Child Obesity in America
Edward Clarke
New York City College of Technology
Comprehensive Client Care for Urban Health Issues
NUR 4110
Professor Rafferty
May 1, 2012
Child Obesity in America
      Child obesity in America has morphed into a seemingly uncontrollable phenomena that has no end in sight and many proposals, measures and programs designed to reduce its impact seem to have minimal if any effect on its perpetual pervasive presence. Efforts by stake holders inclusive of the federal, state, local governments, non-governmental and community organizations, parents and the children themselves, have been thwarted by vested opposition from commercial interests, lack of economic resources, inadequate resources directed to those who are most affected and in many cases self-denial and lack of choices(Alessandrini, Faith, Spivack, Swielik, 2009). Inadequacy or the lack of well-meaning efforts to combat child obesity still lingers while children continue to consume in increasing quantities energy dense foods consequently fuelling obesity rates to epidemic proportions.
“The prevalence of obesity among American youth increased significantly between the 1980′s and the present decade. Between 1976 and 1980, approximately five percent of youth two to nineteen years of age were obese. In 2006, the rate had increased to sixteen percent. Obesity among children aged two to five years doubled, increasing from five percent in 1980 to approximately thirteen percent in 2006; among children six to eleven it doubled, increasing from seven percent to seventeen percent; and it tripled among adolescents aged twelve to nineteen, increasing from five percent to eighteen percent . Forty percent of children and adolescents aged two through nineteen years were found to be overweight or obese, with BMI at or greater than eighty five percent. Furthermore, twelve percent of children and adolescents aged two through nineteen years were found to be severely obese, that is, their BMI was above the 97th percentile. CDC′s Youth Risk Behavior Survey also records data about obesity among ninth through twelfth graders. The percentage of nine through twelve graders who were obese increased from eleven percent in 1999 to thirteen percent in 2007”. (CDC 2009).These increases affected the poor and minorities disproportionately compared to whites.
Current literature reveals significant disparities in the prevalence and rates of obesity among minority groups compared to whites. “In 2008, fifteen percent of low-income, preschool-aged children were obese compared to approximately ten percent of those from moderate- to high-income families. Among males aged twelve to nineteen, twenty two percent of Mexican American were obese, nineteen percent of Non-Hispanic blacks were obese, and seventeen percent of Non-Hispanic whites were obese. Among females aged twelve to years, obesity prevalence was higher among non-Hispanic Blacks, twenty eight percent and Mexican Americans twenty percent compared to non-Hispanic whites fifteen percent” (Centers for Disease Control and Prevention 2009).Despite an increasing number of studies indicating that obesity among children is rising at a phenomenal rate, efforts and measures implemented to address the issue have proven to be disappointing.
Framers of national policies and objectives present national health goals and objectives each year and some every decade that should be achieved.
One such framework emanating from the Department of Health and Human Services is that of Healthy People. “Healthy People provide science-based, 10-year national objectives for improving the health of all Americans. For three decades, Healthy People has established benchmarks and monitored progress over time in order to encourage collaborations across communities and sectors, empower individuals to make informed health decisions and measure the impact of prevention activities” (United States Department of Health and Human Services 2011).      Healthy people 2020 in its mission for the next decade hope to see improvements on the dismal results of the previous decade that instead of reductions in child obesity rates and decrease in prevalence of disparities across races has seen quite the opposite. According to Healthy People 2020 its mission is to “Identify nationwide health improvement priorities. Increase public awareness and understanding of the determinants of health, disease, and disability and the opportunities for progress. Provide measurable objectives and goals that are applicable at the national, State, and local levels. Engage multiple sectors to take actions to strengthen policies and improve practices that are driven by the best available evidence and knowledge. Identify critical research, evaluation, and data collection needs”.
In its advisory role to local and federal agencies Healthy People 2020 is hoping that American children, achieve high quality of life that is devoid of the complications of obesity and not subject to health disparities present in previous decades. It is also the goal of Healthy People 2020 that environments are created which will facilitate physical and mental wellbeing of children, promotes learning and behaviors conducive to good health. According to Healthy people 2020 “ By increasing the number of States with nutrition standards for foods and beverages provided to preschool-aged children in child care, the proportion of schools that do not sell or offer calorically sweetened beverages to students, and increasing the proportion of school districts that require schools to make fruits or vegetables available whenever other food is offered or sold”( healthy people.gov 2010) would somehow significantly lower obesity rates among children. Current trends and statistics suggest that much more is required to reduce childhood obesity. Many programs and models have been initiated but have experienced limited success to have any degree of mass effect.
