meals eaten in front of the television. There were no significant differences between groups for changes in high-fat food intake, moderate-to-vigorous physical activity, and cardiorespiratory fitness" (Robinson, 1999: 1566). Rapid and huge increase in time spent watching TV and playing computer games is linked to obesity not only because this type of activity (or inactivity) diminishes energy expenditures. Spending time in front of TV is often associated with concurrent consumption of various high-calorie snacks (Drohan, 2003). This trend seems especially disturbing when we take into consideration the fact that only 8 percent of American elementary schools offer daily physical education programs these days (Koplan et al, 2005). Apparently, American educators greatly underestimate literally critical importance of physical activity for normal physiological development of children. Making children aware about the role of physical activities in maintaining proper energy balance must be addressed as a critical issue in fighting obesity. Moreover, there is an opinion that precisely physical inactivity must be held responsible for the recent increase in obese children population instead of excessive energy intake (Schlicker et al, 1994). Although this opinion is not a predominant one, low physical activity does play a very important role in the epidemics of childhood obesity in the U.S. Dietary factors Dietary factors have recently moved to the focus of academic research devoted to obesity. Absolute majority of scholars believe that contribution of these factors to the epidemics of obesity. They identify a variety of nutrition factors contributing to obesity: "family meal patterns and food choices, food availability, portion control, fat intake, school food service, sugar beverages, and nutrition products qualifying under the Food Stamp and Supplemental Nutrition Program for Women, Infants, and Children (WIC) programs" (Kibbe, 2003: 6). Abundant statistics vividly demonstrates that dietary patterns has transformed greatly over the last decades. Thus, only during one year (from 1997 to 1998) the amount of food income spent outside the home increased by 2 percent: from 36 to 38 percent (Nader et al, 1999). This increase, in its turn, led to more calories consumed by children: it is a well-known fact that meals eaten in eating establishments is more saturated with fat and contains more calories than meals eaten at home. Increased availability of cheap and highly nutrient products also seems to play a certain role in proliferation of obesity. Besides, portion sizes of meals served in eating establishments are normally bigger than portion sizes of home-served food. One recent study compared current portion size of the most popular meals (hamburgers, pizza, pasta and fries) to the portion size of same products in the past when these meals were first released on the American market. The result was astonishing: "In general, most marketplace portions were twice the standard serving sizes, and portions offered by fast-food chains often were two to five times larger than the original size (Young et al, 2003: 234). Another similar study carried out by Pennsylvania State University stuff, confirmed that though the increase in portion sizes was not that serious over the last two-three decades, portions of some highly nutrient food - such as peanut butter, bread, cereal and soda - had increased too (McConahy et al, 2002). Consumption of carbonate drinks is also attributed to the epidemics of obesity. Over the period from 1970 to 1997, the US Department of Agriculture (USDA) reported an increase of 118 percent in consumption of carbonated drinks per capita, while consumption of milk and milk products has declined by 23 percent over the same period (Putnam & Allshouse, 1999). Precisely excessive intake of soft carbonated drinks is widely associated with childhood overweight and type II diabetes in children (Dehghan et al, 2005). Although there is no definitive clarity as for direct relationship between drinking carbonated drinks and accumulation of excessive weight, the chances are that this disturbing relationship does exist. Consequences In the past obesity was not even considered a medical disease and, consequently, was not associated with health problems. However, the advance of medical science over the recent decades has significantly shifted this opinion. Nowadays, the dominant opinion is that excessive weight has several serious effects on both physical and psychological health of children. In medical literature obesity and overweight are normally associated with Hyperlipidaemia, infertility, hypertension, abnormal glucose tolerance, cardiovascular and digestive diseases in adulthood, and various depressive syndromes (Daniels et al, 2001). Consequences of obesity fall into three large groups: immediate, intermediate and long-term. Each of these groups implies serious health consequences, but the last group is perhaps the most dangerous. Thus, long-term consequences of obesity include such serious conditions as increased level of cholesterol, low-density lipoprotein and triglycerides, high blood pressure, elevated insulin levels, abnormal heart functions, abnormal endothelial functions, and the presence of metabolic syndrome - presence of these factors in obese people is hardly noticeable, but they are commonly associated with obesity and cardiovascular diseases in adulthood (Reilly et al, 2003; Woo et al, 2004). Moreover, several recent studies tend to establish a relationship between cancer and obesity. For example, last year a group of European scientists examined hormonal abnormalities in children diagnosed as obese, and attempted to reveal these implications on the risk of cancer in adulthood. The major finding was that "levels of certain hormones known to play a role in cancer development are very high in obese children. Although the high hormone levels may not produce cancer in childhood, they are risk factors for cancer development and increase the likelihood of an overweight child developing cancer in adulthood" (Gascon et al, 2004). Childhood obesity and its harmful consequences continue into adulthood substantially increasing the prevalence of cardiovascular and other diseases in adults (Dietz, 1998). Prevention and Treatment Obesity treatment is a highly challenging task. Studies show most overweight adults are unable to permanently sustain a lighter weight (MacKenzie, 2000). Children past the age of puberty also have difficulty maintaining weight loss (Thompson, 2003). Therefore, preventive interventions are commonly recognized as critical in decreasing the incidence of obesity, especially in children. Unfortunately, there is rather limited research in the field of obesity prevention. Thus, one school based intervention reported positive effects of educational lessons and reduced TV, video, and videogame time on body fat, eating habits, and exercise participation in children (Robinson, 1999; Jerum & Melnyk, 2001). The ongoing 5 A DAY health promotion programs designed and implemented by the Department of Health and Human Services are meant to address the growing incidence of chronic diseases associated with nutrition, including obesity. The core of the 5 A DAY initiative is increase consumption of the health benefits of fruit and vegetables (DHHS 2007). The UK Department of Health claims that The School Fruit and Vegetable Scheme (a variation of 5 A DAY initiative for educational institutions) rely upon a solid body of pilot studies confirming its positive effect on children. Unfortunately, the search revealed no credible studies showing any kind of relationship between the program and childhood obesity though indirect evidences of the positive effects of fruits and vegetables consumption can be found in the dietary factors research (Kibbe 2003). Discouraging TV watching and junk-food advertising, promoting physical activity, and even adjusting food prices are also named among the potentially effective measures in fighting obesity on the national level. However, national effort and good coordination is required to make sure that the participation of researchers and health practitioners, legislators and educators, businesses and nonprofit groups in formulating and implementation all-inclusive public health campaign brings the targeted effect. References Betz, L. (2000). Childhood obesity: Nursing prevention and intervention approaches are needed. Journal of Pediatric Nursing: Nursing Care of children & Families. 15(3), 135-136. Daniels S. R., Arnett D. 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