Childhood Obesity
Beverly Tennant
New York City College of Technology
Comprehensive Client Care for Urban Health Issues
NUR 4119, SEC D539
Professor Margaret Rafferty
November 06, 2013
Childhood obesity has become a public health concern globally, creating serious health problems, economic, and social consequences for individuals and society (“Institute of Medicine,” 2013). Childhood obesity has more than doubled in children in the past thirty years. According to the Centers for Disease Control and Prevention (2013), The United States maintains an alarming trend of higher obesity rates in children and adolescence than most countries, with one in three American kids and teens overweight or obese. Despite several programs initiated at the Federal and State level to combat this epidemic, the prevalence of obesity in children and young adults have steadily increased over the last few years, with estimates as high as 17% of children considered obese (McCance & Huether, 2009). Although the development of obesity is very complex, it is confirmed that obesity occurs when energy intake exceeds energy expenditure. Childhood obesity can be brought on by a number of factors, such as dietary choices, genetics, developmental factors, and medical illness which often act in combination to negatively impact the child’s health.
The causes of obesity in young children are multidimensional, ranging from poor eating habits, binging, lack of exercise, family history of obesity, medical illnesses, family culture, peer problems, depression, , and stressful life events. Other risk factors associated with developing childhood obesity includes race, socioeconomic status, and lack of health insurance. (McCance & Huether, 2009). Children of African American and Hispanic race are of higher risk, as well as children with no health insurance. The prescence of prenatal obesity is also associated with childhood obesity. In addititon, early childhood nutrition, low levels of physical activity, and engagement of sedentary activities, such as watching television, computer games, is associated with the development of overweight and obese children. (McCance & Huether, 2009). Today, childhood obesity is now the number one health concerns among parent, community leaders and many healthcare officials in the United States, topping drug abuse and smoking.
Childhood obesity are of increase importance because of it’s many adverse health effects, it is recognized as a serious public health concern (“Wikipedia,” 2010). Additionally, the prevalence of obesity is so high that it may result in a decline in the life expectancy of today’s generations of children and diminishes the quality of their lives. One in four children in the United States under age five is either overweight or obese, with BMI greater than 95%, with minority groups being seriously affected. In 2007, the prevalence of obesity was greater among publicly insured children ages 1—17 than their privately insured peers (Schwarz & Petersn, 2010). These statistics raised alarming concerns because obese preschool-age children are five times more likely to be overweight during adolescents and more than four times as likely to be obese as adults (Natale et al., 2013).
Children who are obese are at risk for acquring other serious and potentially life–threatening health problems such as asthma, sleep apnea, hypertension, type two diabetes, increase serum lipids, decreased hepatic function, cardiovascular disease, several types of cancer, and osteoarthritis. Obesity is a contributing factor to the increase in type 2 diabetes and has been reported to result in lower health-related quality of life (Allender & Spradley, 2009). Not to mention the many social consequences such as low self esteem, negative body image, and depression that is associated with obesity. In America, obesity is considered shameful and pepole who are obese are usually viewed as lacking self-discipline, greedy and lazy, which usually caused emotional disturbance and poor self image in children. In addition, obese children are vulnerable to teasing, bullying, social exclusion and other manifestation of stigma and weight bias (Seipel & Shafer, 2013). Obesity has been shown to cause huge rise in healthcare cost, therefore affecting economic growth. According to a 2008 magazine report, the total economic cost of obesity for children and adults together was over $147 billion dollars and rising (Seipel & Shafer, 2013). While obesity can affect anyone, the population of main concern are children. Excessive weight at a young age has been linked to higher and earlier death rates in adulthood. In fact, it is stated that obese children have 70-80 percent chance of staying obese their entire lives (American Heart Association, 2011). According to a quote made by Richard Carmona a former Surgeon General, “Because of the increasing rates of obesity, unhealthy eating habits, and physical inactivity, we may see the first generation that will be less healthy and have shorter life expectancy than their parents” (American Heart Association, 2011, p. 1).
