Main causes of UK childhood obesity and what can be done to prevent childhood obesity - Essay Example

Main Causes of Childhood Obesity in the UK and Prevention Introduction Obesity is a major public health crisis in children. It is a complex condition that occurs when the excess in adipose tissues mass reaches levels considered to disrupt the balance between energy intake and energy expenditure. It could simply be considered as excessive body fat (Milligan 27; Waumsley 5). The World Health Organisation, WHO associates childhood obesity with the development of numerous health complications including obesity in adulthood. Whereas it would be ultimately appreciated that health behaviours are an individual responsibility, policymakers observe that personal choices would be undertaken in the context of a greater environment. Such a wholesome systems approach considers even the social factors that influence obesity. Whitehead and Dahlgren refer to such a model as the social model of health rainbow which considers individual, socio-cultural, socioeconomic and environmental conditions (91). These present significant intervention levels for childhood obesity that this paper seeks to articulate following an evaluation of the major causes of childhood obesity. Whereas there could be varied ways to determine obesity, the use of body mass index, BMI has gained much prominence in the UK and globally. The BMI refers to a measure of weight against height, calculated by dividing the weight of a child in kilograms by their height in meters squared (Ahima 319). Thus: BMI = Weight (Kg)/Height2 (m2) BMI-for-age centile charts are gender-specific and vary with age, usually used for children aged 2 and above. A child would be considered as overweight if they are plotted anywhere between centile lines 91 and 98 and obese if plotted on or beyond centile line 98, even though the UK government uses BMI centile lines 85 and 95 respectively in its statistics (More 197). BMI is preferred by the UK government in measuring obesity because it requires no specialised equipment, thus easy to consistently and accurately measure across large populations. Additionally, its widespread use among other countries globally makes comparison practical between countries and population groupings. To distinguish between body fat mass and muscular physique mass or fat distribution, waist circumference centile charts which determine truncal fat stores would complement BMI measurements. Recent statistics show that obesity is on the increase in the UK. However, among children, obesity has been noted to be on the decline. In 2011, it was noted that 31% of boys and 28% of girls aged between 2 and 15 were either overweight or obese, with increase in waist circumference outstripping BMI measurement increases (Ahima 320). Statistics from the Health and Social Care Information Centre indicate moderate decrease in the proportion of overweight and obese children, the proportion having declined from 22.6% in 2011/12 Reception Year to 22.2% in 2012/13. Despite these improvements, the current 1 in every 5 Reception Year children (aged 4 to 5) and a third of Academic Year 6 children (aged 10 to 11) being obese has been noted to be among the worst cases in Europe (National Obesity Forum 8). Obesity is thus a critical public health issue in the UK that calls for understanding of the underlying problems in order to develop effective preventive strategies. Causes Generally, childhood obesity results from eating too much and being involved less in physical activities. More specifically, the NHS observes that it results from a consumption of diets rich in energy, particularly from sugars and fats, with no burning of the energy through physical activity or exercise. As a result, surplus energy would be stored in the body as fat. To gain deeper understanding of these causes of obesity, the social model of health provided by Dahlgren and Whitehead would be useful (91). The framework provides a way to determine the relative influence of various factors to health and their interactions. The first major cause of obesity is poor socioeconomic status. Indeed, Dahlgren and Whitehead observe that people lower on the social ladder have twice the risk of contracting serious illnesses and premature deaths than those at the top (91). In the same way, lower ranked officers in an organization suffer more from diseases than the higher ranked workers. Such determinants also play a role in childhood obesity which could be blamed on material and psychosocial issues, including poor education conditions, poor housing and insecure employment among others. The 2012 Health Survey for England, HSE report indicates that 19% of boys in the lowest income quintile households were likely to be obese with 15% to 17% of the girls in the lowest three quintile households most likely to be obese. On the other hand, 8% and 7% of boys and girls respectively exhibited the least possibility of being obese (Milligan 26). In a similar manner, the prevalence of childhood obesity has been linked to lower social classes, with social class referring to the classification of occupational clusters based on the level of skills involved. Generally, it has been noted that the prevalence of childhood obesity increases with a decrease in occupational skill level. As such, children from households with parents in unskilled labour would be more likely to have obesity than children whose parents are in professional occupations. Dietary factors also play a significant role in causing childhood obesity. Dietary