Evaluating Childhood Obesity in the London Borough of Westminster - Essay Example

Evaluating Childhood Obesity in the London Borough of Westminster Introduction Obesity prevalence has been found to be lower among white, mixed Asian/white, and Chinese children, and high among Caribbean, African and other black children in London. This high level of obesity among African, black Caribbean children is associated with higher deprivation levels (Greater London Authority, 2011). This partly explains the high level of obesity in Westminster. It is a region composed of all these ethnic groups. Whites are the majority (69.5%), followed by Asian or Asian British (12.8%), then Black or Black British (7.2%), Chinese or other ethnic groups at 6.6% and Mixed at 4.0% (Findlay, Yeowart & Kail, 2012). Although the borough is the third most prosperous, it has specific parts that are most affected by poverty and deprivation. High deprivation levels have been associated with high levels of obesity, and in Westminster, there is severe deprivation in the south and North West. The lower layer super output areas, which are about 14% of its neighbourhoods, are in the top 10% most deprived. Half of the population ho are classified as deprived come from Churchill, estbourne, Harrow Road, Queen’s Park, and Church Street. 24% of the children in Westminster live in severe poverty. This is due to various social and economic inequalities (Findlay, Yeowart & Kail, 2012). Westminster has the highest levels of obesity compared to all other boroughs with a level of 39.4%. This paper is an evaluation of childhood obesity in Westminster. It has described the determinants of childhood obesity in an urban setting which reflects the determinants in Westminster, the consequences of the condition, and strategies and interventions of management. Information obtained for the strategies and intervention in relation to determinants’ section informs the conclusion and recommendation. Why Childhood Obesity is an urban Health Issue In 2006, the level of obesity in Westminster was already high. A third of the children were obese or overweight. 39 out of 40 primary schools in Westminster were assessed to find out the level of obesity among five-six year olds, and nine-ten year olds. Results showed that 18% of these children were obese; 32% were either overweight or obese, and 14% were overweight. The level of obesity was highest among children of six years, and that obesity level was still going up. Because of such findings schools initiated programs that were to ensure reduced obesity levels. These were; healthy eating and physical activity programs (GP News, 2006). In 2011, the obesity rates had gone up, with the boys being at a higher risk. Westminster had a rate of 28.6%; the highest among other boroughs. Newham had 25.9%, Hackney 25.5%, Richmond has 12.1%, Tower Hamlets 25.7%, Bromley 17.2%, Southwark (26%) and Kingston 16.7% among children of 10-11 years (BBC, 2011). In 2013, the obesity levels were even higher. According to Bradbury (2013), obesity levels were at 39.8% among children of ages 10-11 in Brent, and 39.4% in Westminster and Hounslow. In Ealing, the rates dropped by 4.1%, making the obesity levels reach 37.9%. The trend as shown by these few findings from 2006 show that, cases of obesity and overweight among children in England has been rising. This is irrespective of prevention and management steps such as physical activity programs, promotion of healthy eating habits, among others. The only areas that have seen a reduction in obesity levels are; Fulham, Chelsea, Hammersmith, and Kensington. Obesity has been blamed on a variety of issues; some studies have associated obesity to an individual’s genetic make-up, some have associated it to poor eating habits, while others have shown that it is as a result of people’s lifestyles, lack of activity, and deprivation among children (Bradbury, 2013). It is indicated in Greater London Authority’s report that genetics, family factors, economic factors, lack of physical activity, nutrition, and the living environment. The genetics of an individual play a major role, but the parents’ inability to guide the child in maintaining a healthy weight contributes to a child being obese. Parents should ensure that; a child’s eating habits are appropriate, the child exercises, there are appropriate family eating patterns, and low level of stress. Determinants of Childhood Obesity In An Urban Set Up Obesity is usually as a result of the interaction between one’s genetic predisposition and environmental factors. These environmental factors are the determinants of obesity. Childrens diet plays an important role in maintaining balanced energy storage in the body. Children in the urban areas are exposed to aggressive advertising practices that show energy-dense foods. Since most of these children have easy access to such foods and have the funds to buy such foods because of their low cost; they can easily become obese. This explains why children in the urban settings are obese. Most of them are exposed to fast foods with high energy content which are readily available in fast food shops and school cafeterias (Kinra, Nelder & Lewendon, 2000). Another determinant is physical activity. It helps burn excess fat hence maintains a balance between energy intake and output. High prevalence rates of obesity in urban areas could also be explained by lack of physical exercise among the children. It was established that, in the current generation, children take a lot of their time playing games in computers, watching television, and playing indoor games. There is little physical activity that they engage in. Additionally, physical activity in schools has reduced, and more emphasis placed on academic performance. This increases the chances of children getting obesity (Kinra, Nelder & Lewendon, 2000). Consequences of Childhood Obesity There are a variety of consequences of obesity. Some of the most commonly found among literature sources are; high blood pressure, sleep apnea, breathing problems, high cholesterol, and asthma. Daniels (2006) indicates that obese children are at increased risk of insulin resistance, impaired glucose, and type II diabetes. Obese children may also have musculoskeletal discomfort, and joint problems. Hofbauer, Keller and Boss (2004) have classified these problems into six categories; physical symptoms, social problems, metabolic problems, endocrine problems, anaesthetic problems, and psychological problems (Hofbauer, Keller & Boss, 2004). These problems have been found in obese adults, but studies have shown that even children suffer similar complications brought by obesity. According to Daniels, (2006), health conditions related to obesity that were thought to affect adults only are nowadays seen with increasing frequency among children. Childhood obesity intensifies the damages to body organs. Obesity destroys the cardiovascular system, and at childhood it increases the risk of heart disease development in an individual. Because of such effects on the body organs, it is even feared that obesity may reduce people’s life expectancy of the general population if its rates continue to increase among the children (Daniels, 2006). Kelsey, Zaepfel, Bjornstad and Nadeau (2014) also indicated that the health conditions increase as obesity rates increase among children. Strategies and Interventions of Preventing and Treating Obesity Due to increasing prevalence rates of obesity among children, the government came up with various interventions. These were developed considering the determinants of obesity, and the diverse ethnic, social, and economic backgrounds of the children. There was also a need for multidisciplinary intervention because of the complexity of the consequences of obesity. The main problem in obesity is an imbalance in energy consumption and expenditure. Interventions, therefore, focused on ways in which this balance could be maintained. The interventions were; increased physical activity, and improved diet. Improved diet limits energy intake, while increased physical exercise helps in burning excess fat, although there are other associated health benefits (Proietto & Baur, 2004). Practices that lead to obesity as indicated earlier are such as diet, lack of physical exercise and hereditary factors mainly. These factors are both from the school environment and home. Because of this, it was essential to develop interventions that were school-based and family based. Parental participation is very important in ensuring the children adhere to recommended exercise activities and diet regulations. In order to achieve its goals on reducing obesity levels among children, the English government began by a social marketing campaign. This involved leisure and the food industry through a multi-agency strategy. The government interventions specified groups according to ages, for example, one intervention focused on children aged 2- 10 years. The government also developed weight-loss guidelines, and obesity management care pathways, for health and education professionals (Milligan, 2008). The government also developed an obesity toolkit with information for developing local strategies for prevention and management. The national strategies had priorities such as consideration of multidisciplinary team working, which partners and stakeholders involved in the fight against obesity were to follow. The toolkit was a resource with information and tools that should be used to develop obesity strategies reflecting local needs. The government also initiated social change programmes. One of such programs was social marketing. Another area of focus was advertising campaigns that promoted eating fast foods. The government intervened by introducing legislation that regulated the food industry’s influence on children. This was in 2003, and it was expected to help shape the children’s eating behaviour (Milligan, 2008). In Spear and others’ report, it was established that obesity management clinics used motivation techniques on their patients and families, encouraged healthy behaviours, and had office systems that supported care and monitoring of obese children. The providers implemented a staged approach to management of obesity that adapted to the family and the individual child (2007). Spear and colleagues (2007) proposed a four-staged treatment programme based on evidence from reviews. The four stages are; "the prevention plus, structured weight management, comprehensive, multidisciplinary intervention, and tertiary care intervention" (Spear, 2007, p. 270). This four staged treatment was proposed after a review of already available interventions which were also classified into four: Dietary interventions, physical activity, control of television viewing and media usage, behavioural approaches, and other interventions. The review came to the conclusion that childhood obesity effective treatments should include both physical activity and dietary interventions. It is, however, not enough to just provide education about the required changes. Dietary and physical activities interventions have certain recommendations about certain changes that should be made in order to treat obesity. These have been found to be well facilitated by behavioural therapy techniques such as monitoring, environmental control, contingency management, and goal setting. There are other interventions such as the use of approved medications by relevant authorities. There is the use of sibutramine, an appetite suppressant, and weight loss medications. Weight loss medications have been associated with dangerous side effects and have since been withdrawn from the market. Sibutramine use is only associated with vasoconstriction. This side effect limits the use of this drug (Spear et al., 2007). Spear and colleagues (2007) analysed childhood obesity interventions and proposed that the following approach would be the best in management. Prevention Plus This stage focuses on ensuring adherence to certain prescribed levels of food intake, screen time, and physical activity in order to prevent obesity. It is recommended for children with normal range BMI percentile. This stage is expected to develop a good eating habit, enough exercise and minimal screen time culture, which may go up to adulthood and eliminate the chances of a child getting to be obese. Structured Weight Management This is the second stage and is similar to the first stage except for the additional structure and support. These structures and support are additional trainings in behavioural counselling that will help the care providers achieve health eating behaviours among the children. There are more monitoring activities, more structure, and closer follow-up monitoring. Comprehensive Multidisciplinary Intervention This stage also makes use of the dietary and physical exercise interventions, but justifies the need for multidisciplinary treatment and behavioural therapy. Reference can be made for a child to be monitored under stage