Childhood Obesity as a Major Health Challenge - Coursework Example

Childhood Obesity Childhood obesity is a major health concern and infact, it is occurring in epidemic proportions all over the world. Obesity inearly years of life is a matter of concern because of potential health consequences that can occur like hypertension, cardiovascular disease, respiratory problems, obstructive sleep apnea, diabetes type-2, sleep problems and orthopedic problems like arthritis and lumbar disc prolapse (Eisenmann, p.382). There is evidence that 80 percent of adolescents who are overweight continue to be obese even when they become adults (Eisenmann, p.382). Other than the above said health problems, obesity can also contribute to increased health care costs and social problems (Uwaifo, Emedicine). A physical state in which excess body fat is stored is known as obesity. It has been estimated that 7 percent of the population in the world suffer from obesity. The prevalence is more in developed countries. In the United States alone, about 30 percent of the population is obese (Uwaifo, emedicine). In Europe, about 17 percent of population is obese. Of recent interest is obesity among children (Uwaifo, Emedicine). There are several measures to measure obesity, the most common of which is body mass index or BMI, which is also known as Quelet Index. In children, BMI above 95th percentile is considered as obesity and that between 85th percentile and 95th percentile is considered as overweight. (Uwaifo, Emedicine) Calculation of body mass index is as follows: BMI = weight/height2, where weight is in kilograms and height is in meters. Body fat percentage can be calculated using the formula of Deurenberg equation as follows: Body fat percentage = 1.2(BMI) + 0.23(age) - 10.8(sex) - 5.4, where age is in years and sex is 1 for male and 0 for female. Other indices for estimating the distribution, severity and degree of obesity in children are circumferences of hip and waist and 4 standard skin thicknesses of suprailiac region, triceps region, biceps region and scapular region. Obesity in children can be primary or secondary. Infact, in most cases, the etiology is multifactorial. Factors which contribute to obesity include genetic factors, metabolic causes, physical activity levels, behavior of the individual, hormonal factors, age of the patient, gender, racial factors, socio-economic status, food habits in the family, ethnic factors and psychological factors. There are several conditions which can cause obesity and these are known as secondary causes. These include endocrine disorders like deficiency of growth hormone, hypothyroidism, Cushing syndrome, insulinoma and polycystic ovarian disease; genetic syndromes like Bardet- Biedl syndrome and Prader-Willi syndrome, intake of certain drugs during long term like corticosteroids and phenothiazine and presence of certain eating disorders like binge eating. Obesity is now considered to be a chronic disease with onset in as early as childhood or even adolescence mainly due to imbalance in input-output. Several co-morbid conditions are associated with obesity (Schwarz, Emedicine). Increased accumulation of fat occurs when intake of total energy exceeds expenditure of energy in the body. In children, the most common cause of such energy disparity is television viewing, inadequate physical activity and excessive use of computer and videogames (Schwarz, Emedicine). There are several theories to ascertain energy imbalance and obesity. One of the latest theory is the gut-brain-hypothalamic axis imbalance in which the hrelin/leptin hormonal pathway is disrupted. Abnormalities in this pathway can lead to abnormal control of appetite and excess intake of energy. N-Leptin, which is a 16-kD protein is predominantly produced in the white adipose tissue. It is very important in controlling the satiety center in the hypothalamus. Deficiency of leptin leads to abnormal satiety and excess consumption of food leading to obesity. In some patients, leptin may not be deficient, but can be resistant contributing to obesity despite high leptin levels (Schwarz, Emedicine). Increase in television entertainment has led to increased television viewing in children. Computer home works, video games, laptop movies have increased and these lead to decreased physical activity in children. There is significant decrease in physical education in schools. Also, decrease in afterschool athletic activities like play in parks, increased availability of fast foods and binge foods, increased access to tasty foods like burgers, pizzas, fried foods and sugary drinks have contributed to energy input and output disparity contributing to childhood obesity. There is enormous rise in the number of fast food centers and outlets, super-sized food proportions in the restaurants and increased availability of high-calorie and high fat foods