Abstract
Childhood obesity has evolved into a major health and social issue in the modern society. It is one of the leading causes of deaths in the United Kingdom today, directly and indirectly. This paper explains the problem of childhood obesity in the society. The paper begins with an introduction to the situation and some of the major causes and problems associated with childhood obesity. The paper also looks at some of the proposed solutions and an evaluation of the costs of diseases attributed to obesity.
Outline
Introduction
Causes of Childhood Obesity
III. Problems Associated with Childhood Obesity
Intervention of Childhood Obesity
Diagnosis of Childhood Obesity
Solutions to Childhood Obesity
VII. Nutrition
VIII. Physical activity
Medication of Childhood Obesity
Costs of Diseases Attributed to Obesity
Conclusion
Advanced Perspectives of Public Health and Social Policy of Childhood Obesity
Introduction
Childhood obesity is one of the most common health problems affecting children in the world today. The prevalence of childhood obesity has increased considerably since the 1990s particularly in the United Kingdom. For instance, the UK is one of the leading countries in obesity prevalence. This is in regard to cases of obesity among children and adults. This increase is attributed to multi-factorial interaction between family lifestyle and behavioral issues. Childhood obesity is prevalent in children who are as young as two years of age. As of 2009, 23.1percent of children between 4 and 5 years old were obese or overweight. In addition, 33.3 percent of children, between 10 and 11years old were also obese. The numbers are high among teenagers and adults. This implies that obesity develops during childhood and persists into adulthood. In addition, this epidemic is affecting all children worldwide regardless of sex, race, and ethnic lineage. In this respect, childhood obesity is described as the condition where excessive body weight or fats in a child’s body affects his or her well-being. There are various causes, problems, and solutions, as well as the intervention of childhood obesity.
Childhood obesity is determined using the body mass index (BMI) (Bagchi, 2010). The BMI is the measure of the child’s body fats on the basis of his/her weight and height. However, due to the serious of this public health issue, it is interestingly becoming important for all stakeholders in the health care and the society at large to take this health issue seriously. In addition, managing of this public issue requires attention from the children, their parents and the entire family at large. Therefore, those managing childhood should appreciate incorporating and appreciate the complexity of behavioral issues, causes, and effects of childhood obesity. According to the vast majority, obesity is attributed to long term energy imbalance regardless of age. This is the overall energy input from the consumed foods and drinks that exceed the total energy output through physical activity amongst other activities. The growth and development of infants from inception is one of the key factors for the development of obesity later in childhood. This paper examines all aspects of childhood obesity among children of between 0 and 5 years of age.
Causes of Childhood Obesity
Childhood obesity is caused by several factors majority of which are related to lifestyle issues. Furthermore, other factors also contribute to childhood obesity like the genetic factors, socioeconomic status, and physical inactivity. Notably, eating or dietary habits play a crucial part in the development of childhood obesity. This starts from birth and continues in the child’s lifestyle. Currently, parents of newborn infants are limiting the breastfeeding period only to introduce solid foods. There have been imbalances associated with consumption and calorie intake. Children are regularly consuming calories above the recommended daily requirement. This makes them prone to obese if the situation is not timely reversed. This is attributed to many children significantly changing their diets. The traditional healthy foods such as whole grains, vegetables, and fruits have been abandoned. Instead, their place has been taken by fast foods, processed snacks, and sugary drinks (Kazaks & Stern 2012). These foods contain considerable calories and are not nutritious. Apart from consumption and calorie intake, several eating patterns contribute to childhood obesity. These include feeding or eating even when a child is not hungry, overeating and eating while undertaking sedentary activities such as watching television and movies amongst other works.
In addition, the eating or dietary habit is highly influenced by the social economic status. For instance, children from low income families are prone to consuming significant calories due to lack of proper balanced diets. On the other hand, children from high income are associated with fast foods hence consume a lot of calories. Moreover, they are prone to eating while undertaking sedentary activities. In regard to genetics, childhood obesity is linked to heredity. Therefore, this condition runs in families. A child associated with a family that is affected by obesity either from the parent, sibling, or any family relative has a high likelihood of becoming obese. Nevertheless, genetic factors alone have an insignificant contribution to childhood obesity other factors have to come along. Though the genetic factors rarely cause childhood obesity, children under the age of 2 having a rapid gain in weight are at a severe obese risk and becoming hyperphagic (Kipping, Jago & Alawlor, 2008, p. 984-989).
