Childhood Obesity: Causes and Concerns and Intervention Strategies - Research Paper Example

Childhood Obesity: Causes and Concerns and Intervention Strategies Introduction Childhood obesity is a rising problem. It is defined as having a BMI of equal to or greater then 95% of the population (Deckelbaum & Williams, 2001, p. 240s). There are a number of reasons why childhood obesity is on the rise. Increase in television viewing is one culprit (Reilly, 2004). Increases in fast food intake is another (Bowman et al., 2004). There are a variety of reasons for childhood obesity, but one thing is clear - childhood obesity is a problem, as it leads to a range of health problems for the obese child, including diabetes, hypertension and heart problems (Deckelbaum & Williams, 2001, p. 240s). Because childhood obesity is such a problem, and it is becoming more and more widespread, there is a need for a study to understand the problem better, including the reasons why the problem is becoming so widespread, and what can be done about it. Discussion Childhood obesity, defined as having a BMI (Body Mass Index) of equal to or more than 95% of the population, is on the rise. (Deckelbaum & Williams, 2001, p. 240s). This is problem that is global – for instance, in England the rate of childhood obesity tripled between the years of 1982 and 2003, while a third of Canadian children between the ages of 2 and 11 are overweight, with half that number considered obese. In Australia, children of either sex “were twice as likely to be defined as overweight in 2000 as in 1985.” (Nakaya, 2006, p. 45-46). There is also increasing evidence that this problem is worldwide (Wang & Lobstein, 2006, p. 11). Cheng (2003) warns that China is experiencing an obesity epidemic in its children, which is linked to the rise in fast food there, as 27.8% of its children are now overweight, and that the number of obese male students in Beijing has doubled between the years 1990 and 2000 (Cheng, 2003, p. 773).  Schlosser expects the diseases which attend obesity, such as heart disease, diabetes, colon cancer and breast cancer, to rise in Japan, coinciding with the rise of the fast food culture there.  He also notes that, in Great Britain, when the number of fast food restaurants doubled, so did that country’s obesity rates (Schlosser, 2001, p. 242).  The problem of obesity is serious, as pediatric obesity is associated with increased risks of concomitant psychological or psychiatric problems, cardiovascular risk factors, chronic inflammation, type 2 diabetes mellitus, and asthma. (Deckelbaum & Williams, 2001, p. 240s). Children are also being diagnosed, for the first time, with hypertension and diabetes, diseases that usually affect only adults (Deckelbaum et al., 2001, p. 239s). Other diseases associated with obesity and fast food include hypertension, hyperlipidemia, hypercholesterolemia, cardiovascular diseases, and Type II diabetes (Ebbeling et al., 2002, p. 473). Obese children are also at risk for metabolic syndrome (Boney, 2005, p. 290). Coronary heart disease is another affliction which is attacking children (Freedman, 2001, p. 712). Other health problems that were typically thought of as “adult” health problems that are striking children as sleep apnea and gall bladder diseases. Anecdotal evidence supplied by doctors have also linked childhood obesity with heart-problems, cancers and windpipes closing up. (Nakaya, 2006, p. 48). Rickets is another disease which has been seen in overweight children in Oakland, California (Pollan, 2008, p. 122). Moreover, obesity tends to persist into adulthood (Clarke & Lauer, 1993, p. 423). Other risks associated with childhood obesity are increased health risks, and increased mortality rates in adulthood (Deckelbaum & Williams, 2001, p. 240s). Add to these woes are the fact that obese children suffer more than normal-weight children from low self-esteem. (Strauss, 2000, p. e15). Metabolic syndrome is partially caused by the presence of trans fats in one’s diet, which is linked back to fast food chains which use trans fats in making their food (Azadbakht & Esmaillzadeh, 2008, p. 2). At its core, obesity is a matter of an imbalance in energy expenditure – too many calories coming into the body without enough calories going out. Restaurant food plays a large role in this imbalance (Bowman et al., 2004, p. 112). Fast food intake has increased 300% among children between the years of 1977 and 1996, with 42% of children reporting that they consumed fast food. This has led to a study that showed that the amount of fast food consumption by children is proportionate to an overall poor diet – in other words, the more fast food a child consumes, the more likely his or her overall diet would be considered poor. Also correlated is the consumption of fast food with overall BMI and body fatness in children. For instance, one study showed that the frequency of eating fast food is positively associated with higher