The targeted group that I would like to focus this paper on are children ages 2-19, who are severely impacted by this disease. Obesity is affecting this group in unprecedented numbers and is causing a broad range of health problems that previously were not seen until adulthood. Obese children are more likely to have life-threatening conditions such as high blood pressure, tpye 2 diabetes, breathing problems, joint problems and other metabolic problems. Obese children often suffer from teasing by their peers. Some are harassed or discriminated against by their own family, leading to psychological problems, such as poor self-esteem, anxiety and depression which can affect them into adulthood (“Wikipedia,” 2010). As per internet sources, several studies have found that children who are obese or have high cholesterol show early warning signs of heart disease. The report further states that the thickness of the artery walls of children and teenagers who are obese or have high cholesterol have age prematurely by as much as thirty years (“Wikipedia,” 2010). Research studies continue to report that obesity affects students health, which in turn have a negative effect on attendance in school. Reports also found that obese children tend to perform worse academically and socially than children of normal weight. The author indicated in the article that the reasons obese children do not perform well in school is due to their poor attendance because of illness and health issues. Obese childen experience more health complications, due to the strain obesity places on their bodies (Campbell, 2010). The earlier we as public health nurses intervene to reduce this epidemic, the better it will be for children and the country as well. Is is predicted that the United States life expectancy rate will decline, for the first time in recent history, as a result of increasing childhood obesity rates (Kumar, 2007). Wilkinson & Pickett (2009), states that the current generation of children could potentially live less healthier lives and possible die younger than their parents due to obesity related diseases. We will now examine some of the challenges and barriers that we face in tackling obesity.
There are serveral barriers and challenges in tackling the obesity epidemic in obese children, such as socioeconomic, environmental factors, parental educational level, accessibilty of unhealthy food, culture, and healthcare system. There is a strong relationship between economic status and obesity, especially among women. Women who are poor and of lower social status are more likely to be obese than women who are of higher socio economic status (“University of Rochester Medical,” 2010). People eating habits are also directly related to the availability and access to healthy food, especially in disadvantaged communities.
The changes in family structures have greatly impacted our children, with vast majority of parents if present, worked full-time outside the home to make ends meet. Many children have no one at home to prepare them healthy meals or to supervised their eating habits and as a result many children are eating commercially prepared unhealthy foods or eating from fast food restaurants. Many of these foods are usually high in calorie content, salt, and fat. For many low income families with limited budget, healthy foods are considered too expensive and is therefore viewed as a lower priority for their family, so most families will eat foods that are cheap and are of less nutritional value. According to (Schwarz & Petersn, 2010), United States Department of Agriculture estimates that 116.3 million American live in areas with low access to supermarkets. The migration of supermarkets away from low income neighborhoods creates a barrier to for low income residents to access fresh, healthy, and affordable foods.
Other environmental barriers that makes it difficult for families and children to eating healthy foods are ease of access to cheap snacks at local stores and fast food for school age children. Fastfood restaurants and Bodegas are often clustered around schools in poor neighborhoods, providing children with sugary drinks and high calorie snacks. One report states that one-third of the children and adolescents eat fast food each day (Kumar, 2007). Another possible barrier to physcial activities and leisure time are the changes in built environment which have resulted in lack or restricted access to side walks, green space, parks and recreational centers. Parents also work longer hours, reducing their ability to engage in more physical activities with their children. In previous years, children played outdoor games with their friends for long hours, with friends and family supervising them. Today, most neighborhoods are no longer considered as safe for children to play and this has caused a shift towards more indoor entertainment, such as computer games, videos, and television In addition, children are continously bombarded with advertisments for burgers, fries, soda,candy, and gum, which help to influence children food belief and eating patterns negatively. Commercials also tend to encouraged snacking between meals.
