Childhood Obesity: The Assumption that an Obesogenic Environment - Essay Example

Childhood Obesity Summary The general assumption, that an obesogenic environment is inevitable, is flawed. Identifying that we are aware of what thisassumption means and providing evidence that we are actually able to take charge of our evolution and not resigned to accepting an obese fate. Overeating and sedentary lifestyle, two major contributory factors in childhood obesity, can be countered at an early stage with better food and more physical activities in schools. Introduction According to the World Heart Federation (2007) the dramatic worldwide surge in childhood obesity may be the cause of a change in disease trends: diseases previously associated with adulthood are now becoming commonplace in childhood. Obesity as a consequence of reduced physical activities is becoming more and more frequent in the modern world and is increasing at an especially alarming rate in children. Globally 155 million children with ages ranging from 5-17 years are overweight. Lobstein et al. (2004) claimed that of these 155 million children approximately 30-45 million are obese (cited in World Heart Federation 2007). According to our own National Health Service (NHS, England , January 2008) statistics on obesity, physical activity and diet, 16% of children aged from 2-15 are classified as obese. In the under five year old group the figures for 2007 show that there were approximately 22 million overweight children and that roughly 75% of those live in the low-middle income bracket (WHO, 2008). We are creating an increasingly obesogenic environment where this rising trend in obesity may be associated with the increase in: Fast food chains and pre-cooked meals which allow easy consumption of food depleted of nutrients and composed mainly of saturated fat (Lediwke et al., 2005; Hawkes, 2006). Technologies and affordability of televisions, computers, etc. Fox (2004) suggested that the time spent being physically inactive by playing video-games, watching television and using computers has increased. Transportation has increased allowing little expenditure of calorie intake due to fewer or reduced physical activities (St-Onge et al., 2003). Children are driven to school or use public transport rather than walk as parents are worried by the apparent lack of safety in the communities in which they live (Fox, 2004). In a cross sectional study by Voss et al. (2005), within a cohort of 277 families in Britain 75% of parents with overweight children did not realise that their children were overweight; 33% of mothers and 57% of fathers thought that their children were at the correct weight when they were, in fact, obese. The current school curriculum allows for a minimum of two hours of physical activity per week. 86% of schools in Britain achieve this level (School Sport Survey 2006/07) but the high level of obesity in 5 to 11 year olds indicates that this amount of physical activity is insufficient. Clearly schools are not setting adequate activity levels. Kalinowski (1985) (cited in Kirk 2005) states that the early years of childhood set the basis for children to gain expertise in order to achieve some level of skill that can be carried forward and used in later years. Côté et al., (2002; cited in Kirk 2005) suggested that in these early formative years children should be encouraged to play games that involve physical exertion and a wide variety of activities that they enjoy in order to progress them on to the next level. Time is a restricting factor in the quality of Physical Education in primary schools considering the significant amount of time that is spent changing into and out of kit before and after the lesson (Carrel et al., 2005). Teaching staff in primary schools are not properly trained for physical education activities, but are proficient general studies teachers. They may teach the fundamentals of sport, such as rules and skills, but have no expertise in prescribing programmes in order to get maximum results from the exercise sessions with the children (Ofsted, 1998). Côté et al., 2003, (cited in Kirk 2005) suggest that specialist teachers of PE should be employed to work with children in KS2 classes (Key stage 2: ages 7-11; Years 3-6) and KS3 (Key stage 3: ages 11-14; Years 7-9) as these are formative years. A study carried out by Veugelers et al. (2005) concluded that children whose parents had attained higher education and whose annual income was over a certain threshold were at a decreased risk of being overweight, as were children who lived in affluent neighbourhoods. Furthermore it was recommended that more physical education classes should be included, healthy lunches should be promoted at schools and family suppers should be eaten at home. Veugelers et al. (2005) also suggest that low-income neighbourhoods should be the first areas to be targeted by public health organisations, as the likelihood of obesity in children who lived in high-income neighbourhoods was halved. These studies would appear to confirm that there is a socio-economic connection between obesity and parental