Obesity has become a current epidemic in the United States. Many children are affected negatively due to health and emotional related issues. Children are consuming an unhealthy diet, causing excessive weight gain that places them at risk for morbidity and mortality. The topic is very important because the health of the society is based on the health of the children. If children are unhealthy the society is unhealthy placing our future in a very costly and unprogressive state. To prevent the progression of an unhealthy America change must occur, interventions must take place, and barriers must be addressed

Children are considered a vulnerable group. They require more assistance, protection, and resources. With the obesity epidemic there is a great need for interventions to take place. The health status of an obese child is likely to be poor. To prevent this, research has been done, laws have been passed, and the involvement of the community has taken place. Obesity impacts the health issue greatly among children. Obesity affects the physical and mental health status of children, which place them at risk for developing diabetes, high cholesterol, and high blood pressure. They are psychologically affected as well due to social prejudice and low self esteem.

Children who are overweight are ostracized by their peers. They are socially unaccepted and are mocked causing them humiliation and low self esteem. The circumstances of not being befriended and isolated from the social world in school can contribute to poor mental health status. This can cause further disability in these children.

Taking account the affects obesity has on a child psychologically, we must take into consideration health related concerns that coexist with obesity. With the development of diabetes, high blood pressure, and high cholesterol children are being put in the position of developing further co morbidities in their adulthood. With this occurring there is a great likely hood of health care costs rising, further placing us in a greater deficit. There is a high chance that an obese child would also become an obese adult that faces heart related diseases. This alone can increase hospitalizations and health care costs.

            To prevent the possible increase in costs, interventions must take place. Through the use of primary interventions the increase of the obesity prevalence in American children can be prevented. Primary prevention consists of actions directed at enhancing the general well-being of the public. To achieve this, barriers and challenges must be addressed.  To do this one must understand the causes and related factors of this epidemic. Narrowing the causes can aid in tackling the issue. Such presumed causes are diet, lack of exercise, and low socio economic status.  Research supports the idea that living a sedentary life, consuming high fat and high glucose containing meals increase the chances of morbidity. If the cause is known, actions can take place to minimize access to unhealthy living and encourage healthier choices.

There are many challenges and barriers in tackling the childhood obesity epidemic. Flynn et al. 2006 states “Facilitating preventative action to address childhood obesity is complex” (p. 9).  The first issue is to deal with the discrimination and stigma held against the obese. Many people look down on the obese and place blame on the individual rather than helping them and addressing the root or source of the problem. Secondly there is a need to assess the environment these individuals reside. One can view and connect the disadvantages or disparities that may be factors of obesity. Lastly one must consider the socio economic status of these children. If they do not have the funds or resources to better food choices, then they are placed in the predicament of having unhealthy food choices because they are more available and in reach. Because they do not have the financial means to provide their children with more nutritious foods, those of low socio economic status are more apt to buying unhealthy foods. This financial disparity increases the chances of obesity in low income families.

 Research has shown that the environment manipulates the physical activity of people, “An active lifestyle has direct health benefits” (Lovasi et al., 2011, 1144).  So it is in the society’s best interest to create a walk-able and safe environment that supports and encourages activity and minimize obesity.  If the environment has no parks, trees, or attractions there is greater chance the community in that environment remain indoors and entertain themselves with television or the computer. They are not encouraged to leave their homes and remain sedentary.  People however are more likely to go out and take walks, enjoy the fresh air, and exercise if the environment is pleasant consisting parks, green land, and bike lanes.

Other barriers include education, culture, and trust. With low knowledge and mistrust of the health system many do not seek help nor fully accept the recommendations of their physicians. It is important to build trusting relationships and become culturally competent so that these barriers may diminish. If the families trust their providers, resources can be provided and referrals made to assist them financially. It is important to address and remove the barriers so that the obesity epidemic can decrease.

