Childhood Obesity

INTRODUCTION

Communities around the world face an increasing epidemic of childhood obesity. According to many nutritionists, children are considered obese by measuring their body mass index (BMI). BMI is determined by examining a person’s height to weight and also takes into account age, gender, and body build. Children who fall in between the 85th and 95th percentile are considered at risk of being obese and above the 95th percentile are considered obese. Five factors that contribute to childhood obesity are nutrition in schools, cultural differences, fast food, media, and physical fitness. Schools and teachers should take responsibility for educating today's youth about how each of these factors contribute to childhood obesity and implement preventative strategies in order to cause a decline in this epidemic.

Nutrition in Schools

According to several sources, the number of children who are overweight or obese has increased significantly in the last 30 years, and those numbers are still steadily increasing. Most researchers of this epidemic agree that schools are very influential in adding to or changing these numbers. Although schools should be responsible for ensuring that children receive adequate amounts of physical activity during the school day, this section will focus on the impact that school nutrition programs can have.

Four separate research studies conclude that children make healthier choices when schools implement nutrition programs (Fahlman, Dake, McCaughtry, & Martin, 2008; Powers, Struempler, Guarino, & Parmer, 2005; Veugelers, & Fitzgerald, 2004; Wojcicki, & Heyman, 2006). These studies ranged from elementary, middle school, and high school students.
Many schools have implemented nutrition programs where they monitor the food that they sell for lunch and snacks to ensure that the foods are nutritious and low in fat. Some schools have even banned the sale of soda and junk food from vending machines and snack bars altogether. According to the research studies cited above, the changes resulted in students making healthier choices in what they ate at school.

The nutrition programs also included educating students on healthy eating habits. Students learned about the Food Pyramid and what they should be eating each day. The studies report that the students who participated in these nutrition education classes were more knowledgeable about healthy eating habits and the Food Pyramid than those who did not. Also, these students were more likely to make healthy choices themselves and to feel confident that they could make healthy choices.

Despite these positive findings, all schools have not yet implemented nutrition programs that include both changing the food options to include healthier choices and educating the students about nutrition. Furthermore, most schools that do have a nutrition education program only spend about 13 hours each school year teaching about nutrition, although 50 hours is the minimum thought necessary to most impact behavior (Briggs, Safaii, & Beall, 2003).

Cultural Comparison

Food is very much a part of popular culture, and the beliefs, practices, and trends in a culture affect its eating practices.

In the article Culture Matters in the Obesity Debate, Kelly D. Brownell, who is a professor of psychology, epidemiology and public health at Yale University, where he serves as director of the Rudd Center for Food Policy and Obesity, discuss that obesity is rampant in all races, in both genders, and across all ages. The prevalence of significant obesity in the U.S. population is 29% for Caucasians, 34% for Hispanics and 40% for African Americans. Fully 78% of African American females are overweight or obese. (Brownell, 2007). With the advent of TV programs such as "Baywatch," adolescent girls in these cultures have begun to act like so many of their American counterparts as they learn that they have the "wrong" kinds of bodies. As Laura Fraser points out in her book Losing It, most white women already “can't make it through a day without getting disgusted with themselves for not having a better — meaning thinner — body.” (Fraser, 1997) But studies generally find that African American girls and women have much more positive views of their own bodies than white girls and women do. And this affects their ways to raise their children.

In the article Obesity in Chinese Children, Tsung O Cheng, MD, a professor at the George Washington University Medical Center, has done extensive research into obesity in Chinese children (2004). Dr. Cheng claims that China has only recently started to fight obesity, as the country has adopted Western cultural practices, such as fast food and physical inactivity. In terms of fast food, McDonald's and KFC are particularly effective in advertising and promoting its unhealthy, high calorie, fatty food. In terms of physical inactivity, Chinese children are now exposed to television, video games, and computers, which have contributed to obesity in children, in particular those in urban areas where they have more pressure to perform scholastically and less opportunity to engage in field work.

