The Growing Epidemic of Childhood Obesity and the Health Risks Associated with It - Research Paper Example

Health Psychology: The growing epidemic of childhood obesity and the health risks associated with it Ever Since science has been on the summit of success, many queries have arising regarding different fields. Some of them are of medical sciences. The human knowledge has expanded and individuals have started to analyze issues that may not have been considered important previously. The awareness with regard to health issues has greatly increased over the years and people have started to realize the importance of a healthy living. This knowledge has led to the analysis of the issue of obesity. Obesity is a condition which has become a subject of global concern owing to the rise in the statistics of the condition. The condition was marked as an epidemic by the World Health Organization in the year 1997. This was owing to the alarming increase in the number of people suffering from this problem as well as the serious health risks that an individual is exposed to owing to this health condition. Obesity is a life hampering condition which tends to affect the living of an individual and this issue needs to be dealt with in the best possible manner to control the rise in the number of people suffering from this problem (McCambridge 2006). Childhood obesity has grown to epidemic proportions in recent years especially in developed nations and is now considered as one of the most serious health problem of this century. The prevalence of obesity in children has more than doubled since the 1980’s and currently about forty three million children under the age of five years are overweight. Out of these forty three million, almost thirty five million are from developing countries. This health risk is steadily increasing in lower income countries too. The precise etiology of obesity is not completely understood as yet but it is strongly associated with a child’s environment, life style preferences, genetics, endocrine and metabolic factors. Obesity is known to have many deleterious effects on both physical and mental health of a child. Such children are more likely to stay obese during adulthood and develop non communicable diseases associated with abnormal fat accumulation e.g. diabetes mellitus and cardiovascular diseases. Although the prevalence of obesity and its related complications seen around the globe is a very grim picture, this disease is generally preventable and it is imperative that this issue be given high importance. (WHO) Obesity is defined as “an abnormal accumulation of adipose tissue or fat in body which poses a risk to the person’s health” (WHO). Being overweight generally refers to a person’s body weight instead of fat accumulation. However there are no direct measures of calculating body fat and thus evaluation of obesity is determined through anthropometry i.e. indirect estimates of body fat. The standard ratio accepted globally for measuring obesity is the body mass index (BMI), which is the square of a person’s weight divided by the square of their heights. A BMI of thirty or above in adults is considered obese, however in children there is no fixed cut off value. This is because children grow in height simultaneously with gain in weight. Thus there are different reference standards formulated according to the normal trends seen in the population. These standards take into account the weight as well as the height of children and consist of a whole range plotted on a growth chart. The Centers for Disease Control and Prevention delineate five categories of weight status according to the percentile of the population they fall in. (Flegal KM) These categories are: Underweight: children with BMI lesser than the fifth percentile for their respective age and sex Normal Weight: children with BMI which falls between the fifth and eighty fifth percentile for their respective age and sex Overweight: children with BMI which falls between the eighty fifth and ninety fifth percentile for their respective age and sex Obese: children with BMI greater than the ninety fifth percentile for their respective age and sex Severe Obesity: children with a BMI of greater than thirty five or above 120 percent of the ninety fifth percentile of the population. The epidemiology of obesity underscores the fact that this problem is on the rise globally. In 2010 it was estimated that up to forty three million children worldwide were overweight. Although being obese or overweight was considered to be a problem of developed nations, statistics show that nearly thirty five million of these children are in developing countries and only eight in developed nations (WHO). In the United States presently, almost one third of children and adolescents are either overweight or obese. Statistics indicate that almost 10.4 percent of preschool children (ages between two to five years), 19.6 percent of school age children (between six to eleven years) and 18.1 percent of adolescents (between twelve to nineteen years of age) are obese. At the same time 6.9 percent of preschool children, 14.5 percent of school-aged children and 12.5 percent of adolescents are severely obese (Ogden CL). These numbers show that within one category e.g. obese children a higher percentage of the children population is getting obese with increasing age. Other stats show that obesity is more prevalent in low and middle income families as compared to families with higher income. Also