three because of its additional structured weight management. This stage is different from the previous two because of its greater frequency of patient-provider contact, behavioural change strategies, and the specialists involved in the treatment. It has to be established that a child formally needs multidisciplinary treatment and behavioural therapy before referral to this stage of management. This need has to exceed the need of other primary care offered in previous stages (Spear et al., 2007). Tertiary Care Intervention This stage is developed for special cases of severity where life style interventions have not been successful, and the children have not been able to improve their degree of morbidity and adiposity risks. Children only qualify for this stage if that have passed through stage three. The child’s admission is also determined by level of maturity to understand the requirements of stage four; that is, willingness to follow prescribed diet and physical activity requirements, and participation in, behaviour monitoring program. Passing through stage three does not qualify a child to be admitted in stage four (Spear et al., 2007). Conclusion Childhood obesity has increased over time irrespective of interventions thought to be appropriate. Childhood obesity has a variety of health problems which make it a serious national problem. The increased level of obesity in urban cities has labelled it an epidemic in such areas. Westminster, like other urban areas, has obese children who get obese due to poor eating habits, lack of physical activity, and too much time spent on the television screens. These determinants are the main factors that have informed intervention strategies. There are other factors that developers of intervention programs have considered. There is consideration of multi-agency collaboration, behavioural change, the families, the schools and the community involvement. One study that reviewed childhood obesity interventions proposed a four staged approach management that may be successful. Recommendations As early as 2003 there were intervention programs already developed by the English government to deal with childhood obesity. The trend, however, shows that these interventions have been ineffective. This research was not focused on finding out the effectiveness of the interventions, but the discussion has shown that there are common practices in childhood obesity management. These are; making use of dietary interventions, physical activity, and incorporation of behavioural programs. The English government also went further and developed an obesity toolkit with information and strategies for programs’ implementation. These common practices have not been effective in reducing what is now considered an epidemic. In the above discussion, there is an approach developed from already available interventions. This approach allows the incorporation of any available intervention to help control obesity. It is based on a four-stage prevention and management theory which assumes that control has to identify various stages of the disease. There are children who have not developed the condition, but are likely to develop it because of certain behaviours and practices. Based on this information, the approach proposed a prevention plus stage of management. This stage identifies children within the 4-85 BMI percentile and recommends specific eating habits, physical activity, and screen time. The approach also recognizes that there are those who will need support in order to adhere with the requirements specified in stage one. It comes up with stage two which provides the necessary structures and support. It also recognises the severity of the condition and the need for special support in such cases. Stage three is developed to manage such conditions. The last stage also has its conditions which have to be fulfilled, and this depends on the disease severity, just like in stage three. The only difference is in the patient’s willingness to try the intervention, and the inability of the obese children to change their morbidity and adiposity risks. Based on its incorporation of all intervention strategies, and allowance to incorporate more, and its stage by stage management of the condition, this approach could be the best for management of childhood obesity in Westminster. Westminster is an urban area that predisposes children to poor eating habits, lack of exercises due to the easily accessible indoor games, and too much time spent on the screen. References BBC News, 14 April 2011, Childhood obesity could cost London £111m a year. BBC News London. Retrieved from: http://www.bbc.com/news/uk-england-london-13078956 Bradbury, P., 2013, Child Obesity In North-West London Among Worst In England. Retrieved from: http://www.getwestlondon.co.uk/news/local-news/child-obesity-north-west-london-among-6410377 Daniels, S. R., 2006, The Consequences Of Childhood Overweight And Obesity, Future Child, 16(1): 47-67. Findlay, R., Yeowart, C. and Kail, A., 2012, Understanding Social Needs In Westminster. Retrieved from: https://www.thinknpc.org/publications/understanding-social-needs-in-westminster/report-for-grosvenor-and-the-westminster-foundation/?post-parent=6650 GP News, 21 December 2006, Westminster Child Obesity Second Highest In London. Retrieved from: http://www.gponline.com/westminster-child-obesity-second-highest-london/article/931748 Greater London Authority, 2011, Tipping the scales: Childhood obesity in London. Retrieved from: http://dera.ioe.ac.uk/9999/1/HPS%20Childhood%20Obesity%20report%20FINAL.pdf Hofbauer, K. G., Keller, U. and Boss, O., 2004, Pharmacotherapy of Obesity: Options and Alternatives, Boston, MA: CRC Press. Kelsey, M. M., Zaepfel, A., Bjornstad, P. and Nadeau, K. J., 2014, Age-Related Consequences Of Childhood Obesity, Gerontology, 60(3):222-228. Kinra, S., Nelder, R. P., Lewendon, G. J., 2000, Deprivation and childhood obesity: a cross Sectional Study of 20 973 Children in Plymouth, United Kingdom, Journal of Epidemiology and Community Health, 54:456-460. Milligan, F. (14 August 2008) Child obesity 2: Recommended Strategies And Interventions. Nursing Times, 104: 33, 24-25. Proietto, J. and Baur, L. A., 2004, Management of obesity, Medical Journal of Australia, 180 (9): 474-480. Spear, B. A., Barlow, S.E., Ervin, C., Ludwig, D. S., Saelens, B. E., Schetzina, K. E. and Taveras, E. M., 2007, Recommendations for Treatment of Child and Adolescent Overweight and Obesity, Paediatrics, 120(4): 120-254. Read More