Researchers believe that education, counseling, motivational strategies, cultural competency, social support, and behavioral reinforcements can make a difference in the behaviors and lifestyles of these children and their family. According to Gallagher, et al. 2010, “ acquiring an understanding of how socio-cultural factors influence eating, physical activity, and degree overweight and/or obese would be important to help better understand the factors that promote or protect against obesity, and assist in formulating culturally appropriate approaches to promoting healthy lifestyles” (p. 177).

Interventions such as the planet health intervention have shown to be effective in the management of childhood obesity. This intervention integrated mathematics, English, history, and physical education. Budd & Volpe, 2006 states “the objectives focused on classroom education and behavioral modification” (p. 486). The goal was to decrease sedentary activities such as television, computer time to less than two hours and increase physical activities as well as decrease fatty food consumption and increase consumption of fruits and vegetables. After two years of using this intervention in schools the occurrence of obese girls decreased from 23.6% to 20.3%.

Another intervention that can restore the health of American children is the involvement of the primary care setting. In this setting obese children can be identified, parents can be educated, and preventative / therapeutic strategies can be established and placed into practice. To go forth with the interventions of identifying, educating, and establishing strategies the primary physicians has to be trained.  Trainings are created to increase the knowledge regarding the assessment of obese children and developing skills in the use of evidence based motivational counseling techniques. The training basically helps the physician according to Ewing 2009, “discussing weight, BMI, healthy eating, and physical activity with parents” (p. 398). 

An intervention that was taken place in the primary care office consisted of eight weekly group sessions for referred children and at least one parent, followed by three monthly individual sessions. The parents would also have short individual coaching weekly. To participate, the child would have been referred by a physician and be between the ages of 8 and 12. To enhance the likely hood or a change in this behavior nurses were also trained to take part in leading the sessions and coaching. The 8 week group intervention focal points were to adopt a healthy lifestyle and pay attention to dietary and physical activity. Participants were to self monitor daily food intake, activity, sedentary behavior, and other behavior changed skills. During these sessions the participants would be educated on nutrition and proper portion sizes.

Seventy three children were enrolled in the five month program. The average weight loss was greatest by the 8th week; however the change in BMI was statistically significant at five months. For those who completed the program, the adaptation of the Epstein et al intervention aided in the reduction of weight and BMI in the pediatric population. Interventions such as this can make a difference and prevent or help manage the obesity epidemic we are facing today. Through education, the family is provided instructions and resources to assist them provide better circumstances for their children

Laws have been passed in certain states such as New Jersey, Massachusetts, Tennessee, and Ohio that address the obesity epidemic. Such laws are the prohibition of sugar sweetened beverages in school vending machines and the required physical education for grades K-12.  These laws are placed to decrease the prevalence of childhood obesity. According to the state legislation report 2011 “president Obama signed the Child Nutrition Reauthorization. This bill will reduce administrative burden associated with school meal programs and improve school nutrition quality standards” (p.43). With laws put into place children are given the opportunity to receive healthier foods in the school environment increasing their chances of better health.

Another governmental intervention is the New York City ordinance banning the sale of large sodas and other sugary drinks holding more than 16 ounces. They include energy drinks and pre-sweetened iced teas, at restaurants, movie theaters, sports arenas and street carts. This ordinance is supposed to help put a stop on obesity. “New York Mayor Michael Bloomberg has said the city spends an estimated $4 billion each year on medical care for overweight people and that the ban is both a health and fiscal initiative”. (Caldwell, 2010).  So to decrease the cost of health care Bloomberg looks to use preventative measures.

Stake holders such as Coca-Cola are against this ban. When the ban was proposed they immediately released a harsh rebuttal to the ban. The company controls 70% of U.S. fountain sales, so if the ban was to pass a huge loss will occur. Coca-Cola, McDonald’s and other beverage industries feel the ban is unreasonable and takes away the freedom of choice.

The supporters of the soda regulations include the American Academy of Pediatrics, Weight Watchers, and Jenny Craig. Health and advocacy programs, including Energy Up! and United Way also support the regulations. These supporters feel that if there were restrictions the epidemic on obesity would decline. The ban will be enforced by the Health Department’s restaurant inspection team. Eateries will have nine months after the proposal is passed to implement changes. If changes are not implemented they will face $200 fines.

