Health Consequences of Obesity in Children and Adolescents - Essay Example

Global changes in diet and activity patterns are fueling the obesity epidemic, as obesity is reaching pandemic proportions throughout the world (World Health Organization (WHO), 1998). As the availability of fast, inexpensive, energy-dense foods grow and physical activity declines, obesity rates across all ethnic and age groups is projected to increase. Within England the rate of obesity has almost tripled in the last two decades and the statistics indicate that almost 20% of adults are classified as obese (National Audit Office, 2001a; Erens et al., 2001). The statistics with regards to obesity in children and adolescents are almost as profound as those for adult. In fact, the prevalence of obesity among children and adolescents has been rising at an astounding rate, nearly doubling over the past three decades, and has reached epidemic proportions. As of 2002, a reported 31.5% of youth were at risk for overweight and 16.5% could be classified as overweight (Medley, Ogden, Johnson, Carroll, Curtin, & Flegal, 2004). The negative health consequences of obesity in children and adolescents are indisputable. When compared to children of normal weight, those who are obese are twice as likely to develop cardiovascular disease or hypertension and are three times as likely as their non-obese peers to develop diabetes as adults (Mossberg, 1989). Obese children also are at increased risk for dyslipidemia, both increased low-density lipoprotein levels and decreased high-density lipoprotein levels (Leung & Robson, 1990). Longitudinal data from the Bogolusa Heart Study indicates a significant risk for developing type 2 diabetes for obese adolescents (Srinivasan, Bao, Wattigney, & Berenson, 1996). Among those who were obese as adolescents, 2.4% had developed type 2 diabetes by the age of 30 compared to none in the non-obese population. The detrimental health effects of obesity are pervasive and enduring. Strauss (1999) reported that being an obese adolescent predicted early mortality even more consistently than obesity in adulthood. The complications related to obesity in youths are not limited to physical health. Obesity in adolescents also has been associated with fewer years of education, higher poverty, lower marriage rates and lower family income (Dietz, 1997; Maffeis & Tato, 2001). However, evidence for an association between overweight and obesity and low self-esteem are inconsistent. Some studies have found no significant relationship (e.g., Gortmaker, 1993; Renman, Engstrom, Silfverdal, & Aman, 1999), while others find that those children and adolescents who are obese exhibit significantly lower self-esteem than their peers (French, Story, & Perry, 1995). Israel and Ivanova (2002) posit that severity of obesity is related to self-esteem with those more severely obese experiencing the most damage to their self-esteem. This hypothesis has been validated in the findings among clinical populations where self-esteem has been significantly related to obesity status (Rumpel & Harris, 1994). The most consistently replicated psychosocial outcomes for obesity relate to negative body image (Israel & Ivanvova, 2002). In addition, clinically significant problems with memory functioning and learning abilities have been found among overweight children (Rhodes et al., 1995). These deficits are seemingly the result of sleep apnea, which has been reported at rates as high as 94% among samples of obese children (Brenner, Kelly, Wenger, Brich, & Morrow, 2001). As overweight and obesity among youths became a significant concern in the 1960s and 1970s, the development and evaluation of treatments became a popular area of inquiry (for examples of early clinical trials of obesity treatments for children, see Aragona, Cassady, & Drabman, 1975; Christakis, Sajecki, Hillman et al., 1966). As treatment options developed, qualitative reviews of the literature emerged that identified common themes that seemed to be efficacious in treatments including behavioral interventions (e.g., Epstein & Wing, 1987), diet programs (e.g., Ryttig, et al., 1989), exercise components (e.g., Sasaki, Shinko, Tanaka et al., 1989) and school based interventions (e.g., Lansky & Brownell, 1982). However, consensus on the effect size of these treatments remained obscure (Dietz, 1983; Spence, 1986). Theoretical Framework In order to examine obesity in children, it is prudent to that we examine a theoretical framework on which we can build a practical examination. The Social Cognitive Theory (SCT) evolved from research on the Social Learning Theory (SLT) which asserts that people learn not only from their experiences, but by observing their actions and benefits of those actions. SCT is a behavioral prediction theory that represents a clinical approach to health behavior change (Rimer & Glanz, 2005). This theory has been widely applied to health behavior with respect to prevention, health promotion, and modification of unhealthy lifestyles for many different risk behaviors. According to SCT, an individual’s behavior is uniquely determined by each of these three factors (Redding et al., 2000). The interaction between the person and behavior involves the influences of a person’s thoughts and actions. The interaction between the person and the environment involves human beliefs and cognitive competencies that are developed and modified by social influences and structures within the environment. The third interaction, between the environment and behavior, involves a person’s behavior determining the aspects of his or her environment and, in turn, their behavior is modified by that environment. The theory identifies human behavior as a triadic reciprocity interaction of personal factors, behavior, and the environment (Bandura, 1986). According to SCT, three main factors affect the likelihood that a person will change a health behavior: (1) self-efficacy, (2) goals, and (3) outcome expectations. If individuals have a sense of personal agency or self-efficacy, they can change a behavior even when faced with obstacles. If they do not feel that they can exercise control over their health behavior, they are not motivated to act, or to persist through challenges. As a person adopts new behaviors, this causes changes in both the environment and in the person (Rimer & Glanz, 2005). The usefulness of the theory in public health is that SCT has been used successfully as the underlying theory for behavior change to study a wide range of health problems; from dietary change to medical theory compliance, alcohol abuse, immunizations, and pain control. A number of SCT techniques such as modeling, skill training, self-monitoring, and contracting currently are used in interventions (Rimer & Glanz, 2005; Brown, 1999). SCT also is helpful for understanding and predicting both individual and group behavior and identifying methods in which behavior can be modified or changed (Bandura, 1986). The main limitations of the theory are that its comprehensiveness and complexity make it difficult to operationalize; and many applications of the SCT focus on one or two constructs, such as self-efficacy, while ignoring the others (Rimer & Glanz, 2005; Brown, 1999). Conceptual Framework SCT integrates concepts and processes from cognitive, behaviorist, and emotional models of behavior change; so it includes many constructs (Bandura, 1986; Rimer & Glanz, 2005). Bandura considers self-efficacy the most important personal factor in behavior change, and it is a nearly ubiquitous construct in health behavior theories. In addition to the concept of self-efficacy, behavior change also is determined by outcome expectancies. Outcome expectancies are the results an individual anticipates from taking action. Strategies for increasing self-efficacy (e.g., exercising for 10 minutes each day) include behavioral contracting and monitoring, and reinforcement (Rimer & Glanz, 2005). Social cognitive theory also is the most commonly used theoretical framework for developing behavior-based school interventions (IOM, 2005). Because literature has shown that SCT is most widely used in designing interventions to elicit individual behavior change, it would have been appropriate for this study. However, this study is not testing the SCT model. The Beattie Model In attacking the problem of obesity, Beattie (1991) proposed a very practical model for dealing with disease from a preventive point of view through the embodiment of health promotion principles and practices. This model is analytical in nature in that it facilitates an understanding of the different approaches while enabling us to critically evaluate those approaches through an in depth look at governmental response to the problem. The model has two dimensions and consists of four paradigms. Each paradigm delineates the means by which professionals within the particular realm promote health and are identified as the health promotion, personal counseling, legislative action and community development paradigm. Each paradigm embodies its own philosophies, values, belief system and tools for the measurement of outcome. The manner of delivery can be authoritarian and therefore top down or negotiated and bottom up. The tops down approaches are labeled as health persuasion techniques (HPT) and legislation for health (LAH). The bottom up approaches are named personal counseling for health (PCH) and community development for health (CDH). The top down approaches operate with the aim of changing unhealthy behaviors while the bottom up approaches are aiming to increase individual and community empowerment. For the purposes of this paper, the community development and legislative action paradigms will be examined in great detail. First, one of the most prolific examples of the community development paradigm is that of empowerment. Empowerment is operationally defined as a process of enabling individuals to gain control over their health and well-being and in so doing impact overall improvement (WHO, 1986). The notion of empowerment within the community paradigm is one that can be traced by to the late 1970 and is concerned the refocusing the distribution of power in such a manner as it is taken from the governmental bodies and reallocated on the individual and community level. Essentially, empowerment serves the primary health promotion activity (Tones & Tilford, 1994). Empowerment both in theory and practice is one which relates to the active participation of many individuals within a multidisciplinary approach and at varying levels of the process. Active participation within the scope of empowerment entails a bottom up approach whereby the activity [in this case, combating obesity] is undertaken on an individual basis and is initiated by the individuals impacted by the problem rather than individuals who operate on their behalf (Beattie, 1991). The end result of empowerment is that it should impact some fundamental change in the value system of an individual or community which facilitate equity and sustainability (WHO, 1997). One of the most central components of empowerment is education. Education has been portrayed as playing a vital role in the process of empowerment and as such is fundamental to health promotion. Empowerment was viewed as one of the most viable solutions to a wide array of health problems and embodied the notion that individuals are encouraged to take an active role in educating themselves with regards to the etiology of organic disorders. In so doing, they are able to actively implore the government to provide support on the