Diverse cultures, attitudes , and belief about food and what constitutes an apprpriate body size, might be a challenge to tackling obesity in this group. In African American and Hispanic cultures, being overweight is sometimes viewed as a signs of good health and also a sign that family is feeding the child well. Many parents of obese children are unable to recognize that their child was above their normals weight for their age (Jefferson, 2006). In addition, some parents because of cultural preference might prefer to prepare fried, fatty foods instead of baking or boiling their foods. Maternal obesity is also a major contributor to the developemt of childhood obesity. In one study, it was revealed that the mispreception of the children’s weight status was more common in mothers with less education, and may be a barrier to prevention of childhood obesity (Durand, Logan, & Carruth, 2007).
The authors further asserted, that in a sudy of 854 young adults it was indicated that parental obesity more than doubled the risk that a child, under ten years of age will become an obese adult. They also reported a stronger relationship of mother to child obesity than with father to child obesity (Durand et al., 2007). Many parent report feeling confused because there are so many conflicting stories about what to eat on the news. Another research report that is of atmost importance is that children who sleep less than eight hours per night leads to same year increases in body mass index. The author reported that sleep deprivation can lead to increase hunger for high energy dense foods, which can lead to weightgain (Spruijt-Metz, 2011). Another study examines the effects of physical activity related built environmental variables and actual weight status on in children and found that school play space, road safety,and lower population density have been found to be related to lower obesity rates in young children (Spruijt-Metz, 2011). The inceasing prevalence of childhood obesity and its adverse effects, is a critical public health challenge in the United States and worldwide.
In recent years, the rates of childhood obesity have soured around the world, imposing heath and economic burdens on both developed and developing counteries. Experts predicted that if the epidemic of childhood obesity is curbed the gains that were made with in reducing heart disease, diabetes, and many other chronic health problems may be reversed. On study indicated that the risk of childhood obesity is strongly associated with pre and postnatal factors such as mother’s weight during pregnancy, smoking, breastfeeding, and childcare. Other studies also support the premise that the risk for obesity is deeply rooted in prenatal care and continues through various phases of childhood (Seipel & Shafer, 2013). It has also been shown that women who smoked during pregnancy and have gained more than 50 pounds during pregnancy are at greater risk for having overweight children (Seipel & Shafer, 2013). In addition, studies have shown that lifestyle changes over the past several years may be one of the factors contributing to the higher obesity rates.
There is increasing evidence that the consumption of high-caloric foods from restaurants is more common because people have less time to prepare foods at home (Seipel & Shafer, 2013). It is also reported that many of the packaged foods that are marketed as “low fat” or “all natural” are extremely high in their total caloric content. Study findings have shown that the risk for obesity decreased considerably when infants are breast fed in the first year of life. These benefits continue into early childhood and beyond (Seipel & Shafer, 2013). One study in particular suggested that primary care clinicians felt that their role in obesity management was centered upon raising the issue of the child weight with the family, but that the responsibility of solving the problem was primarily the responsibility of the family, while others reported feeling uncomfortable discussing weight issues with families. Some clinicians also think obesity was too sensitive topic to discuss with their patients (Walker, Strong, Atchinson, Saunders, & Abbott, 2007).
In laboratory studies, children consumed more food when watching a continuous television program than when they watched a repeated segment of television program. Similarly, individuals who viewed television while eating a meal were less accurate in estimating the amount of food they had consumed than those who consumed the food without television As per cost, studies have indicated that because obese children are more likely to become obese adults, resulting a less productive workforce. It is reported that obesity results in about 117 billion dollars in lost wages and other costs to employers annually (Gollust, Niederdeppe, & Barry, 2013). Obesity needs to be tackled in childhood in order to prevent the consequences of ill health later on in life. Healthcare cost attributable to over weight and obesity have been shown to increase the rate of several common adverse medical conditions, resulting in economic cost of 300 billion per year in the United States (Kumar, 2007). Thus the roles of education, life style changes and support cannot be stressed enough. Healthcare professionals play a major role in shaping the health of future generations and addressing childhood obesity.