There is some evidence to support the idea that having limiting access to sugary beverages in schools works if it is part of a thorough approach. There were a lesser amount of obese children in schools who did not sell soda pops and unhealthy snacks compared to school that did. When the legislation on smoking took place there was a change, there was a significant decline in smoking. People did not want to pay. This is effective because people are making the choice to quit even if it is because they do not want to pay for the cigarettes.  Because these were successful, it is believed the ban on soft drinks can be successful as well.

Stake holders such as politicians, health care providers, citizens, tax payers, schools and schools are affected by the laws and policy recommendations. With the restriction of sweetened drinks being sold in schools, the marketing for the stakeholders of theses drinks decrease affecting them financially. Tax payers and the general public is affected because the right to choose is threatened. The ban on sugary drinks decreases the autonomy of the public. A better intervention could be to tax these drinks. When we assess the socio economic status of those who buy these drinks, we see a correlation. Because these unhealthy drinks are more affordable they invest their money in them. However if we make these unhealthy choices less affordable the choice of buying these items will change.

Schools are affected because they are mandated to place physical activity in the curriculum as well as follow the new policy Obama passed regarding school meals. With policy in place competition can decrease on more focus can be placed on the children and healthier food consumption.

Health providers are affected because more pressures are placed on them to learn different strategies to educate the public and decrease obesity in children. They are given the responsibility to advocate, educate and provide resources to the family so that effective management can be adopted. To successfully do this they are trained to communicate effectively and incorporate the cultural beliefs of the individuals. The goal is to increase compliance and decrease the obesity prevalence in children.

All in all it is important to create new effective strategies to tackle the issue of childhood obesity. With the involvement of policies and laws we see a difference and can acknowledge that they do make a great difference. However when laws are made politicians should take into consideration of the unintended consequences that can take place. If thoroughly thought out using evidence based practice change can occur in a positive manner. Through the incorporation of cultural competency, education, motivation, counseling, and policies the epidemic of childhood obesity can decrease creating a healthier America.

 

 

References

Budd, G. M., & Volpe, S. L. (2006). School-Based Obesity Prevention: Research, Challenges,

and Recommendations. Journal Of School Health, 76(10), 485-495.

Carla Caldwell, September 14, 2012 NYC bans large, sugary soft drinks despite protests from   

Coke, others Atlanta Business Chronicle. Retrieved from http://www.bizjournals.com/atlanta/morning_call/2012/09/nyc-bans-large-sugary-soft-drinks.html

Ewing, L. J., Cluss, P., Goldstrohm, S., Ulrich, R., Colborn, K., Cipriani, L., & Wald, E. R.

(2009). Translating an Evidence-Based Intervention for Pediatric Overweight to a Primary Care Setting. Clinical Pediatrics, 48(4), 397-403.

Flynn, M. T., McNeil, D. A., Maloff, B. B., Mutasingwa, D. D., Wu, M. M., Ford, C. C., &

Tough, S. C. (2006). Reducing obesity and related chronic disease risk in children and youth: a synthesis of evidence with ‘best practice’ recommendations. Obesity Reviews, 77-66.

Gallagher, D., Larson, E. L., Yun-Hsin Claire, W., Richards, B., Chunhua, W., Hametz, P., &

Akabas, S. R. (2010). Identifying Interdisciplinary Research Priorities to Prevent and Treat Pediatric Obesity in New York City. CTS: Clinical & Translational Science, 3(4), 172-177.

Lovasi, G., Jacobson, J., Quinn, J., Neckerman, K., Ashby-Thompson, M., & Rundle, A. (2011).

Is the Environment Near Home and School Associated with Physical Activity and Adiposity of Urban Preschool Children?. Journal Of Urban Health, 88(6), 1143-1157.

State Legislation Report. (2011).  American Academy of Pediatrics. Retrieved from

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