choices among children would be a factor of parental decisions or government recommendations. According to Griffiths et al., the current recommendation by the UK government is that children be exclusively breastfed for the first 6 months, similar to the World Health Organisation 4- to 6-month recommendation (220). Defiance by a majority of mothers who choose to introduce children to solid foods before they are 4 months has promoted overweight status among children. More also supports similar sentiments noting that formula-fed infants would lose less weight in their early days after birth thus making them more prone to obesity (199). Such diets contain large amounts of sugar and fat responsible for obesity. According to NHS, 2,500 and 2,000 calories of energy per day would be adequate for a boy and girl respectively, calories being the unit for measuring the energy value of food. Similarly, fast foods are mostly rich in sugars and fats which expose children to obesity. Children could also eat larger portions than they need, either sociologically as learnt from their adult companions or psychologically as a result of low self-esteem that leads to comfort eating or binge eating (Gatineau and Dent 6). Such excessive eating makes obesity inevitable. Much of the poor diet habits are sociological, with NHS noting that children learn such habits from their parents or other adults. Also attributed to childhood obesity are individual lifestyle factors. Sedentary behaviours and lack of physical activity have been widely linked to childhood obesity. A UK study cited by More observed that obese 9-year olds gained excess weight before they were age 5, having spent considerable portions of their preschool time seated watching TV, playing computer games and browsing the Internet for long without taking regular exercises (199). Such behaviours promote social exclusion or deprivation and addiction, predictors for illnesses (Dahlgren and Whitehead 92; Rugg 28). Studies conducted by Griffiths et al. observed that children at age 5 who watched TV or used computer for a minimum of two hours a day were more likely to be obese, measured independent of other confounding factors (223). The studies also show that children aged 5 who commonly used a vehicle for transport to school were at a greater risk of obesity than those who cycled or walked to school. Without activity, children fail to use the energy from the food eaten thus causing the extra energy to be stored as fat by the body. Environmental conditions have also been fronted as possible causes of obesity. With reference to Karnik and Kanekar, these refer to those surrounding the children and thus influence their physical activity and their food intake (4). They include settings such as school, home and the community. The interaction between parents and children at home influence food choices and motivation to healthy lifestyle among children. According to Rugg, parents spend a lot of time working and therefore lack time to supervise the sedentary behaviours of their children (28). The ability of a community to afford healthy food or the accessibility of healthy food in a community could affect the nutrition of children. The lack of participation of children in physical activities could be a result of lack of safe parks, safe sidewalks and bike paths. Thus, the environment in which a child grows affects the proneness of the child to obesity. Genetics could also play a role in increasing the susceptibility of a child to obesity. As noted by Dahlgren and Whitehead, biological markers and physiological factors determine health conditions (92). Genetic factors could interfere with metabolism, altering the content of body fat and energy intake and expenditure thus making a child more prone to obesity (Karnik and Kanekar 3). NHS gives the example of Prader-Willi syndrome, Cohen syndrome, Alstrom syndrome and Bardet Biedl syndrome as examples of the genes that expose children to obesity. Others include single-gene defects such as deficiencies in melanocortin 4 receptor, MC4R and leptin (More 199). Children could also inherit genes of large appetites and other similar traits that would make it impossible for them to lose weight. Even so, it has been widely argued that obesity results from environmental factors, learned during childhood, more than it could be caused by genetic factors. Finally, obesity could be caused by medical reasons. More documents that endocrine disorders, usually signalled by short stature, could cause childhood obesity (199). These include Cushing’s syndrome, hypothyroidism and deficiency in growth hormone. According to NHS, hypothyroidism refers to a condition where the thyroid gland fails to secrete enough hormones while the Cushing’s syndrome is a rare condition which leads to steroid hormones being overproduced. Other than these medical conditions, some medications have also been cited as possible causes of obesity. Some of the medications used to treat diabetes and epilepsy, corticosteroids and mental illness medications, including medicines for schizophrenia and antidepressants, could cause weight gain among children thus increasing susceptibility to obesity. This relates to the argument for socio-economic factors affecting health, particularly considering healthcare services as documented by Dahlgren and Whitehead (92). Consequences of Childhood Obesity There are numerous health related issues associated with childhood obesity. These health problems would be expressed physiologically, psychologically and sociologically. The