community level to address the inherent disparities and inequality in the rendering of health services to the marginalized. WHO place emphasis on this by embodying the notion that health development within any given community begins and end with the residents of that community. Essentially, the developments should be made for the people in their respective communities by those very same people. Framed within this context, it is necessary for the constituents within a community to engage in the process of effective learning. Through effective learning, one is able to engage in a process of self-discovery with the end result being a permanent alteration of behavior. This alteration is necessary on both an individual and community level (Daloz, 1986; Bevis & Watson, 1989). Legislative action, on the other hand, involves the institution of laws, rules and regulations as well as funding initiatives to combat the problem of obesity. In this vein, The House of Commons Health Committee recommended collaboration between the Department of Health, Department of Work and Pensions and Department of Trade and Industry. The scope of this collaboration entailed an ongoing collaborative effort to provide consultation on the measures which can be utilized in order to address the underlying behavioral correlates of obesity which commenced with the organization of a conference aimed at promoting awareness of obesity within the workplace (House of Commons Health Committee, 2004). Another facet of the legislative response and an integral part of the preventative aspect of obesity management is the adoption of an initiative to prevent obesity and its associated chronic diseases undertaken on the part of the Parliament. In a 620 vote in favor of its initiative and 24 votes against and 14 abstentions, the new initiative which maintained that schools serve as the focal point of intervention and prevention of obesity was passed. Under this initiative, the house reiterated the notion that by virtue of the fact that children spend most of their time in school, school should be the first target for behavioral modification and the establishment of healthy eating habits. This initiative involved the allocation of funding to ensure that the school environment was one which proved to be conducive to healthy eating habit, promote regular physical activity and incorporate element of a healthy lifestyle in the nation’s youngest citizens. This effectively and efficiently facilitated the provision of freshly produced meals which were predominantly organic in nature and embodied high nutritional. Much of this was in adherence with the clear and concise guidelines set forth by the Department of Health. Building a Multi-Disciplinary Model As illustrated by the Beattie Model and the interdependent nature of obesity, there is a dire need for a multi-disciplinary approach to health promotion. One way of conceptualizing interdependence among children, their health, and their environment is through ecological models (Glanz, Lewis, & Rimer, 1997; Sallis & Owen, 1996). The need and value of a comprehensive ecological model to prevent childhood obesity with the purpose of identifying significant environmental risk factors has been substantiated in the literature (Berg, 2001; Davison & Birch, 2001; Neumark-Sztainer, 2000). Consistent with the ecological perspective, models that integrate theory and concepts from across disciplines are theorized to generate more comprehensive explanations for behavior and may facilitate more successful interventions to change behavior (Grzywacz & Marks, 2001). Ecological models guide attention to how prevention research can be pursued at the individual, group or community level (Booth et al., 2001; Fisher, Walker, Bostrom, Fischhoff, Haire-Joshu, & Johnson, 2001). Such a model would move beyond intrapersonal factors such as acquisition of knowledge, attitudes, and skills that have been the traditional emphasis of health education programs (McLeroy, Bibeau, Steckler, & Glanz, 1988; Watts, Donahue, Eddy, & Wallace, 2001). The ecological perspective emphasizes multi-factorial causes of childhood obesity and recognizes a need to develop multi-level interventions to combat the epidemic (Neumark-Sztainer, 2000). While a number of ecological models appear to lend support to one another, a clear picture of environmental antecedents cannot emerge until all ecological obesity prevention models are viewed in total (viz., across disciplines concerned with prevention of obesity). By examining multi-disciplinary research, environmental antecedents found to significantly contribute to a prevention model could elucidate leverage points of prevention for childhood obesity. After having examined the etiology of obesity as well as the underlying approaches to dealing with the problem in a proactive manner, it is prudent that we realize that this is a problem that has risen to epidemic proportions over the course of decades. As such, it is one that will take time and arduous effort on the part the individuals affected as well as the community at large to impact a solution. It is prudent that each and every individual take the initiative to encourage healthy eating practices from childhood. These practices will transcend through generations and serve to repair the damage that has been done of the course of decades. Essentially, it will take a collaborative effort and a series of eclectic approaches to combat this problem as its etiology is a complex one. 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WHO (1997) The Health Promoting School: an Investment in Education, Health and Democracy: Conference Report on the First Conference of the European Network of Health Promoting Schools, Thessaloniki, Greece. Copenhagen: WHO Regional Office for Europe. Read More