The complexity of causes contributing to obesity suggests that preventions provide a challenge to healthcare professionals. Assessments and preventative programs need to take into account the cultural values and belief of families and should be tailored to meet those needs. Reducing inequalities is important as those who are from lower socioeconomic groups are most at risk (Marmitt, 2013). Some of the potential interventions include a structural physical activity program that is combined with diet to reduce weight. Exercise is important both in weight reduction and maintenance. Besides providing a positive emotional outlet and a general sense of well being, exercise is a good way to tone the body. Encouraged children to walk up the stairs instead of using elevator or even walking home from school are some routine activities that can increase physical activities. Swimming, dancing class or boxing classes are good exercises that encourage flexibility and build body strength. Exercises also promotes the development of socialization skills, provides time away from foods, decreases appetite, improve both physical and mental health (Marmitt, 2013). Family-targeted behavioral lifestyle interventions appear most effective, and combined with diet, physical activity, and behavioral interventions were promising in the prevention of obesity, according to one research report (Spruijt-Metz, 2011).
Primary care providers such as nurses, physicians have important roles in meeting obesity prevention goals. Primary care providers have traditionally measured patient height and weights to assess growth, development, and body mass index and treat obesity and other health related condition, but there is a need to expand these roles to include advocacy and counseling for patients and families about obesity prevention (Vine, Hargreaves, Briefel, & Orfield, 2013). We as nurses can educate young adult women during clinic encounters, prior to conception. We can provide health promotion information and provide age appropriate guidance. Nurses should encourage families to take part in physical exercise that they enjoy, such as dancing; family walks and reinforces the health benefits of sustained physical activity. In addition, nurse should encouraged families to reduce intake of fried fatty food and reduce high sugar drinks. We might also educate families to eat foods that are high in fiber and encourage more fruits and vegetables intake. Children should be advised drink less high sugary drinks and drink more water. Eating more meals together as a family and limiting daily intake of fast foods could be a family goal (Rabbit & Coyne, 2012).
Initiative to improve nutrition and prevent obesity and its complications are also important. The use of financial incentive can be used to encourage healthy behaviors, such as reducing taxes for families participating in sports or join a gym. We should advocate for policy makers to simplify the applications process for food assistance program by ensuring that people who qualify for these programs are aware of them and have access to apply for them. We should also collaborate with community leader to increase community access to healthy foods through supermarkets, grocery stores and convenience stores, by creating incentive programs through grants, loans, tax credits and other economic incentive to attract supermarkets and grocery stories to underserved neighborhood (Institute of Medicine, 2013). We should also promote community efforts to provide fruits and vegetables in a variety setting, such as farmers markets, community gardens, youth-focus gardens, fruit stands, by encouraging farmers markets to accept food stamps and women infant and children food vouchers. Improve funding for outreach, education, and transportation to encourage use of famers markets and fruit stands by residents in lower income neighborhoods (Institute of Medicine, 2013). We should encourage increased funding to school breakfast and lunch programs (Schwarz & Peterson, 2010). Another important factor in the battle to fight against obesity is access to good healthcare. According to one author, “with health insurance, parents can more effectively seek medical care from the community and use resources to address obesity and better attend to its effects (Seipel & Shafer, 2013). We are all involved in this fight to combat this epidemic.
Stakeholders in the fight against obesity in children are healthcare providers, business leader, schools, community leaders, politicians, media, and the general public. In just two decades the number of children who are either obese or overweigh has tripled. The recent rise in obesity is due largely to complex changes occurring in the social or physical environments of children. This epidemic is occurring both in boys and girls across all states and socioeconomic lines, and among all racial and ethnic groups, although Hispanics, African Americans, and Native Americans are disproportionately affected. Changing these trend in childhood obesity require engaging stakeholders who can improve the quality of these environmental factors, while successfully collaborating with others both in the public or private sector to improve health outcome. Mayor Bloomberg, Health Commissioner Dr. Thomas Farley and other political figures in New York has taken bold steps to help reduce the obesity epidemic by proposing numerous policies, programs and initiatives. Some of the initiatives or polices includes a limit to the size of sugary drinks sold in service establishments to 16 ounces or less. This would apply to restaurants, delis, concession stands at movie theaters, stadium, and arenas. According to Health Commissioner Dr. Farley, “This intervention will begin to curb the thousand of empty and unnecessary calories New Yorkers consume from sugary drinks every year, and educate people about the health risk they pose” (Bloomberg, 2012. p.1). Many studies have shown that consumption of sugary beverages has been linked to weight gain and increased risk of heart disease and diabetes (Bloomberg, 2013). In 2005, New York became the first city to force restaurants and food vendor to cut out the use of artificial trans-fat, which have been strongly linked to heart disease and obesity. Mayor Michael Bloomberg also implemented policies that require all restaurants to post calorie information on menu boards and menus.
