Epidemiology of Obese Children in the UK - Report Example

Epidemiology of obese children in the UK s Introduction Obesity is defined by Flegal et al. (2010, p.236) as an abnormal growth of the dipose tissue because of enlargement or increase in the number of fat cells (hyperplastic). Essen ( 2013, p.409) also defines it as a medical condition whereby there is the accumulation of excess body fat to the level that it might have deleterious effect on a person’s health, resulting in reduced life expectancy and increase in health risks. An individual is considered to be obese when the body mass index (BMI) is better than the 95th percentile. Obesity is comprehended as an internal immutable problem that affects all life dimensions. Childhood obesity is a very serious epidemic that has substantial long term social and economic costs, and also increases morbidity and mortality. Discussion Evidence of the epidemiology The epidemiological features of obesity include global prevalence, risk factors, burden of illness related to obesity and secular trends (Nguyen & El-Serag, 2010). For very many years obesity was rarely evident (Haslam, 2007). However, by the 20th century it started becoming common. It continued to be develop so rapidly in that the World Health Organization (WHO) recognised it as a global epidemic in 1997 (WHO, 2000). By 2005, it was estimated that nearly 400 million adults were obese, with higher rates being manifested in women than men and children. By 2008, WHO reported that 1.5 billion adults aged 20 and above were obese or overweight, and 200 million children were also reported to be obese (WHO, 2008). As a result, according to the WHO statistics an estimated 2.7 million people die yearly because of being obese. In addition, another 35.7 million or 2.3 % of the global DALYs are as a result of obesity (Flegal at al, 2005). The top five nations with highest obesity rates include Mexico, the United States of America, the United Kingdom, Canada and Australia (Kopelman et al., 2005). Graph showing obesity rates as a percentages of total population in the OECD member states in the years 1996–2003 (Anon, 2005). In Europe, from the 1970s to date, the obesity rates in majority of European nations have been increasing steadily. The 27 nations that make the EU reported obesity rates of 10-26 % in men, 11-35 % in women and 6-25 % in children and adolescents. Although the recent surge in obesity cases has been recorded in almost in all the countries, the rate of increase in England has been very high as shown in the figure below. In the UK, the rate of obesity has increased about fourfold in the last three decades, attaining the levels of 23-24 % in 2008/2009 as shown in the graph below. Graph showing obesity rates in Europe. Currently, the UK has one of the greatest obesity rates in Europe (Public Health England, 2014a). The WHO considers childhood obesity as a global epidemic of the 21st century. Adolescents and children who are obese are a higher risk of developing several health problems and are also have a higher probability of becoming obese adults. Year Percent males obese Percent females obese Percent of children obese 1980 6% 8% 2% 1993 13% 16% 4% 2000 21% 21% 15% 2008/9 22% 24% 18% Table 1: Showing obesity prevalence in the UK from 1980 to 2009. The obesity rate in the UK has been varied in relation to sex and age group. The rapid increase in obesity prevalence has led to number of adults in the England having a healthy BMI of 18.6-24.8 to reduce from 41% - 30.9% in men and 49.4% - 40.3% in women from 1993 to 2010 respectively. By 2050, it has been projected that obesity prevalence will impact on 60 % and 50 % adult men and women, and 25 % children. Figure 1: Showing obesity prevalence in persons aged 16 years and above (Public Health England, 2014b). According to the British 1990 population monitoring on obesity, 10.1 % boys and 8.9 % girls aged 4-5 years and 20.6 % boys and 24.6% girls aged 10-11 years are also classified as being obese as shown in the figure below (Reilly et al., 1999). Figure 2: Showing prevalence of obesity (with 95% confidence limits) by year of measurement, school year, and sex (Public Health England, 2014) Utilising data from the Health Survey for England, the trend in obesity prevalence in children in increasing from 1995 to 2004. Especially for older children, it is evident the rate has been slowing down since 2004 (Public Health England, 2014). Figure 3: Trends in children (aged 2-15 years) obesity prevalence (Public Health England, 2014). The national estimates of obese or overweight children based on HSE data, indicate that in the years 2002 and 2010, 30.9 5 of children aged 2 to 19 years old had a BMI of 85th percentile