in the grocery shops (The Henry J. Kaiser Family Foundation, 2004). Watching television for several hours in a week in adolescence and childhood has been linked to several adverse effects like smoking, raised levels of cholesterol in blood and obesity. Hancoux et al (2004, p.258) conducted a study to evaluate the association between television viewing in childhood and adolescence and health during adulthood. This study concluded that increased television viewing contributed to obesity and cardiovascular problems in adulthood. Their study also suggested that time spent watching television during childhood and adolescence might even exceed time spent in school. Various studies have predicted that physical activity at age 15 years was inversely correlated with adolescent television which infact predicted adult cardio-respiratory fitness. Association between increased television viewing and obesity in childhood came into light because explosion in media targeted to children and childhood obesity occurred during the same period. Children and adolescents spend a considerable part of their life watching television. Children spend as much as five and half hours a day in front of television equivalent to a full-time job. The average child or adolescent watches an average of nearly 3 hours of television per day. To facilitate this, 32% of 2- to 7-year-olds and 65% of 8- to 18-year olds have television sets in their bedrooms (Grund, 1248). It is not only television that has attracted children, but other forms of media like computers, videogames and videos have also attracted children. Children tend to get glued to the media because of the interesting programmes which attract them. Though TV viewing can have its own potential benefits, many negative effects can result like violence and aggressive behavior, sexuality, poor academic performance, body concept and self image, substance abuse, dieting and obesity. The media also advertises and promotes foods like sodas, snacks and candies. This can contribute to unhealthy food choices and weight gain (Grund, 1250). Environmental factors frequently discourage physical activity and promote over eating, thus leading to childhood obesity. Due to increased television watching, the amount of time spent in other activities like playing is curtailed leading to decreased physical activity. Reduced physical activity results in a reduction in total energy expenditure, thus creating a positive energy balance. Obesity occurs as a result from an energy imbalance wherein caloric consumption exceeds energy expenditure. Also, obesity itself increases TV viewing (Grund, 1245). Increased adiposity occurs as a result of increased percent calories consumed from fat. Physical activity contributes to energy expenditure and prevents adiposity. So, sedentary life style resulting in decreased physical activity can lead to adiposity and obesity. The most studied form of sedentary behavior is watching TV. Viewing TV is associated with consumption of binge diet like increased consumption of soda, fried foods and snacks. Grund et al (2000, 1245) studied the relationships between TV viewing and body composition energy expenditure, physical activity, fitness and nutrition habits in prepubertal children. They concluded that there is a positive relationship between TV viewing and fatness. They also opined that increased TV viewing does not reflect reduced 24-hour energy expenditure, but increased TV consumption is associated with a low socioeconomic status. Eisenmann et al (2002) also studied similar aspects and reported that increased levels of physical activity are associated with a lower BMI and less TV watching. They also pronounced the relationship between TV watching and weight status. There has been enough research to relate television watching to increased prevalence of childhood obesity. The first study was by Dietz and Gortmaker in 1985 (The Role of Media in Childhood Obesity, 2004). They reported that there was significant association between the amount of time spent by the children in watching television and obesity (The Role of Media in Childhood Obesity, 2004). They also inferred that among 12 to 17 year olds, the prevalence of obesity increased by 2% for each additional hour spent in front of television. It has been estimated that 29% of obesity cases can be prevented by reducing television viewing to less than an hour a day (The Henry J. Kaiser Family Foundation, 2004). In general, increased physical activity and decreased intake of unnecessary calories seem to be crucial in most cases of childhood obesity. However, there are conflicting reports about the type of physical activity interventions and the place of interventions. According to a meta-analysis by Harri et al (2009; pg. 720) in which the objective was to "determine whether school-based physical activity interventions improve childrens