What drives children's and adolescent obesity and overweight is the essential question that the authors attempt to answer in the article Social, Cultural and Environmental Influences on Child Activity and Eating in Australian Migrant Communities (Green, Waters, Haikerwal, O'Neill, Raman, Booth, & Gibbons, 2003). The authors designed a study that examines the underlying socio-cultural, familial and environmental factors that ultimately influences health, eating habits and patterns of physical activity for children and adolescents. The approach was to conduct a broad range of family interviews that span across three generations and four cultures and to analyze the commonalities and differences across the results. The key findings are that culture plays an enormous role in family lifestyle across generations and cultures and that it is vital to design interventional programs that take into account the complexity and the necessary collaboration required with diverse groups and communities.

In the article Cross-national Comparison of Childhood Obesity: the Epidemic and the Relationship Between Obesity and Socioeconomic Status, Youfa Wang, MD, MS, PhD, an Assistant Professor at University of Illinois at Chicago, did nationwide surveys for children aged 6-18 in the US, China and Russia (2001). Data shows that the relationship between obesity and SES varied across countries. According to the surveys, higher SES subjects were more likely to be obese in China and Russia, but in the US low-SES groups were at a higher risk. Obesity was more prevalent in urban areas in China but in rural areas in Russia. In the US no consistent rural-urban difference emerged. Like China, the recent Egyptian national survey got similar results. These patterns are particularly attributable to the differences in people’s access to food and health services, physical activity patterns, and social norms in rural and urban areas in these countries. Food is very much a part of popular culture, and the beliefs, practices, and trends in a culture affect its eating practices.

Fast Food

Over the past three decades, fast food retail sales in the United States have soared. “In 1975 the retail sales were $16.1 billion to a projected % 153 .1 billion in 2004. There are now more than 280,000 restaurants in the country” ( Am J Public Health. 2005; 95: 1575 -1581).With the increase of restaurants, many Americans have become fast-food dependent. Fast food is inexpensive and offers a ready to eat mode. The growth in fast food sales is not the only increase, along with it the portion sizes have increased as well. The “Super Size” is twice the recommend portion size for an adult.One study shows that "people eat more in the prescence of large portions"(Nutrition Today.2003;38:42-53). Fast food is high in calories and Trans fats, which are in the hydrogenated oil used to fry the foods.

Fast food is very appealing to many American families who have no time to cook a meal. On a typical day, one-third of children and adolescents in the United States eat fast food. The convenience of fast food does not only affect how children eat at home but also outside the home. Fast food restaurants are often within walking distances from schools. Also, it is served at amusement parks, fun centers and bowling alleys. The low cost for the food also makes it accessible to children and adolescents for mere pocket change. Major fast food chains all advertise their Dollar menu items so that children can fill up on high calorie, low energy snacks for less than $5.00.

In Chicago, the nearest fast food restaurant was 0.52 km away from schools, which is less than five minutes walking distance. Fast food restaurants are clustered around many of the schools. Those that are not near schools are met with a plethora of advertising on bill boards. Fast food commercials are shown heavily during after school hours and even paid endorsements within schools so students can buy their products.

A study conducted in Chicago examined the concentration of fast food restaurants in school- neighborhood areas. In order to obtain research a “…geo-coded database of restaurants and school addresses were used to examine locational patterns of fast-food restaurants and schools.” The relationship between the two variables was demonstrated using a bivariate K-function statistical method to quantify the clustering of fast food restaurants around school locations (Am J Public Health.2005; 95:1575-1581).

Approximately 6 % of students attending Chicago public schools use school buses, walk, or ride in cars to and from schools. Therefore these uses of transportation give children more access to fast food restaurants in their school neighborhood. The research found that fast food restaurants were clustered in moderate and high commercialized areas which shows that the location of fast-food restaurants were among all of the schools, not just the commercial areas. It was also found that there were many fast food restaurants in low income areas. Therefore, children in middle and high income areas are exposed to more fast food venues in their environment.