or more of the British 1990 growth reference charts (Cole, Freeman, & Preece, 1995). The BMI is extensively utilised in the United Kingdom. With regard to children and adolescents, the BMI usually varies with age and sex. As a result of this, a growth reference should be used. In England, the 1990 British growth reference charts have been utilised to classify the weight status of children in relation to their sex and age (Prentice, 1998). The overweight prevalence has changed dramatically between 1980 and 2004, and 2004 and 2010, increasing to 25 % and reducing to 17 % respectively. The National Child Measurement Programme measures the weight and height of an estimated 1 million school children in England annually. They then provide a comprehensive picture of the prevalence of child obesity. The latest figures, for 2012 and 2013 indicate that 18.9% of children in Year 6 that are aged 10-11 years were obese and a further 14.4% were overweight. For those children in who are in the Reception aged 4-5 years, 13.0% were overweight, whilst 9.3% of them were obese. This implies that nearly a third of the 10-11 year olds and more than a fifth of 4-5 year olds were obese or overweight (Public Health England, 2014). According to the National Health Service’s (NHS) statistics, a quarter of the children have been found to be overweight by the time begin primary school, and a further third will be obese by the time they leave (Campbell, 2010). The underlying fact that childhood obesity is on the rise in the UK is indicated in the data provided by the NHS which reported that in 2010, one in four reception pupils was obese (23.1% ), while among year six children the figure was 33.4%, up from 22.8% and 32.6% in the previous year (NHS, 2012). 31% of children aged 2–15 years are either obese or overweight. The direct cost of obesity to the National Health Sservice is about £4.2bn annually. At Reception and Year 6, children who are in the poorest decile are twice more likely to be obese than those in the most affluent decile (National Obesity Observatory, 2011). Similarly, the number of children who are overweight including obese, increase as income quintile decrease, ranging from 26% of boys and 24% of girls in the highest quintile to 35% of boys in the lowest quintile (NHS, 2012). In Manchester it is estimated that about 14,000 children aged 1-15 years are obese (Joint Strategic Needs Assessment , 2008). Symptoms of obesity The symptoms of obesity include: snoring, breathing disorders such as sleep apnea, difficulty in sleeping, rashes in the fold of the kin, back discomfort, joint disease such as osteoarthritis, difficulty in doing simple tasks, depression, constant sweating (Chiarelli, Dahl-Jørgensen & Kiess, 2005). How it has been measured The reference measures of body composition comprise of densitometry, single cut imaging of the abdomen and dual-energy X-ray absorptiometry as well as body mass index (BMI). The first three methods are used for research purposes with BMI being widely used in practice due its low cost nature and simplicity (Nguyen & El-Serag, 2010). There is a consensus that childhood obesity can be measured using the BMI (Reilly, Dorosty, & Emmett, 1999). It is usually computed by dividing the body weight (kilograms) by height (metres), multiplied by 703. The risks associated with obesity increase with increasing BMI (Ogden et al., 2002). Besides, the mortality rates also increase with increasing weight levels, as measured by the BMI (Prentice, 2006). Similar to the weigh-for-height tables, BMI has the limitation of not measuring body fat or muscle directly. However, a BMI of 30 is an indication of excess body fat (Dietz, 2008). The table below offers a guideline to checking BMI. Find the person’s weight at the bottom of the graph. Then go straight up until a line is met that matches the height of the person. The readings are then taken. Graph showing BMI chart. A BMI of 25-29.9 shows that the person is overweight. A BMI of 30 or more implies that the person is considered as being obese (Ackard et al, 2003). The WHO uses the BMI classification system as shown in the table below. Table 2: Showing WHO BMI classifcation system. In order to attain maximum health, the median BMI for adolescents and adult population needs to be between 21 to 23 kg/M2. Evidence has shown that there is increased risk of co-morbidities for BMI that is the range of 25 to 29.9, additionally, there is severe risk of co-morbidities for BMI more than 30. Skin fold is also used to determine the obesity levels. As noted by the NHS (2012), the method entails measurement of the subcutaneous fat that is located directly under the skin by grasping a fold of the skin as well as the subcutaneous