Another important stakeholder in the fight against obesity is Mr. Obama. In her anti-obesity campaign, “Let’s Move”, Mr. Obama said she hope to attack the problem of obesity through educating children on healthy eating habits and encouraging young people to exercise. In her campaign the First Lady has recommended that restaurants offer healthier children’s menu choices. She also recommended that schools ensure children have some form of physical activities and that cafeterias improve the nutritional value of its lunches. She also encouraged families to eat well balanced home cooked meals. Studies have shown that people who eat meals prepared from scratch in the home consume less and eat healthier nutritious foods (Seipel & Shafer, 2013). Another stakeholder in the war against obesity is Wal-Mart Stores one of the country’s largest retailer and grocer. Wal-Mart plan to start making its food products healthier and its healthy foods more affordable. Wal-Mart also plans to build stores in underserved areas to help make healthy foods available to families. Other food makers such as Campbell Soup, Kraft announced sodium reduction to their products also. Health Insurance plans have also emerge as partners in the fight against obesity, by education providers about screening children, creating incentives for plan members to participate in weight loss programs, sponsoring worksite programs, and funding community-based weight management programs. Each and everyone do have a role to play in reducing childhood obesity.to better improve health outcomes for our children.
Policy recommendations for addressing childhood obesity should include increase access to healthy food, implement policies to limit childhood exposure to food marketing, improvements to physical education in schools such as adding non-competitive activities such as dance, music, yoga, and increase physical activity time, and regulate foods served in schools. All schools such as daycares, after schools, and childcare setting should provide more nutritional healthy meals to children, by including low fat milk, more fresh fruits and vegetables, and whole grains into meals. Educate children, preschool through high school on appropriate diet and lifestyle. Mandate minimum standards for physical education, including 30 to 45 minutes of strenuous exercise 2-3 times weekly (Kliegman, Stanton, St.Geme, Schor, & Behrman, 2011). We should increase family-friendly exercise and play facilities for children of all ages. Mandate age-appropriate nutrition labeling for products aimed at children, install water fountain in schools. We should advocate for tax deductions for the cost of weight loss and exercise programs and provide urban planners with funding to establish bicycle, jogging and walking path to encourage families to walk and exercise. Recommend banning advertisements of fast foods directed at preschool children and restrict advertisements to school-age children. Last but not least, encouraged parents to breast feed and provide parents with information on nutrition and healthy eating habits. We should support ads on the potential health risk of consuming sugary drinks and high calorie foods for children (Kliegman et al., 2011). We should also mandate to reduce portion size of fast foods and food served in restaurants.
The cause of childhood obesity is very complex, and may include poor eating habits, readily available processed food that are high in fat and sugar, and technology that has made it easy for children to avoid physical activities. Childhood obesity has reached epidemic proportion and as a result has become a major worldwide concern. The increased rate of obesity can result in long-term health risk such as heart disease, diabetes, and other chronic diseases, resulting in increase medical cost of over 147 billion. The obesity epidemic strikes hardest in communities already suffering from health and economic disparities. New York State was ranked second highest among states in total obesity related expenditure, with estimated spending of nearly 6.1 billion in 2003 (CDC, 2012). While several factors may play a role in this epidemic, the key to solving this problem is through educating the public and bringing awareness to the importance of this problem, providing families with education about obesity, and encouraging them to make healthy choices. As nurses it is our duty to help educate families on the dangers of childhood obesity and advocate for changes in policies to reduce disparities and restrict the availability of fast food in the community. It is indeed within our interest to reduce this epidemic in order to create a better future for our children.
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