income. Aetiology The World Health Organization (WHO, 2000) described obesity as a condition in which excess body fat has accumulated to a point where health is adversely affected. As defined by the National Institute of Health, it is a body mass index of >30 (WHO, 2000; ACSM, 2006). [Body mass index (BMI) is weight in kg divided by height in meters squared.] This is caused when energy (calories) taken in is more than the energy output by the body, resulting in a positive energy balance (Shamley, 2005). Poor diet, lack of exercise or lack of activities, in general, accelerate the process of becoming obese (Willmore et al., 2004). Obesity is one of the leading and most preventable causes of death worldwide (Mokdad et al., 2004; Barness et al., 2007). Obesity increases the risk of a number of serious medical conditions such as cardiovascular disease, some cancers, respiratory problems, non insulin dependent diabetes mellitus (Type II DM), and joint and back problems (Haslam et al., 2005; Shamley, 2005). Studies such as Saad et al., (1991); Nakamura et al., (1994); Anderson et al., (2001) and Nesto, (2003) have identified central obesity and insulin resistance as the root for metabolic syndrome. Metabolic syndrome is a group of signs/symptoms that indicates an increased risk of coronary heart disease, Type II DM, stroke, and atherosclerosis and has been associated with other co-morbidities such as the pro-thrombotic state, pro-inflammatory state, non-alcoholic fatty liver disease, and reproductive disorders. These risk factors are said to reflect over-nutrition, sedentary lifestyles and central adiposity (Cornier et al., 2008). According to the World Heart Federation (2007), obesity in childhood can lead to premature metabolic syndrome. The Chief Medical Officer (Health - Third Report, 2004) reported that obesity is “a health time bomb” that needs defusing. Poirier et al. (2006) found that obesity is a combined result of genetic and environmental factors. Polymorphic genes which control appetite and metabolism predispose to obesity when there is an excess in energy intake (Poirier et al., 2006). Adams et al. (2000) evaluated the commonly expressed myth that some obese people eat little yet gain weight due to a slow metabolism. They say that on average, obese people actually have greater energy expenditure than thin people as it takes more energy to maintain an increased body mass. Shamley (2005) also supports the view that genes act as predisposing rather than causative factor for weight gain showing significant genetic influence on body weight; 25-40% of variance in the energy intake and physical activity influence ‘weight gene’ expression. Pi- Sunyer (1988) (cited in Mcardle, Katch and Katch, 1991) argues that ‘this view of obesity is overly simplistic as available evidence indicates that excess weight gain throughout life often closely parallels reduced physical activity rather than an increased calorific intake’. Although in some cases there may be other reasons, such as genetic factors or a hormonal problem, the overwhelming majority of obese people do not suffer from such disorders (British Medical Association 1995). Management of Obesity Dieting and physical exercise are the main treatment for obesity (Strychar, 2006). According to the American College of Sport Medicine (ACSM’s, 2003) physical activity is one of the most important aspects in maintaining weight loss. Physical activities require activation of muscle power, which consumes energy derived from both fat and glycogen (Strychar, 2006). During exercise, especially when large muscle groups are engaged, there is a greater use of fat as fuel (Strychar, 2006). Shaw et al. (2006) found that exercising alone was not enough to maintain weight loss but that exercise in combination with diet gave a more positive outcome than dieting alone. Bessesen (2008) found that high levels of physical activity were necessary for effective and maintained weight loss. Discussion A systematic review by Strong et al. (2005) of 850 journal articles on the effects of physical activity (PA) on the health, behaviour and the development of adolescents claimed that more than 30-45 minutes of moderate to vigorous PA 3-5 days per week was necessary to attain positive effects on health and behaviour in ordinary daily life. It was concluded that school age children should engage in at least 60 minutes of a variety of PA that is enjoyable a day. The rise in childhood obesity has been the subject of numerous recent studies. A study by Rudolf et al. (2004) suggested that today’s children require waistline clothes two sizes larger than twenty years ago. A Lazaar et al. (2007) study based on physical activity alone used obese and non-obese subjects as samples and found, in the boys who were both obese and non-obese, that there was no significant change in BMI. The only effect was on girls in the obese group. However, in a Gortmaker et al. (1999) study the BMI was decreased in both the control and intervention groups of boys. Mo-Suwan et al. (1998) studied cardiovascular exercise and the effects on BMI, triceps skin fold and waist hip