Relative to physical activity, most children all over the world spend almost their entire lifestyle dormant (Bouchard & Katzmarzyk, 2010). They are involved with sedentary activities rather than physical activities. Physical activities are beneficial in burning the excess calories consumed. Physical inactivity is attributed to advancements in technology and parents’ and school’s negligence. Technology has led to the involvement of childhood games mostly video games. This contributes to children indulging and adapting to sedentary activities where they spend a lot of time. Studies have indicated that children spend an average of three hours daily in sedentary activities mainly video games. This has also affected their eating habits and patterns. Parents do not engage in physical activities where this attitude is transferred to their children. Additionally, parents expose children to sedentary activities, which will require little intervention due reduced risks of physical injuries and limited child disturbance. Schools have also neglected children in terms of diet and physical inactivity contributing to children becoming obese. Apart from homes, schools are the second place where children spend most of their time (Stanley 2008). Currently, the majority of parents enroll their children in schools or child care centers at an early age. In addition to this, body functioning and medical issues also cause childhood obesity although very rarely. These include chemical or hormonal imbalances and metabolism disorders (Korbonits, 2008). Infants and young children considered obese coupled with small stature should consult a pediatric endocrinologist. This is meant to check out the possibility of endocrine causes attributed to childhood obesity like hypothyroidism, hormonal deficiency, pseudohypoparathyroidism and Cushing’s syndrome (Korbonits 2008).
Problems Associated with Childhood Obesity
Recently, there are many problems mostly health problems related to childhood overweight and obesity, which were unheard in children during the past decades. As described by the WHO, these include diabetes, heart diseases, hypertension problems, cancer, arthritis and breathing complexities amongst many others. Childhood obesity results in type 2 diabetes. From ancient times, this diabetes was only prevalent in adults (Hearnshaw & Matyka, 2010, p. 947–957). However, the prevalence of childhood obesity has caused type 2 diabetes a common health problem in children (Hearnshaw & Matyka, 2010, p. 947–957).
Obesity has been termed as a major contributor to heart problems and failures among children. Atherosclerosis is one of the most severe heart diseases attributed to childhood obesity. This is health issue where fats, cholesterol, and cellular waste layers collate along the inner linings of the arteries. Therefore, the blood flow rate in the heart is affected leading to heart failure and diseases among children. As for breathing complexities, childhood obesity contributes to this by affecting the growth and development of children’s breathing systems, especially the lungs. Childhood obesity is also linked to some physical and psychological problems. For physical problems, obesity creates hormonal imbalances in children, which can have effects on the puberty/menstruation periods. Furthermore, it can contribute to metabolic syndrome. This is a series of condition, which put a child at risk of developing medical problems. Lastly, childhood obesity contributes to psychological problems including low self-esteem, depression, and poor learning behavior (Davies, Fitzgerald and Mousouli, 2007).
Intervention of Childhood Obesity
Measuring of weights and heights of children regularly is of much significance in identifying the growth problems leading to obesity and health plan interventions to control childhood obesity (Poskitt & Edmunds, 2008). The health care practitioners are recommended to carry out opportunistic measurements in children regarding their weight. Afterwards, they are recommended to discuss this issue with children’s parents and other stakeholders such as the child care facilities and schools. Evidence has revealed that the majority of parents lacks the ability to recognize weight problems in infants and young children. This is attributed to negligence, little knowhow or limited time with children. Currently, most parents are tied to their commitments and have little or no time for their children. In turn, children are left under the care of caregivers and are also enrolled early in schools (Stanley 2008).
Therefore, medical practitioners especially child specialists and nurses are the first point of reference to parents about children weight issues. For this reason, it is required that these practitioners should have the relevant knowhow pertaining to weight issues like gain and loss and its impact. In this regard, they will be able to discuss and advise parents in a sensitive, empathetic, and the nonjudgmental way. In this case, parents react differently about the results of their children’s health, particularly obesity. Some of the parents may be shocked to find their children are obese. Reid (2009) revealed that certain terminologies used to describe childhood obesity and overweight like unhealthy weight give most parents some relief while discussing the child’s well-being with health practitioners. In addition, parents dislike topics that are judgmental or point at mostly on parenting like dietary issues. It is crucial to point out that, the medical practitioners handling infants and young children know the management services and referral criteria besides weight and obesity issues. On the other hand, parents and child caregivers should be acquainted with a healthy lifestyle in order to be good role models to the children.