fat and measured utilising a calliper. It majorly used to establish the relative fatness and the body fat percentage. However, the measurement of the skin fold thickness as an obesity indicator requires some basic training in calliper use. The other method that can be used to determine obesity levels in children is waist circumference. It is usually used as a simple measure of body fatness (Ogden et al, 2008). However, it is used infrequently since it is subject to error. One is considered obese if the waist is 102 and 88 or more for males and females respectively. Next is bio-impedance, Ogden et al. (2007) claim that it entails the opposition or impedance to the flow of very minimal current as it passes through the body. This method estimates the lean tissue that acts as a conductor, and fat mass that acts as an insulator, via alterations in voltage. The method relies on the facts that lean mass comprises of 73 percent water and fat has no water content. However, the measurement of the central adiposity as an obesity indicator requires some basic training in calliper use. Obesity can also measured using the corpulence index. For a normal person, the figure needs not be > 1.2 which implies the desirable weight (Prentice & Jebb, 2008). Lastly, the other measure technique is the utilisation of Broca Index. It is computed by measuring the height (cm) and subtracting 100 (Nishida & Mucavele, 2005). Environmental and social factors that influence obesity Environmental factors are core contributors to the obesity epidemic (Nguyen & El-Serag, 2010). Environment has very strong influence childhood obesity. Consider that most people in the UK alive today were also alive in the 80s, when rates of obesity were much lower. Since this time, even though our genetic make-up has not changed, the environment has (Holsten, 2008). The environment is comprised of factors such as lifestyle behaviours like what we eat and physical activity. Most Britons often eat high-fat foods and large meals, since they put taste and convenience ahead of nutrition. Moreover, these people do not get enough physical activity (Kipke et al., 2007) It is certain obesity develops where there is an imbalance between energy expenditure and energy uptake (Prentice & Jebb, 2008). Evidence point out that excess energy uptake and reduced energy expenditure is the major cause of being overweight. A recent study indicated that television viewing and car ownership and physical inactivity are closely relate to the increasing trends of obesity prevelance in England (Prentice & Jebb, 2008, p.437-439). Dietz and Gortmaker (1999) argue that for each additional hour of television viewing, obesity prevalence increased by 2 % The environment also incorporates the world that is around us; our access to places and foods. In today’s world, more people are driving to work and other place instead of walking, they also reside in neighbourhoods that have no sidewalks, have a tendency to eat out than cooking, and have high-calorie snacks at their work place. This makes them to increase their chances of developing obesity conditions. Additionally, NHS (2012) claims that social factors such as low education levels and poverty are linked to obesity. According to Hunt et al. (2008), high-calories processed foods usually cost less and are also much easier to find and prepare as compared to the healthier foods, like fruits and vegetables. The other reason as cited by Essen ( 2013), the high cost acquiring physical training services such as gym membership limits the opportunities for physical activity. On the other hand, the high income groups have also exhibited increased obesity levels. This is attributed to the easy access to the non-nutritious foods in the stores. McDermott (2013) reports that in the last three years, an estimated 932 children who are under the age of 15 required urgent healthcare attention due to Britain’s obesity epidemic. McDermott adds that the true scale of the problem is more probable to go up since less that a third of the hospital trusts have disseminated information regarding the number of children whose weight has become unmanageable. For instance, Portsmouth Hospitals NHS Trust reported that, according to the hospitals admission data, at least 101 children under the age of 5 and 283 children of primary school age were diagnosed with obesity. Biological factors that influence childhood obesity Evidence has shown that obesity tends to run in the families. This implies that they are caused genetically. On the contrary, families that also share lifestyle and dietary habits have a higher chances of developing obesity. It is often very difficult to separate the genetic influences of obesity. Even so Haupt