The research indicates that “fast food restaurants are concentrated within a short walking distance from schools exposing children to poor quality food environments in their school neighborhood” (Am J Public Health.2005; 95:1575-1581). The availability of fast food in more urban settings needs to be considered when dealing with issues in children such as obesity, low energy and concentration, and possibly even malnutrition.

Attitudes about food are formed in early childhood. It is a part of socialization and a learning process where children know when, what, and how much food to eat. Major fast food chains have toys and promotions tied in to popular movies and TV shows so the advertising doesn’t stop once the food is gone. Children make connections to eating this food and the toys and shows they love. Fast food is fun. Fast food is a way to celebrate after a Little League game or ballet recital.

Children learn what food is “good" and “bad”. When looking at the views and attitudes of students about consuming fast food, they are aware of the positive and negative characteristics. Children and adolescents may know that fast food is not good for them, but they also know that nothing bad has happened to them by eating it. They know that it makes them feel good, and the immediate gratification can often outweigh consequences that occur slowly over time like obesity, bad skin, high cholesterol, and heart disease.

According to one study conducted in Sweden, male and female high school students both are knowledgeable about fast food choices and have different perceptions. The findings of the study showed that there “was no clear difference between the definitions of fast-food” (Int J Consumer Studies.2007, 31:117-121). However there was a difference on male and female perceptions when it comes to fast-food. “Male students focus on unwholesome fast-food with the intent to satiate whereas female students take in a broader context and compares with better home cooked food and the logistic benefits of fast-food in the entire food chain”. (Int J Consumer Studies.2007, 31:117-121) Fast food may be perceived in many ways, which plays an important role in the choice to eat it. “When it comes to the outcomes of the consumption female students displayed the benefits of the time efficient food and meal habits, that is the entire food consumption process from purchase to doing the wash-up. Male students on the other hand perceive the satiation of the outcome”. (Int J Consumer Studies.2007, 31:119-121) Perceptions and consumption of fast food may also play a role in the views about fast-food as a whole. The study has found that Swedish high school students in general have a clear opinion about the unwholesomeness of regular fast food consumption. The students were aware of the positive and negative characteristics of fast-food.

Researchers indicate that more research must be done on how to change food choices and why these food choices are made knowing the implications to their health. Fast food is one of the leading culprits in the obesity of children. To regain the health of our children, a healthy diet and exercise must be added into the equation.

Media

Over the past two decades the United States, Europe, and Japan have seen dramatic increases in the childhood obesity rate. Many researchers have concluded that media technologies such as television, the rise of the internet\computer, and wide scale availability of video game technology have had a major impact on childhood obesity. Since the 1980’s a number of different research studies have attempted to study the relationship between childhood obesity and media usage with mixed results.

Since the 1980’s researcher conducted by the Center for Disease Control (CDC), Kaiser Family Foundation (KFF), and National Health and Nutrition Survey (NHANES) conclude that television is a main form of media utilized by children 8-10 years old. According to the KFF (2004) children use media (mostly television) approximately five-and-a-half hours a day. Major studies have targeted high television usage and conducted studies to see if there is a relationship between media usage and obesity among children. Roland Strum (2005) reports that “television may contribute directly to obesity by reducing energy expenditure through displacing physical activity indirectly by increasing dietary intake through snacking during viewing or changing eating patterns caused by food advertising”. Data collected by the KFF in 2004 seems to back up Strum's claim. The KFF indicates “analysis of data from a nationally representative survey of more then 700 kids age 10-15 conducted in the late 1980’s concluded that “The odds of being overweight were 6.5 times greater for youth watching more than 5 hours of television per day compared to those watching television for 0-1 hours” even when controlling factors for prior weight, race, SES, etc" (p.4). The authors concluded, “Estimates of attributes risk indicate that more than 60% of overweight incidence in this population can be linked to excess television viewing time”. More recent studies such as NHANES 1988-1994 indicate that “data among 8-16 year olds, both boys and girls “who watched the most television had more body fat and greater BMI’s than those who watched less then 2 hours a day” (p.4). Furthermore, "the CDC’s 1999 Youth Risk Behavior Survey, which sampled 12,000 high school students nationwide, found that adolescents watching more than 2 hours of TV per day was related to being overweight." (Kaiser Family Foundation 2004, P2).