Diagnosis of Childhood Obesity
A diagnosis of childhood obesity requires evaluation of the body fats with respect to its health impacts. The proxy measure of childhood obesity, BMI, is widely recognized as the best diagnostic measure for childhood obesity (Bagchi 2010). BMI is calculated by dividing weight in kilograms over height in meters. Nevertheless, when this measure is used for children, it has a clear meaning when calculated correctly based on age and sex profiles on the control charts. In the UK, all the medical practitioners dealing with childhood obesity should incorporate the BMI centile charts in the diagnosis, monitoring, as well as managing childhood obesity. These BMI profiles are accessible and available from the Harlow Printing. The 1990 UK guidelines about obesity recommended use of 98th centile or above in the BMI charts for obesity diagnosis whereas 91st centile for overweight diagnosis (Webster-Gandy, Madden & Holdsworth 2012). Most notably, the UK standard practices recommend the use of the World Health organization (WHO) growth charts in diagnosing of children of between 0 and 4 years old. The WHO growth charts contain an automatic conversion calculator for BMI centile charts where the child’s weight is plotted against his or her height. Like other methods, the WHO BMI method for obesity diagnosis are also prone to some degrees of error. Therefore, when calculating for childhood obesity and overweight, the BMI is first calculated followed by plotting on the BMI charts.
Solutions to Childhood Obesity
Nutrition
Nutrition plays a crucial role in the healthy development of infants and young children. As already mentioned, malnutrition has contributed to childhood obesity. This shows that the nutritional needs of infants and young children have not yet been met. The provision of balanced nutrition to children starts during the pregnancy period through to baby feeding, weaning, and eventually childhood development.
In regard to pregnancy, studies have proposed that even fertilization begins, and conception follows the parental nutrition influences the healthy growth and development of children in the long run. Women who have attained the age of child bearing should abide to a proper balanced nutrition in their lives. This would help to optimize the maternal health and minimize the risks associated with birth defects, substandard fetus development, and chronic problems that may occur in the first and subsequent offspring’s. A good and healthy lifestyle based on pregnancy period is characterized by the consumption of balanced nutritional diets and safe handling as stipulated by the Food Standards Agency. This includes appropriate and timely intake of mineral and vitamin supplements like vitamin D, gaining appropriate weight and adequate physical exercise (Food Standards Agency (FSA), 2008a).
Relative to the early child’s life, a balanced diet coupled with good feeding habits and patterns is a core to the child’s healthy growth and development. The nutrition status of a child has been seen as beneficial to the health well-being both in the early childhood years and the future. However, recent studies have revealed that the majority of infants worldwide are not entitled to balanced diets that provide the required nutrients adequately. Later on, this is replaced by huge energy intake that accelerates childhood obesity to high levels. For instance, the UK hospitals recorded children with different health problems related to nutrition 16 percent had stunted growth, 14 percent muscle loss while 20 percent were at risk of secondary malnutrition triggered by metabolic stress (Underdown, 2007).
As far as breastfeeding is concerned, this is considered the best and most important aspect of infant feeding. Health care policies particularly in the UK highly recommend exclusive breastfeeding of infants for the first six months of their lives (Underdown, 2007). Afterwards, breastfeeding is continued to specified durations based on the mother and baby’s wish. It is during this moment that solid foods are gradually introduced. Most studies have shown that babies breastfed appropriate for the recommended duration of the first six months have high chances of becoming obese (Underdown, 2007). As a result, the child is prone to suffering from health problems like colic, constipation, diarrhea and other diseases related to childhood obesity. Breastfeeding helps to build up infant immunity thus preventing the development of certain diseases like diabetes (Hearnshaw & Matyka, 2010, p. 947–957). However, there are no proves that breastfeeding helps to minimize the incidences of cancer and leukemia. In addition, there is no correlation that has been shown to exist between cognitive development and breastfeeding. Furthermore, studies have indicated that the breast milk lacks all the required nutrients to trigger full attainment of the required energy level by the sixth month. This factor predisposes infants to nutritional disorders.
Sometimes, infants and young children are fed with infant formula exclusive as an alternative or part of their breastfeeding regimen. These infant formulas contained protein content closely related to natural breast milk. Moreover, the formulas are regarded as safe and having adequate nutrients for infants. On the part of infant growth pattern, the infant formulas and natural breast milk show considerable difference. This is attributed to the fact that the natural breast milk’s composition changes in order to accommodate the needs of the infant during the entire lactation period. This is opposite to the infant formulas, but there has been suggestions of changing them in the same manner in order enhance their efficiency in promoting infant growth and development. Natural breast milk contains docosahexaenoic acid (DHA) and arachidonic acid (ARA) as the two essential fats. These fats are of much importance in the cognitive development, central nervous, intellectual and visual systems. Adding supplements with either or both DHA and ARA in the infant formulas has yielded poor results.