circumference and Lazaar et al. (2007) used the same measures to calculate the outcomes. Neither study showed any significant reduction in BMI of the samples. Sallis et al. (1997), Carrel et al. (2005), Mo-Suwan et al. (1998), Young et al. (2006) all reported an increase in cardiovascular fitness in the intervention groups. The amount of physical education time spent in moderate to vigorous activity was higher in the intervention group than that of the controls by almost 20% in the Rohm Young study but this did not improve BMI. Mo-Suwan et al. (1998) used a younger cohort (4.5 years old) in their study which appeared to concentrate on cardiovascular fitness rather than BMI. They limited the exercise to aerobic dance, walking and, in one school where there was a pool, swimming. The duration of the trial was limited as was the lack of recorded intensity of exercise. Studies by Sahota et al. (2001), Kelder et al. (2003), Gortmaker et al. (1999) and Hurtih-Ennlof et al. (2007) offered greater involvement in the children’s lives both in and out of school. This included reducing television viewing, educating families, teachers and children on diets, health risks and physical activity. Overall, by targeting the children from such a young age school-based physical activity would become an accepted regime and would encourage adherence to exercise. Thus scientific studies and common sense show us that families need to be involved if changes are to be made to halt the increase in childhood obesity. Parents have a greater responsibility in controlling obesity. They can monitor what children eat, drink, watch and do. Families need to be made aware of what they eat and to understand that fresh foods are cheaper to buy and cook than the fast foods which so many people are consuming on a daily basis. Children of nursery age should be encouraged to be active as this is the beginning of the school period which takes them through to adulthood and sets the pattern of physical activity for later in life. Families also need to become more active as a unit so that children can learn from a young age that physical activity is the norm and a pleasurable experience to be enjoyed throughout a lifetime and not simply something that has to be done only at school. Governments need to make sporting activities outside the school environment more accessible to all children, not just the privileged. Kirk et al. (2005) and Kay (2000) stated that a child’s participation in sport outside of school is largely dependent on social status and class. Affluent families can afford to buy equipment, pay fees and buy relevant kit. There are many families living on low incomes or who have more than one child and the cost of participating in outside sporting activities can be prohibitively expensive. Adolescents tend to decrease their levels of physical activity so reasonably priced and age-appropriate activities should be made available. Children need to have safe, supervised clubs or venues where they can go to play games and sports. Physical education should be taught by fully trained teachers. Physical education lessons need to be of longer duration, so that children are getting at least an hour of moderate-vigorous activity per session at least three times a week. Focus should be placed on activities that increase cardiovascular fitness and resistance training for bone loading. Girls, in particular, should be motivated as they appear to spend more time inactive than boys. Importance should be placed on cardio respiratory fitness and bone loading to help prevent orthopaedic problems rather than focussing on BMI to ensure the health of the future adults. Further research is necessary to test the theory that ensuring cardiovascular fitness in children is the best way of managing children’s health in school. Conclusion The assumption that an obesogenic environment is inevitable is ‘nonsense’. This would suggest that the human race is unable to change course and is merely functioning as a passive spectator in its own demise. Having identified the two major factors (overeating and sedentary lifestyle) of our increasingly obesogenic environment, we now need to find solutions. Although there may be barriers in fully understanding the aetiology of obesity, it is clear that overeating and sedentary lifestyle contribute to the condition. While the medical professions try to find solutions to the condition as pathologically diagnosed, we, health promoters, should contribute to the prevention stage by promoting healthier lifestyles. Therefore it is urgently important to design effective strategies and recommendations to prevent and to eradicate this condition: Individuals are responsible for their own well-being. Early education can reduce the trend towards obesity. This education should be part of the school curriculum so that children have an understanding of the reasons why it is important to integrate fruit and vegetable in the daily diet. By investing more in embedding the importance of choosing a healthy lifestyle in children at an impressionable age it should be possible to eradicate obesity. Physical