Although data indicates an alarming trend of obesity linked to media exposure there does seem to be some hope for change. In Roland Strum's article Childhood Obesity-What We Can Learn from Existing Data and Societal Trends (2005), Strum indicates a 23% (approximately 6 hours per week) drop from 1981-1997 in the amount of TV watched by children age 6-8 years old. Further studies on adolescents also indicate a similar drop among adolescents. Hopefully, in the future the reduction of hours spent by children will continue to drop, resulting in a decrease in overall obesity rates.

Physical Fitness

Schools are the primary source in promoting physical activity. Unit of Health Policies and Programs Study's national survey reports 8% of elemetnary schools in 2006 provided physical education for grades kindergarden through eigth grade. Children in elementary schools received 150 minutes of physical activity weekly (McKenzie,2008). The Health Related Physical Education goals are to for students to develop lifelong skills that will encourage them to remain consistent and dedicated to remaining physically active beyond the classroom, beyond skill, and into their daily lives (McKenzie, 2008). It is suggested in the McKenzie article that students need at a minimum 33 of moderate to vigorous movement. Recess is described as unstructured activity and physical education is structured with a curriculum. However, only 71.4 % of schools provide recess at the elementary level (McKenzie, 2008).

In this article physical education and recess were combined and considered equally important. The research survey covered 94% of public elementary schools across the United States. The data was gathered in 2005 using a variety of research sources as stated by Parsard & Lewis (2006). Most public schools state they have scheduled recess, but only 17-22% honor their reported statements. According to the data collected parents would like to see choices that are non-traditional to encourage all students to become physcially active (kick boxing or dancing). There were schools where no recess was given (7-13%). Students in rural elementary schools received more physical education than their city schools. The elementary schools in the northeast of the United States registered the lowest average physical activity and students of small schools were more physically active (recess and physical education).

This article's survey is based on data received from 344 (53.4%) respondents (Murnam, Price, Telljoham, Dake, Boardley, 2006). Table 5 surveyed parents perception on how important physical education is: 38% thought it was very important, 100% deemed that physical education should be weekly with about 109 minutes, however this number is lower than the national time of 150 minutes. The parents of this survey, 99.7%, felt recess deserved or required more time than physical education. It was very important to 26% of the parents that children should not be disciplined by push-ups or laps. There should by at least 20 minutes of vigourous movement in physical education classes, according to 46.6% o parents. The data collected in this article valued the importance of physcial education, however the children will need more than physical activity to fight obesity.

In the article School-based Obesity Interventions:a literature review the authors studied students over a duration of time (Fadia, Flores, Gbarayor, Wang, 2008). The time varied from as little as four weeks to as much as eight years. The authors believe in order to have accurate, effective, and meaningful data subjects would need to be tracked for more than a school year. The studies observed physical activity strategies, model and behavior modification strategies, self-reporting, and body mass indices/waist-to-hip ratios to measure the effectiveness of the intervention. There is a 79% likelihood that if one parent is obese the child will be an overweight adult. This study revealed physical activity is not the singluar answer to get the most effective results. Physical activity or movement failed to provide long-term outcomes because of the short-term interventions.

RECOMMENDATIONS

  • Schools should offer nutritious, balanced meals for lunch
  • Schools should offer a variety of healthy foods to meet the needs of different cultural backgrounds/lifestyles
  • Nutrition education programs should be mandatory for all students
  • There should be no pop machines; schools should sell water and juice instead
  • Vending machines should be filled with healthy snacks
  • Fast food restaurants should not be permitted to be located in close proximity to schools
  • Schools should increase the amount of time for physical activity
  • Schools should offer a healthy eating workshop for parents
  • Educate kids on the correlation between the overuse of television and computers and the obesity rate
  • Incorporate more choices for students in physical education classes (such as kickboxing and dancing)

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