et al. (2008) note that there is connection between heredity and obesity. Single gene mutations are responsible for the rare forms of leptin receptor (LEPR), melanocortin-4 receptor, and pro-opiomelanocortin are responsible for monogenic obesity (Andreasen & Andersen, 2009). Besides, there is growing evidence that the single-nucleotide polymorphisms (SNP) also play a very crucial role in the obesity epidemic. These SNPs have moderate effects on a person’s susceptibility to the common forms of obesity. However, as a result of their high frequency, they can have a significant impact to obesity prevalence on the population level (Tiret et al. 2002). According to Andreasen et al. (2008), some illnesses may result to or are connected to weight gain or obesity: hypothyroidism is a condition where the thyroid gland incurs failure to release adequate thyroid hormone. As a result, it lowers the metabolic rate and lowers the vigour. Cushing syndrome is considered as a hormonal disorder that is caused by extended exposure of the body’s. A medical practitioner can ascertain if the there are underlying medical conditions that are making weight loss or weight gain difficult (Prentice, 2006). Lack of sleep has been cited by Frayling et al. (2008) as a contribution to obesity. Recent research has indicated that individuals with sleep problems usually gain weight over time. On the contrary, Wadden and Stunkard (2006) assert that obesity contributes to sleep problems such as sleep apnea. Wadden and Stunkard describe it as a condition where an individual stops breathing briefly numerous times during the night. Certain drugs, for instance, steroids, anti-depressants, seizure disorders or some medications may also cause weight gain (Dietz, 2008). These drugs have been found to slow rate at which calories are burnt in the body, causing the body to hold on to water and stimulate appetite. Lastly, the other illness that may cause obesity is the polycystic ovary syndrome. Frayling et (2007) point out that it is a condition that is associated with high androgen levels and irregular menstrual cycles. In some instances, there are many small cysts in the ovaries. Cysts are sacs that are filled with fluids. The health risks are summarised in the table below. Table 3: Showing health risks associated with obesity. Emotional suffering is the Psychological and social effects most painful part of obesity. The British society makes an emphasis on physical appearance and usually equates slimness with attractiveness, particularly for females. Such notions in the society make the overweight individuals to feel unattractive. Most people have a perception that obese people are either lazy or gluttonous. Medically, however, this is not true. Consequently, the obese people often experience discrimination or prejudice at school, in the job market, and social situations (Dietz, 2008). This makes them to develop the feelings of shame, anxiety, rejection and even depression, as well as stress. There is also growing recognition that social networks also have a significant effect on obesity development in children (Christakis & Fowler, 2007, p. 370-376). The study by Christakis and Fowler indicate that an individual’s risk of becoming obese increased 56% when a friend became obese. However, the association became smaller among siblings and spouses, with the risk factors being 40% and 36% respectively. (Nguyen & El-Serag, 2010) argues that obesity is affected by a complex interaction between the genetic, human behavior and environmental factors. Its impact Obesity is a global epidemic (WHO, 2008). Adams et al. (2006) asserts that obesity is associated with an increased risk of death. The researchers also found out that the risk increased by 20% to 40% for those who smoke and are overweight. (Ogden, Yanovski, Carrol, & Flegal, 2007) argues that oobesity varies by age and sex. In children, the researches observed that obesity is connected with a modestly increased risk of all-cause mortality. There are numerous medical conditions that are associated with childhood obesity including high blood pressure, type 2 diabetes, stroke, colon cancer, cardiovascular diseases, cervix cancer, and esophageal cancer ( Field et al. 2001) Other diseases and health problems that are connected to obesity include dyslipidemia/high cholesterol, osteoarthritis of weight-bearing joints, depression, sleep apnea/respiratory problems, urinary stress incontinence, lymphedema, gastroesophageal reflux disease (GERD) and its complications (such as erosive esophagitis), and colorectal polyps cancer (College of Gastroenterology, 2008). The health risks that are associated with obesity have been found to reduce the high prevalence of obesity