One such model is that of the Coordinated Approach to Child Health (CATCH), an elementary school based program that was initiated to support “positive environmental influences to increase physical activity and improve healthy eating. CATCH involves classroom and physical education teachers, food service personnel, and families of students. It was focused on changing the behavior of elementary school students both in and out of school. Classroom teachers use a prepared, age-appropriate curriculum to teach about physical activity and healthy eating. Students in regular classes practice new skills designed to improve their physical activity and eating behaviors. In physical education classes, teachers encourage students to actively participate in physical activity that is fun. School cafeterias served healthy, low fat foods that have been tested for their appeal to elementary students” (Dino, Franks, Gortmaker, Horn, Kelder, Simoes and Wiecha 2007).
Studies over a three year period have found that as children matured and exposed to healthier eating choices and engage in physical activity experienced significant reductions in their intake of high fat meals. Also replication studies in predominantly Hispanic community in El Paso Texas it was found that obesity increased among students in grades three to five from twenty six percent to thirty nine percent among girls and boys saw a nine percent increase compared to those who participated saw a one to two percent increase in obesity rates (Dino et al 2007). The success of the CATCH program could also be seen in another model program, that of Planet Health.
The Planet health model program was initiated by Harvard researchers collaborating with principals and teachers from middle and public schools. It was designed to promote cardiovascular health and reduce obesity rates among students in sixth through the eighth grade. “Planet Health’s goals for youths are based on evidence that healthy eating and physical activity are important and emphasize increasing consumption of fruits and vegetables and decreasing consumption of high fat foods”(Dino et. al. 2007). Studies conducted of Planet health indicated that girls who participated in the program watched less television, experienced significant reductions in obesity rates and increased their consumption of fruits and vegetables. The success of Planet Health was successful in part due to involvement of stakeholders and a curriculum that students and teachers could relate to. The Program for Women Infant and Children (WIC) is yet another model program designed to assist in reducing the prevalence of obesity among children (Dino et. al 2007).
It was initially designed to alleviate malnutrition and hunger in low income communities particularly among women and children. However the “ emergence of the childhood obesity epidemic in the ensuing decades has challenged the WIC program to ensure adequate nutrition for low-income, nutritionally at- risk infants, children, and pregnant and postpartum women while simultaneously promoting healthy eating to minimize the risk of overweight and obesity among participants” ( Dalenius, Edmunds, Reynolds, Sekhobo, and Sharma, 2010). Children between the ages of two to five years old were enrolled into the New York State program during the years 2003 to 2007 and it was found that there was a marked decrease in the prevalence of obesity for both boys and girls for the period between 2003 to 2005 and stabilized during the year 2007. This was evident for predominantly Hispanic children and non-Hispanic black children (Dalenius et al 2010). However despite the success of this program the national statistics indicated an increase in child obesity rates during the years 2002 through 2007.
Thus the enormity of the problem of child obesity seems to be increasing steadily and this has been the symptom of the inadequacies of policies, measures and efforts to avert this downward spiral. Pockets of regional or local success have not been translated into national success and apparently these efforts require a national perspective, mass participation of the general population and in particular convincing messages or actions that will persuade all stake holders that it is their interest as well as the country as a whole to participate in reducing the pace of child obesity rates affecting the nation (Robinson 2010).
Powerful stake holders have been part of the steadfast opposition to any policy that seems to threaten the making of profit and these include the advertising and food industries. They provide the nation with its food and the influences to persuade us to think that the food is edible and healthy for us. However despite numerous studies and the present state of child health nothing significant has been done by these entities to make healthier foods for our children. Considerable efforts and money has been used to convince many policy makers both local and federal to continue to support their interests. These law makers, another set of stake holders in the child obesity debate has not been particularly helpful. Rather than focus on the interests and health of children and the national health of the nation as a whole they have become keepers of the status quo, accepting donations from the food and advertising industry for their campaigns for re-election and therefore simply do not represent the interest of the voters who sent them to address the nation’s issues. Other stake holders include the guardians, parents and children themselves (Ehrenfeld, Natan, Sefer 2009).