activities, such as sports or general/pleasure activities (walking, cycling, gardening, swimming, playing games, outdoors activities) should be part of the educational curriculum, for at least three days a week. The reviewed literature has also demonstrated that social class and ethnicity are contributing factors in determining choices in relation to physical activities and the consumption of food. More needs to be done not only within communities, but at government level to focus policies and strategies to resolve the socio-economic gap between the middle and lower-classes and provide necessary funding for those individuals in need to be able to fulfil a healthy lifestyle. Proper venues and resources are needed in deprived areas. It is fair to say with the growing ‘Olympic 2012’ euphoria our society is enjoying a more active lifestyle. There are increasing groups and initiatives appearing (Be active, be healthy; Change4life; Active children) with a common message that can be summarised as ‘a healthy lifestyle is not a choice but the choice, for a better lifestyle’. The government’s legacy action plan for 2 million more adults to be active by 2012 will fail if retention is not thoroughly thought out and planned. What will happen after 2012? Will there by a fitness legacy for London or other English cities. Legacy is by definition a lasting factor. Is the government really designing a truly lasting legacy? If it is then why is tackling obesity not a main priority? If we are to tackle obesity it is necessary to look again at the governments ambiguous strategies. In this report one of the main factors to obesity has been identified as the increase in availability of processed and fast food. Why does the Food Standards Agency continue to allow the opening of fast food restaurants in close proximity to schools? Why do our children want this food? What is wrong with school meals? In my experience as a student I would say that the food is too expensive in educational institutions, with poor choice and variety. Why are we waiting for a magic solution when the government itself is in a way a facilitator and promoter of the obesity problem? We want to see the closure of restaurants which provide cheap and nutritionally empty food in the proximity of any type of educational institution. We want to see food served in educational institutions reasonably priced, nutritionally beneficial and appetising to the age group. Whilst we recognise that popular media (e.g. Jamie Oliver’s real food campaign) has, in a small way, attempted to address this issue, more and assertive action is required on a nation-wide scale. I hope that by reading this report, more writers and researchers will be encouraged to examine the obesogenic environment in order to highlight solutions for the eradication of obesity. Whilst cluster research supports the need for action, I want to see immediate action in relation to these recommendations. I believe that only in this way can we reverse the trend towards obesity which is epidemic in our society. Although these measures may appear drastic to some, it is only by taking these steps that we can win the battle with obesity and build new generations of healthier individuals and a healthier, fitter society. Reflection “I strongly believe that our society is becoming increasingly overweight and unfit as a result of a combination of factors: an overabundance of unhealthy food and a lack of physical activity. The government has helped to create a multi-tier society where poor people are denied access to reasonable sporting facilities which the wealthier members of society can afford. This social divide is reflected in eating habits: poorer people often eat cheap, readily available, low-nutrient convenience and fast foods whilst the better-off can afford to eat whole foods. An ironic situation when you consider that 60 -70 years ago the poor ate healthier simple foods and the rich were the only ones who could afford fancy nutrient-stripped processed foods. Modern society is also becoming cocooned in technology - computers, televisions, high-tech gadgets and games - which discourage physical activity. Modern working patterns mean that people work longer hours in largely sedentary jobs and commute to and from home by car, bus or train. Schools have sold off their playing fields and physical education has become marginalised within the curriculum”. [Word count: 2,925 - not including: title, subheadings, reference list and references cited within the text.] References 1. Adams JP, Murphy PG (2000). ‘Obesity in anaesthesia and intensive care’. Br J Anaesth 85 (1): 91–108. [Accessed on 20/02/09] 2. American College of Sports Medicine (ACSM’s). (2003) ‘Exercise Management for Persons with Chronic Diseases and Disabilities’. (2nd Ed). Human Kinetics. Durstine, JL, Moore, GE. United States. 3. American College for Sport Medicine (ACSM’s). (2006).‘Resource Manual for Guidelines for Exercise Testing and Prescription’. (5th Ed.). Lippincott Williams & Wilkins. Philadelphia. 4. Anderson PJ, Critchley JAJH, Chan JCN et al. 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