body composition, as measured by BMI" (Harris et al, 2009, pg. 721 ). The results of the study indicated that school-based physical activities did not cause improvement in the body mass index and that such interventions did not have a significant impact on the prevalence of childhood obesity. The authors opined that the "dose" of the physical activity in the schools were probably not significant enough to affect the body-mass index. Thus, from this study it is evident that despite an association between reduced physical activity and childhood obesity, there is no conclusive evidence that increase in school-based physical activity decreases childhood obesity. Similar inference was drawn by Reilly et al (2006, pg. 1041) in which the researchers concluded that physical activity did not reduce body mass index in young children with obesity. According to Nemet et al (2005, pg. 444), a multidisciplinary intervention involving diet, physical activity and behavior is essential to impact the body mass index in children with obesity. There is no definite information as to how much television should a child or adolescent should watch. However, studies show that children and adolescents who watched 1 h or less a day were the healthiest (Hancoux, pg. 262). The American Academy of Pediatrics recommends that parents limit their child’s viewing to 2 h per day (Hancoux et al, pg. 261). While increased TV viewing has been attributed to obesity in children, various studies have also described that reducing TV viewing can infact prevent obesity. Robinson (1999; cited in The Henry J. Kaiser Family Foundation, 2004) reduced television, videotape and videogames use in children and assessed the changes in adiposity, physical activity and dietary intake. He inferred that reducing media viewing is a promising population based approach to prevent childhood obesity. Behavioral interventions aimed at reducing TV viewing have been effective in producing short- and long-term weight loss in obese children. The approaches used by these interventions are information dissemination and restricted TV accessibility. Some other forms of interventions to reduce obesity include increasing activity by using contingent television. For example, making a child increase pedaling on a cycle ergometer to obtain access to contingent TV or by making movie viewing and video game playing contingent on pedaling a cycle ergometer. Thus, it is evident that obesity in childhood is a major health challenge because of its predisposition to obesity in adolescence and adulthood and various health consequences, including cardiovascular disease. The main cause of obesity in childhood is disparity in energy intake and energy expenditure. The prevalence has increased in recent years, especially in developed countries, because of increased availability of fast foods which have lot of calories and less of nutrients and due to decreased physical activity, mainly because of increased television viewing and advent of computer use even for home works. Works Cited Eisenmann, JC, Bartee, RT, and Wang, MQ. “Physical Activity, TV Viewing, and Weight in U.S. Youth: 1999 Youth Risk Behavior Survey.” Obesity Research 10.5 (2002): 379-385. Print. Faith, MS, Berman, N, Heo, M, et al. “Effects of Contingent Television on Physical Activity and Television Viewing in Obese Children.” Pediatrics 107 (2001): 1043-1048. Print. Grund, A, Krause, H, Siewers, M, Rieckert, H, and Muller, MJ. “Is TV viewing an index of physical activity and fitness in overweight and normal weight children?” Public Health Nutrition 4. 6 (2000): 1245-1251. Print. Hancox, RJ, Milne, BJ, & Poulton, R. “Association between child and adolescent television viewing and adult health: a longitudinal birth cohort study.” Lancet 364 (2004): 257-262. Harris KC, Kuramoto LK, Schulzer M, Retallack JE. Effect of school-based physical activity interventions on body mass index in children: a meta-analysis. CMAJ 180.7 (2009): 719- 726. Nemet, D, Barkan, S, Epstein, Y, Friedland, O, Kowev, G, and Eliakin, A. Short- and Long-Term Beneficial Effects of a Combined Dietary–Behavioral–Physical Activity Intervention for the Treatment of Childhood Obesity. Pediatrics 115. 4 (2005): e443- e449. Reilly, JJ, Kelly, L, Montgomery, C, et al. Physical activity to prevent obesity in young children: cluster randomised controlled trial. BMJ 333. 7577 (2006): 1041. Print Schwarz, SM. “Obesity.” Emedicine from WebMD. 2007 Available at: http://www.emedicine.com/ped/topic1699.htm [Accessed 3rd December, 2012] The Henry J. Kaiser Family Foundation . “The Role of Media in Childhood Obesity.” 2004. Available at: http://www.kff.org/entmedia/upload/The-Role-Of-Media-in-Childhood-Obesity.pdf [Accessed 3rd December, 2012] Uwaifo, GI. “Obesity.” Emedicine from WebMD. 2006 Available at: http://www.emedicine.com/med/TOPIC1653.HTM [Accessed 3rd December, 2012] Read More