a public heath priority among children. This would help reduce the high cost of treating obesity. The British government estimated the total economic costs of obesity in the UK to be 156 pounds in 2000. However, due to the prevalence of overweight and obesity increasing since 1980s, the costs today are more likely to be significantly higher (Wadden & Stunkard, 2006). Research has indicated that there is a very strong linkage between increase in advertising for the non-nutritious foods and rates of childhood obesity (Miller at al., 2008). Obesity in children increases with the more hours they spend watching television. Many under age children who are 8 years and below become vulnerable victims of regular advertisements as they can not differentiate between advertising and programming, and the persuasive intent of the advertising. It is therefore very nature exploitative when the advertisement is directed to young children and teenagers Treatment Generally, most health providers agree that individuals who have a BMI of 30 or more can actually improve their health through weight loss. The most effective treatment for childhood is dietary changes, regular exercising and behavioural and lifestyle changes. Preventing additional weight gain is also recommended if a person has a BMI of 25 and 29.9 (Prentice & Jebb, 2008). Weight loss is recommended if you have two or more of the following: a family history of particular chronic diseases; pre-existing medical conditions such s high blood pressure, cardiovascular ailments, low HDL cholesterol levels, diabetes, and high triglycerides; and lastly, large waist circumference. The surgical weight loss programs or bariatric surgery is a method of weight loss for the severely obese people, and are not able to loose weight by any other means. In children, it is only applied when all other methods have failed. The surgery comprises of a broad spectrum of procedures from malabsorptive to restrictive to those combining the two. The restrictive procedures include Adjustable Gastric Banding and Vertical Banded Gastroplasty (VBG) which decrease the stomach size, and the malabsorptive and combined procedures like iliopancreatic diversion, Roux-en-Y Gastric Bypass (RGB), and Fobi Pouch and Duodenal Switch that reduce the ability of the body to absorb the nutrients and calories from food (NHS, 2012). Conclusion The epidemiology data shows prevalence of obesity in women, children and men has been on a steady increase since 1980. However, the obesity rates are reducing in children has been reducing since 2004, while the adult’s prevalence has continued to increase up to date. One in three children is overweight or obese in the UK. The epidemiology data indicate that by 2050, more people will be increasingly affected by obesity. Obesity prevalence in the UK has increased dramatically since 1980 in women, adults and children, with the possibility of recent stabilization, according to data from 1995 and 2010 for women, men and children in the UK. The data also indicate that obesity is affected by a complex interaction between the human behaviour, the environment and biological factors like genetic predisposition. The condition is also associated with an increased risk of numerous chronic diseases, from cancers to diabetes and many other digestive diseases. Additionally, Trogdon (2008) note that obesity epidemic exerts a £4.2 billion toll on the UK economy with its huge healthcare costs. Therefore, it has emerged that obesity and overweight are the most pressing global issues that we will face in the next several decades. This demands close attention from the policy makers, healthcare community and researchers. From the data, it can be concluded that even though we cannot change our genetic make-up, we alter our eating habits, the levels of physical activity, and lifestyle, as well as other environmental factors. There is need to learn how to select foods that are low in fat, lean to recognise and control environmental factors that can make a person want to eat when not hungry, engaging in moderate and high intensity regular physical exercises, health education, dieting changes, as well as seeking treatments through bariatric surgery. However, surgery is only recommended if all other. Reference List Ackard, D. M., Neumark-Sztainer, D., Story, M., & Perry, C. 2003. “Overeating among adolescents: Prevalence and associations with weight-related characteristics and psychological health”. Pediatrics, 111(2): 67-74. Adams, K.,F, Schatzkin, A, Harris T., B, et al. 2006. Overweight, obesity, and mortality in a large prospective cohort of persons 50 to 71 years old. N Engl J Med. 24;355(8):763–778. 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