For the children they will eat what their guardians eat and generally what they are taught to be edible and enjoyable. They simply do not have the capacity to determine what is healthy to eat unless taught. Parents are predominantly responsible for what children eat and for poor lower income families there are often not many alternatives to the unhealthy, affordable and readily available food in their communities. Minorities are particularly affected by this phenomenon and their communities are observed to be predominantly populated by fast food outlets and restaurants that are the primary sources of foods that are high in saturated fat with low nutritional value. There is an obvious absence of fresh fruits and vegetables available and their less than desirable economic circumstances imposes severe limitations on their access to healthy affordable food thus making a considerable contribution to the increasing numbers of children suffering from being overweight or obese ( Brownswell, Harris, Henderson & Schwartz, 2009).
Other stakeholders include local and federal agencies that are at times lax in their monitoring functions as well as being impeded in their functions by some politicians and law makers who believe that regulations restrict the abilities of businesses to carry out their functions effectively. Consequently monitoring agencies are stripped of any enforcement or monitoring capacity and are often times not funded to make them effective guardians of children’s health. What has been manifesting is that a myriad of factors have been responsible for the failure of policies and measures to impact increasing childhood obesity rates on a national scale (Han, Lawlor, Kimm 2010).
What has been lacking is the political will and sincerity on part of law makers and politicians to enact policies that alleviate the poverty stricken circumstances of the poor and minorities so that they can better able to access healthy food for their children. Further there is little being done to cooperate across states and engage in concerted efforts to motivate the populace on a whole to embrace behaviors that could contribute to reducing the incidence of child obesity. We have been successful in identifying the problems and achieving remarkable success in pockets across the country yet has been unable to impact the nation significantly (Huang & Story, 2010). It is certainly a monumental and seemingly overwhelming task to achieve significant reductions in the prevalence of childhood obesity however it must be done and perhaps the most important stake holders are the parents of these children and law makers.
Everyone seems to be aware of the problem but not the need for urgency of action. What needs to be done is a sustained and relentless national education campaign of the public about the prevalence of the problem its cause and consequences if action is not taken now. The public must be enticed, motivated and inspired to embrace behaviors that are positive for the health of children. The use of graphic images and the stories of victims of the disease would be used to convey the message in a manner that children and their parents can relate to. The education campaign would be taken to the schools and to every sphere of life in which children are involved. Simultaneously policy makers should be lobbied and persuaded to initiate policies that are effective in addressing the issue. To ensure that policy makers understand the gravity of the situation and to convince them that the health of children is paramount and should supersede the interests of campaign donors they would be reminded that women and mothers constitute more than fifty percent of the voting public. They would also be encouraged to re-direct resources to minority communities to assist mothers in providing more nutritious meals to children.
Also stakeholders who understand that childhood obesity cannot be allowed to continue and the food that children consume must be healthy whether they belong to rich or lower income families, would be invited to participate positively and begin in the food industry a new approach to food and what is presented to the public for consumption. It is the duty of every government to protect its people and if all overtures to the food industry fails and the education campaign does not translate into significant reductions in the rates of childhood obesity then the food industry would be notified that within a specific period of time the industry must dramatically change the type of foods presented to children for consumption and to the general public at large. Refusing to comply, a national emergency would be declared and a mandate imposed on the food industry banning the sale of processed foods high in saturated fat and low in nutritional value to children.
Further monopolies that exist in the food industry would be forced to break up their operations into smaller entities to facilitate more competition in the market and thus contribute to lower costs for healthy food. Charities and food kitchens that regularly feed the poor would be encouraged to offer healthier choices and be provided with subsidies to offset costs. Influencing the food industry also would include “fiscal food policies, mandatory nutrition panels on the formulation, and reformation of manufactured foods, implementation of food and nutrition labeling, and restricting marketing and advertising of unhealthy foods” (Chan & Woo, 2010, p. 773).
As history suggests and has proven that one of the most successful means of effecting changes in human behavior have been the imposition of mandates with accompanying severe consequences for defying such mandates. Indeed such course of action would inspire outrage even from citizens who are being protected. However should a government allow its children to participate in an epidemic which has grave implications for national health and ultimately the perpetuity of the country itself would be a dereliction of its duties. History indicates that at the onset of the outbreak of an epidemic, governments do everything to prevent its spread and protect its citizens and these actions include imposing measures that mandates certain behaviors. Childhood obesity is approaching epidemic proportions. Baring a collective awareness and collective guilt on part of the general public who have been active participants contributing to the present state of affairs, as well as a national effort that involve the voluntary participation of everyone to combat the inertia of politicians and inevitable resistance of vested interests, then the mandate may be the only measure left that could significantly alter the course of a nation with its children in crisis.
References
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