consequences are severe with 40% to 70% noted to persist into adulthood (More 200). In fact, the older an obese or overweight a child is, the higher the chances of the child remaining obese or overweight in adulthood. Childhood obesity comes with a myriad of medical consequences. These could be classified as mechanical complications or metabolic complications (Lee 76). Mechanical complications could be expressed physically through the musculoskeletal system, with the discomfort as a result of increased weight on joints causing bone and muscle disorders. They include orthopaedic problems like valgus and genu varus deformity of knees, slipped capitates femoral epiphysis and Blount’s disease. It also includes obstructive sleep apnoea. Metabolic consequences would usually not be apparent until in later years, though they begin in childhood. They stress the body of children gradually and in intense cases, they could even become evident in childhood. Childhood obesity increases the risk of cardiovascular diseases and high blood pressure due to the increased cholesterol levels. According to More, 80% of childhood obesity cases suffer from hypertension and dyslipidaemia (200). Additionally, it risks the affected children having the insulin resistant type 2 diabetes. Respiratory problems such as asthma also affect children diagnosed with obesity. Finally, it could affect the liver leading to the liver experiencing fatty degeneration (Karnik and Kanekar 4). These are the physiological consequences of childhood obesity. Often overlooked are the psychosocial consequences of childhood obesity. This is the case despite psychological and social consequences being even more prevalent than the medical complications. Childhood obesity could significantly impact on the emotional development of a child who faces stigmatization and discrimination from adults and peers. This follows the association of obesity with negative characteristics such as being regarded as greedy and glutton, ill-disciplined and weak-minded. A study by Lee shows obese children as being least desired by other children for friends (80). Children with obesity would be more likely affected by negative perception of their body images, compounded by low self-esteem and low confidence than their adult counterparts. This follows mid-childhood being critical in the development of self esteem and body image. Such perceptions, which could most likely persist into adulthood, worsen problems for an obese child, limiting access to school and the social circle (Karnik and Kanekar 3). Ultimately, this exposes them to lower incomes and high poverty rates. As such, finding effective prevention measures would be of great benefit to individuals and the society at large. Interventions With childhood obesity being a public health concern, it has been a policy issue for the UK government since 2004. The government undertook two flagship initiatives that would curb childhood obesity. The Change4Life programme, established in 2007, aimed at educating the public on physical activity and healthy diets. The Responsibility Deal urged businesspeople to make it easier for the public to make healthy choices. Businesses had to commit to the deal, reducing ingredients like salt and fat in their products and availing calorie information on their products (Waumsley 6). Despite such campaigns aiming for the betterment of children health, they would not solely alter the public situation. As such, Gatineau and Dent (5) recommend for more impactful campaigns such as those carried out for non-smoking. Another weakness observed of these government initiatives is their focus on prevention of childhood obesity. This leaves out problems of children who are already obese and the associated costs. As such, Gatineau and Dent advocate for attention to supporting obese children (6). Thus, other interventions should be used complimentarily so as to achieve the intended objectives. School-based interventions have been noted to yield desirable results in curbing childhood obesity. According to Karnik and Kanekar, children spend the greatest proportion of their time in school, thus making school important in shaping the life of a child (5). Successful governments have appreciated this important role of schools, thus introduce regulations on food standards for the meals given. With children taking at least a meal in school, this opportunity should be used to make them make healthy food choices. These include reducing consumption of sugary foods and intake of carbonated drinks, instead encouraging drinking of water and healthy fruit juices and taking fruits and vegetables. Furthermore, schools could involve children in regular, moderate to intense physical activities, encouraging the kids to take up the stairs instead of elevators. This could however be unethical as it amounts to subjecting children to harsh treatment. The Department for Education, in 2013, mandated schools to adhere to curricula on physical education (Gatineau and Dent 5). Emphasizing on non-competitiveness, children should be encouraged to participate in games and even dance groups. These physical activities account for between 25% and 30% of energy expenditure in children thus the need for children under 5 and those between 5 and 18 to be engaged in physical activity for at least 3 hours and 1 hour respectively (More 201). These activities should psychologically influence children to regular exercises thus promoting their wellbeing (Waumsley 7). Including healthy living education in their curricula also