BMIs. (Jeffery et al. 2006, p. 1). The growth of fast food in part explains the “decline in per capita consumption of simples fruits and vegetables in favor of highly processed ones.” (Shell, 2002, p. 205). Because of fast food, we eat 13 pounds more per person of oils than we did 20 years ago, and triple the amount of cheese. (Shell, 2002, p. 205). One of the positive correlates between eating fast food is television viewing behavior (Reilly, 2005, p. 1357). The more a child watches television, the more like he or she is to consume fast food. (Dehghan et al. 2005, p. 5). Other studies have shown a link between television viewing and childhood obesity in general. This may because the act of watching television is one in which the body expends very few calories - “there is no waking activity that we do that burns fewer calories than watching TV – a body in front of the tube is a body at rest.” (Nakaya, 2006, p. 63). And, if a child is watching television, he isnt playing sports, and children who play sports are 80% less likely to be obese then children who do not (Michaels, 2009, p. 17). Other experts contend that the act of watching television exposes children to advertisements that urge them to eat. (Nakaya, 2006, p. 64). Also associated with childhood obesity is the rate of drinking sugary drinks, such as pop (Ludwig et al., 2001, p. 505). Soda pop and other sweetened beverages are associated with higher overall calorie consumption, in that the more soda pop or sweetened beverage a child consumes, the more calories that child consumes. Moreover, mean BMI increases the more a child consumes these beverages. (Ludwig et al.. 2001, p. 505). Of course, there are studies that show that sugary beverages do not increase childhood obesity, but these studies are, by and large, funded by the beverage industry, so they are suspect, especially in light of other studies that show “that soft drink consumption directly predicts weight gain.” (Shell, 2002, p. 211). James (2004) states that an increase in soda drinking over one year results in a 7.5% jump in obesity rates over the control group (James, 2004, p. 1237). Soda, in particular, predicts weight gain, as it relies on high fructose corn syrup (HFC). HFC is much worse for youths than sugar, because, unlike sugar, HFC does not dim appetite. (Shell, 2002, p. 214). The soft drink problem is made worse with the unholy alliance between the beverage industries and our schools. This is a problem because of the sugar, especially the high fructose corn syrup, in the drinks (Freedman & Barnouin, 2009, p. 26). Product placement in schools is driven for a need for brand loyalty - “School is...the ideal time to influence attitudes, build long-term loyalties, introduce new products, test-market, promote sampling and trial usage and-above all-to generate immediate sales.” (Shell, 2002, p. 212). A Coca-Cola salesman echoes this sentiment, stating that “Our strategy is ubiquity. We want to put soft drinks within arms reach of desire.” (Shell, 2002, p. 212). Schools are in collusion with the soft drink industry, helping the soft drink industry to pressure Congress to keep allowing the sales of soft drinks in the schools, despite the objections of the USDA. Schools claim that these soft drink sales are necessary to fund programs that might otherwise be underfunded. (Shell, 2002, p. 213). Additionally, portion sizes of entrees at fast food places have increased 43%, and the entire meals have increased in portion by 25%. (Young & Nestle, 2007, p. 238). Fast food tends to be very calorie dense, and studies have shown that eating meals that are calorie dense leads to a greater overall calorie intake, compared to eating foods that are not as calorie dense. One reason for this could be delayed satiety, in that individuals do not feel full as quickly when eating calorie-dense food then when they are eating food that is less calorie-dense. ( Young & Nestle, 2007, p. 238). The fast food problem further contributes to childhood obesity, as they tend to be concentrated within a short walking distance from schools (Currie et al., 2009, p. 2). The reason why portion sizes have gotten so large is simple economics – a fast food restaurant only has to pay pennies to make a large profit. For instance, serving twice as many fries to a customer only costs the restaurant ten cents. However, they can charge the customer an extra thirty cents, giving them a twenty cent profit for every supersize fries they sell. Bigger portions mean bigger profits. (Garcia, 2006, p. 28). The ubiquitous combo meal is based upon the same principle – combine fries, drink and a sandwich, make it seem more attractive than buying all these items separately, so that the customer thinks that he is really getting his moneys worth, and you have a profit bonanza. The lines move faster, as people can just order a “#1” instead of ordering everything separately, the average check goes up, and everybody is happy (Cardello, 