children with obese parents are implicated to be two to three times increased risk of becoming obese (CDC). Digressing from the studies conducted for the American population, one finds that the prevalence of obesity is escalating in other developed countries too. These studies used the standards defined by the International Obesity Task Force (IOTF) so that the data collected would be comparable. It was noted that more than thirty percent of the child population in most countries of North and South America, Great Britain, Malta, Spain, Portugal, Greece and Italy were obese (Janssen I). It is not easy to predict whether obese children remain so after reaching adulthood. Three important factors have been implicated in whether obese children grow up to be obese adults and these are; the severity of obesity, age of the child and parental obesity. The generally noted trend is that children who are older, severely obese or with at least one obese parent are more likely of being obese as adults. (William J Klish, Definition; epidemiology; and etiology of obesity in children and adolescents) Although the precise mechanism of developing obesity is still not known, it is an established fact that obesity results when a person’s calorie intake exceeds their calorie expenditure. At the same time there are numerous factors which lead to this imbalance. Life style preference is a significant cause of creating this imbalance. With the massive advancement in technology there has been a growing trend of children adopting sedentary lifestyles. Children of our current age find it more entertaining to play games on consoles and computers or watch television instead of playing outdoors. Watching television has a well-known association with obesity and in one longitudinal cohort study it was noted that children who watch television at an age of five years or greater were independently linked to developing a higher than normal BMI by the age of twenty six. (Viner RM) A sedentary lifestyle e.g. watching a lot of television or playing console in children is strongly associated with weight gain because these children have little physical activity and thus burn very few calories. At the same time the quality of diet they eat is also very poor and comprises primarily of food items with ‘empty calories’ e.g. fast food, soft drinks etc. These items are called empty calories because they are deficient in nutritional value but are loaded with high calories. Over the years also food prices have reduced significantly in comparison to income especially in developed countries and this has led to over consumption. Also the perception of food has changed too; from being a source of nutrition, food has now become a source of pleasure and an indicator of a person’s standard of living. Fast foods have also gradually become a regular diet amongst children especially. A single large children meal provides a child with approximately 785 kcal and to burn these excess calories a child would require to robustly exercise for one to two hours; an activity most average children cannot keep up with. (DM) Children who have a sedentary lifestyle also develop a slow metabolic rate which contributes to weight gain and the excess calories build up as fats. What further aggravates the situation is that parents prefer that their children stay at home and entertain themselves as it allows them to keep an eye on the children while the former run their errands. Decreased awareness on part of the parents also contributes to weight gain in their children as the former do not keep a check on unhealthy diets e.g. fast foods. In fact parents find it easier for themselves to provide the children with fast foods as it makes children happy and saves their time. This phenomenon eventually leads to a cycle as obese children grow up to be obese adults and so on. There is also increasing evidence that a child’s metabolic programming plays a role in them becoming obese. Metabolic programming refers to key nutritional and environmental influences on a child during important phases of development e.g. breast feeding, mother’s diet during gestation etc. Genetics and endocrine disorders also play a role in childhood obesity. Childhood obesity is a major health risk and associated with significant morbidity and premature death; this fact is independent of the obesity status of the child in adulthood. Obese children are much more likely to become obese adults and develop various non-communicable diseases such as diabetes mellitus. This creates a very precarious situation in developing countries which are already struggling with difficulties created by infectious diseases. The co morbidities of obesity in childhood and adolescence affect almost all the systems of the body including but not restricted to endocrine function, cardiovascular, neurological, musculoskeletal and pulmonary disorders. Children who are obese are much more likely to develop a pre-diabetic state in which a child faces impaired glucose tolerance. In a study of one hundred and sixty seven children and adolescents who were known cases of obesity it was reported that twenty five percent of the children and twenty one percent of adolescents showed signs of impaired glucose tolerance. (Sinha R) In the same study four percent of the adolescents were symptomatic for type II diabetes. Type II diabetes is a very debilitating disease if glucose levels are not controlled properly. This disease requires major modifications in life style which