deters childhood obesity. These measures have been supported because of their effectiveness in curbing sedentary behaviours and poor dietary lifestyles. However, such measures have been noted to be demanding with regards to budgeting and planning, considering the prohibitive cost of educating teachers of such programmes and providing required infrastructure and facilities. The government would therefore need to develop adequate strategies to promote such activities outside the school setting. Community based interventions could be employed as a sociological form of intervention to curb childhood obesity. Karnik and Kanekar define a community as the environment surrounding a child together with other factors such as ethnicity, race, socioeconomic status and geographic location (5). Community support could be achieved through organisation of social events such as harvest festivals, healthy food festivals, education and encouragement on adoption of healthy lifestyle and imparting healthy messages. This way, the community makes it possible for children to access healthy food options. Community organisations could liaise with parents to promote children activity-based programs such as walk to school, appreciating the important role that families play in shaping the behaviour of children. They could make the community safe and promote the development of amenities needed to encourage physical activity such as gymnasiums. Using their influence on local media or entertainment, the community could play a significant role in educating parents and children on healthy lifestyles (Waumsley 11). Even so, the community remains largely unaware of effective approaches to preventing childhood obesity. Most of these programmes fail as a result of not fully appreciating the benefits or not having qualified personnel to push the required agenda. Therefore, the government should invest more in adequately training healthcare professionals on the management of obesity and weight. According to Gatineau and Dent, the Department of Health should train such professionals on the importance of undertaking waist measurements during medical visits so as to point out indications of ectopic fat deposits or visceral adiposity (6). This should promote the community preventive efforts with regards to childhood obesity. The professionals should provide critical health information, including the importance of adhering to exclusive breastfeeding recommendations so as to realise the intended benefits. In essence, these approaches look to psychosocially orient children to healthy living to deter sedentary behaviours and promote healthy eating. This therefore places the responsibility for psychological intervention in the hands of the social environment of the children which encompasses all those interacting with the children (Dahlgren and Whitehead 91). As such, families, schools, communities, healthcare professionals and the government together play a significant intervening role with regards to childhood obesity. Conclusion Childhood obesity remains a great public health concern in the UK despite recent marginal decline in its prevalence. It basically refers to children having excessive fats in their bodies, measured using the BMI centile, complemented by waist circumference centile for more reliable results. The main cause of childhood obesity is consumption of excessive food with no physical activity. This could be attributed to poor socioeconomic status together with poor dietary choices, individual lifestyle factors, environmental conditions, medical conditions and genetics. Childhood obesity adversely affects children medically and psychosocially, and could extend into adulthood. Despite the UK government policies to regulate the lifestyle of children and their diets, they remain ineffective due to economic limitations and exclusion of other key players. Thus, incorporating school-based and community-based interventions would be more effective. Works Cited Ahima, R. S., ed. Childhood Obesity: Prevalence, Pathophysiology, and Management. Oakville, ON: Apple Academic P., 2014. Print. Dahlgren, G., and M. Whitehead. Policies and Strategies to Promote Social Equity in Health. Stockholm: Institute for Future Studies, 1991. Print. Gatineau, M., and M. Dent. Obesity and Mental Health. Oxford: National Obesity Observatory, Mar. 2011. Web 23 Nov. 2014. Griffiths, L. J., S. S. Hawkins, T. Cole, C. Law and C. Dezateux. “Childhood Overweight and Obesity.” Children of the 21st Century: The First Five Years. Eds. K. Hansen, H. Joshi and S. Dex. Bristol, UK: The Policy P, 2010. 217 – 234. Print. Karnik, S., and A. Kanekar. “Childhood Obesity: A Global Public Health Crisis.” International Journal of Preventive Medicine 3.1 (2012): 1 – 7. Print. Lee, Y. S. “Consequences of Childhood Obesity.” Annals Academy of Medicine 38.1 (2009): 75 – 81. Print. Milligan, F. “Childhood Obesity 1: Exploring Its Prevalence and Causes.” Nursing Times 104.32 (2008): 26 – 27. Web. 22 Nov. 2014. More, J. Infant, Child and Adolescent Nutrition: A Practical Handbook. Boca Raton, FL: CRC P., 2013. Print. National Obesity Forum. “State of the Nation’s Waistline. Obesity in the UK: Analysis and Expectations.” 2014. Web. 22 Nov. 2014. NHS. “Obesity.” Nhs.uk. NHS Choices, 3 Jun. 2014. Web. 22 Nov. 2014. Rugg, K. “Childhood Obesity: Its Incidence, Consequences and Prevention.” Nursing Times 100.3 (2004): 28 – 30. Print. Waumsley, J. A. Obesity in the UK: A Psychological Perspective. Leicester, LE: British Psychological Society, 2011. Web. 23 Nov. 2014. Read More