2009, p. 26). Evolution is one culprit which might be responsible for childhood obesity. Gary Beauchamp, who is cited Shells (2002) book states that humans are hard-wired for the junk, so to speak, stating that we “are born with only a handful of taste prejudices – among these, an aversion to bitter and a preference for sweet and salt.” (Shell, 2002, p. 209). Whats more, children are averse to food that tastes novel to them. Which means that children, with an inborn taste for sweet and salt would tend to seek out foods that are loaded with these items, while rejecting the foods that are different, especially if it is bitter. This would explain why children tend not to like too many vegetables, as they are neither sweet nor salty, and tend to be bitter. However, Beauchamp also believes that the tastes that develop are also cultural. For instance, in Mexico and India, children develop a taste for hot peppers at the age of five or six, while Asian children eat sour plums and African children eat bitter greens. The children develop tastes for these foods because the parents force them to eat them, and, through repetition and consistent exposure, the kids gradually develop a liking for them. However, in cultures where the children dictate what they eat, not the parents, the children never get a chance to develop novel tastes. The parents, in an effort to please the child, keep feeding the child what he or she likes, which usually means something that appeals to the salty, sweet or fat triad. This reinforces the childs inborn food preferences, not expands them, and the cycle never ends (Shell, 2002, p. 210). Parental attitudes towards obesity is another factor that will be delved into. Etelson et al. (2003) conducted a study on parental attitudes towards childhood obesity by conducting questionnaires with 83 parents that were found during well baby visits. Of these parents, 23% had children who were considered to be overweight, defined as > 95 percentile of age and gender-specific BMI charts. The questions consisted of both questions regarding their childrens weight and about other topics, such as the use of safety measures around the house, etc. The goal was to obscure what the questionnaire was ultimately about. The researchers found that 78% of parents would be very concerned about excess weight in their child. The parents also showed knowledge about whether juice consumption and fast food should be limited, as two-thirds of the parents said that children should be limited to two juice boxes per day. Ninety-nine percent of the parents stated that fast food should be limited to one week or less. The researchers also found that the parents of the overweight children were much more likely to be inaccurate about their childs weight, as only 10% of the parents with overweight children stated their childs weight accurately, while 59.4% of the parents of non-overweight children stated their childs weight accurately (Etelson et al., 2003, p. 1362). Interventions There are many ways that schools may intervene in the problem. For instance, in Southwest England, children from ages 7-11 participated in a program where they were discouraged from drinking soft drinks and were required to take health education during four school terms. Although this program seems simple, it was effective in the short term, as the control and the intervention group differed significantly with regards to overweight children. However, the changes did not last, as, two years after the study, childhood obesity increased in both the intervention and the control groups (James et al., 2007, p. 335). Another intervention program is known as the MEND program (mind, exercise, nutrition, do it). In this program, the families of obese children go through nutrition sessions, behavioral change sessions and exercise sessions. Included in the behavioral session are strategies such as goal setting, stimulus control, reinforcement and response prevention. The exercise session consisted of one of exercise a day for the children. The intervention group had a lower BMI than the control group after six month, and recovery heart rate and physical activity level improved for the intervention group as well (Sacher et al., 2010, p. S63). Conclusion Childhood obesity has many causes and many solutions. The best solution is one where the entire family gets involved, such as the MEND program above. The program is comprehensive, and, most importantly, has a component that is geared towards changing the overall behavior of the child. The child may learn about nutrition and exercise, but, until that child has strategies on how to resist temptation and keep working towards their goals, the program will not be successful. Moreover, if the child has parents at home that sabotage, this would also negate success. Therefore, the MEND program is one that should be implemented to help combat childhood obesity. 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