include dietary restrictions, regular exercise and medications. If glucose levels are not controlled, the frequent hyperglycemia damages various other organs and causes problems such as peripheral neuropathy, retinopathy, nephropathy and atherosclerotic cardiovascular disorders. Diabetes results in obese children due to insulin resistance as the excessive fat accumulation gradually leads to down regulation of insulin receptors especially in adipose tissue. Because of the down regulation there is very little glucose uptake by adipose cells despite the high level of insulin as the receptors due not respond adequately to manifest the effects of insulin. Obesity, diabetes, and cardiovascular diseases make up a triad of disease burden as each of the problem increases the risk for the development of the other two. Obese children are approximately three to four times more risk of developing hypertension and diabetes and vice versa. It is reported that nearly fifty percent of obese children had hypertension when they were assessed in an ambulatory setting. (Maggio AB) They are also more likely to develop left ventricular hypertrophy as a result of the hypertension. Once hypertension develops, it has serious implications especially when the child grows up to be an adult, even if his or her weight is controlled later on. Other cardiovascular risks which an obese child can develop eventually include arterial fatty streaks in aorta and coronary arteries, decreased vessel distensibility, and endothelial dysfunction. All these risks can ultimately manifest as atherosclerotic problems and cardiac ischemia when the child grows up and as adults these children are at increased risk for both fatal and non-fatal cardiovascular events e.g. an infarction (as a result of the decreased space in the vessels). Apart from these major effects of obesity, children are also at more risk of obstructive sleep apnea, idiopathic intracranial hypertension and orthopedic co morbidities like Blount disease (tibial varus deformity), high susceptibity of fracture and slipped capital femoral epiphyses (SCFE). (William J Klish) Apart from the above mentioned risks, childhood obesity has resulted in widespread psycho social disorders. Overweight and obese children and adolescents report more commonly with alienation, poor self-esteem, anxiety and depression. They also face strained and distorted relationships with their peers because of the frequent discrimination they face. The extent of this discrimination can be assessed from a report which showed that school children preferred to be friends with children with a variety of handicaps rather than befriending obese or overweight children. (Richardson) Similarly in another study it was reported that children who were obese at 7.5 years of age were much more likely to be bullied in one year’s time as compared to other average children. (Griffiths LJ) At the same time girls who are obese in adolescence often develop a negative self-image which has a serious toll on their mental health. These girls, even after reaching adulthood, are seen to complete fewer years of education, have low incomes, delayed and lower rates of marriage and increased rates of poverty as compared to their non-obese peers. (Gortmaker SL) From the above discussion it is apparent that obesity in childhood bears enormous complications both physically and mentally on a child’s health. These include both short and long term consequences and severely debilitate a person’s quality of life. Thus it is imperative to combat this epidemic at an early stage in the child’s life before any complications develop. Prevention strategies are being carried out currently but there is a need for more extensive approaches. These strategies should be carried out on all three levels of prevention i.e. primary, secondary and tertiary. Most of the focus currently is upon primary prevention and promoting healthier lifestyle and dietary habits. There is no doubt that such measures are essential and are tackling the root cause of this epidemic, there has been little progress in reducing the prevalence of obesity and the complications associated with it. There is a growing need to focus such strategies towards children as they are more likely to change habits as compared to adults who have developed these habits for a long time. To achieve this, incentives should be provided to children so that they refrain from ‘obesogenic’ environments and promote healthy practices amongst their peers too. It is also important to make the prevention strategies culture specific and practical by keeping in mind the ethnical and socio-economic status of the target population. (Mahshid Dehghan) REFERENCES: (CDC), Centers for Disease Control and Prevention. "Obesity prevalence among low-income, preschool-aged children - United States, 1998-2008." MMWR Morb Mortal Wkly Rep. ( 2009): 58(28):769. DM, Styne. "Obesity in childhood: whats activity got to do with it? ." American Joural of Clinical Nutrition (2005): 81:337-338. Flegal KM, Wei R, Ogden CL, Freedman DS, Johnson CL, Curtin LR. "Characterizing extreme values of body mass index-for-age by using the 2000 Centers for Disease Control and Prevention growth charts." American Journal of Clinical Nutrition ( 2009): 90(5):1314. Gortmaker SL, Must A, Perrin JM, Sobol AM, Dietz WH. "Social and economic consequences of overweight in adolescence and young adulthood." N Engl J Med (1993): 329(14):1008. 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