Feeding infants with the natural breast milk is considered the safest and offers the best nutrition to the infant. In accordance with a survey done in the UK, 78 percent of mothers breastfeed their babies immediately after birth onwards. However, the number decreases to 50 percent as the sixth week approaches (Underdown, 2007). This number goes down because of the reduced maternal age, educational attainment, and socioeconomic status. Peer educators are required to sensitize mothers about breastfeeding for the recommended first six months in order to overcome this massive campaign by health practitioners.
In regard to transition from breastfeeding to solid foods-weaning, proper nutritional diet should be adhered to completely. However, this balanced diet is dependent on the individual children and their nutritional status based on their own personal needs. Weaning is recommended to begin after the recommended breastfeeding period. This is the period covering the first six months. On the contrary, weaning can be considered for the fourth month if the breast milk is not meeting or satisfying the child’s appetite and nutritional status. In such cases, parents should first seek advice before incorporating solid foods. Weaning is strictly prohibited for premature babies or those that are under three months old. This is attributed to the fact that weaning at this time can result in adverse consequences on the health of the child particularly the immune system. In turn, this makes the child vulnerable to diseases. Emerging studies have challenged the idea of introducing solids strictly after the six months. Instead, these studies emphasize on the introduction of solid food in smaller portions gradually when a child is four months old onwards rather than larger amounts after the breastfeeding period. Based on their perspective, this minimizes the risk of the infants developing diseases like the insulin based diabetes and allergies.
The choices of solid foods introduced in the specified stages of weaning vary depending on the child’s developmental requirements. For example, solid food requiring chewing and biting are crucial in helping the child develop muscles relevant for speech. On the other hand, the introduction of the solid foods is also determined by the textures and tastes of the foods. Studies have revealed that introducing of lumpy solid foods after the child is nine months old is dangerous and can lead to feeding problems like food refusal and fussiness (FSA, 2008b). The FSA recommends the use of home cooked solid foods during the weaning period. However, commercial foods may also be incorporated. The food incorporated should correspond to the family lifestyle.
Since weaning takes place gradually, the child may eat a wide variety of solid foods. However, some foods are prohibited due to their adverse effect on health. These include mostly sugary foods and high sodium intake. Sugar is not recommended in drinks, and whenever given, it should be added in small quantities (Kazaks & Stern 2012). Honey is totally prohibited to children till they are past one year of age. Honey is said to contribute to food poisoning (Kazaks & Stern 2012). On the other hand, high sodium intake contributes to hypertension risk in children. For salt requirement, one gram of salt daily is recommended for infants during the breastfeeding six month period. This is hard to quantify since the child is only fed using the breast milk. Besides, this can be achieved by mothers sticking to the use of natural herbs and lemon juice as an alternative for salt while cooking. Moreover, if they are using salt, no salt should be added after the food is already cooked. Other foods that should be avoided during breastfeeding and weaning period include cooked eggs and whole nuts due to risks of allergies. Recent studies have revealed that a child is at the risk of vitamin deficiency like iron during the transition from breastfeeding to weaning. This can be serious since deficiency of vitamins and iron hampers cognitive development (Smith, 1999).
In respect to the rising trends in childhood obesity, offering of healthy foods to infants and young children during weaning is a big step towards eliminating or reducing risks of obesity. Thus, the period when the child acquires the taste and food preferences that he/she accommodates during the growth period. The controversy about introducing solid foods related to lower fats is of primary concern. In this case, foods with lower fat levels limit the growth and development of infants and young children. On the other hand, high fat levels may lead to childhood obesity if proper care is not taken. Therefore, guidance is required in this area. In regard to fluid intake, no other extra liquid apart from cooled boiled water is required for a breastfeeding infant (Smith, 1999).
Parents should be critical in developing food preferences, as well as energy intake for their children. Evidence has revealed that parents who apply force in determining what and how the children feed enhances childhood obesity in later life (Connor, 2007). Additionally, schools also play a vital role in controlling or promoting childhood obesity. The early preschool years for a child are considered stage of growth and development. Young children usually learn through copying what their peers are doing. In this respect, children acquire the long term behavioral habits they possess later in life. Like other behaviors, feeding habits and patterns are also developed during schooling. In the UK, there are mandatory the set standards for food served in schools. Therefore, the UK government set up a School Foods Trust in 2005 to support the local education authorities in meeting the required nutritional standards for children under their care (O’Brien, 2008, p. 103-105). Most of evidence based on research has proved that awarding a nutritionally balanced diet throughout childhood help in improving both behavior and lifestyle of children at school (Connor, 2007).
In addition, it has been found that the packed lunches brought by children from home to school have low nutritional standards than the foods served in schools. This portrays the need of sensitizing parents about the components of a healthy diet. Therefore, guidance is provided both to parents and schools from the School Food Trust (Connor, 2007).
Physical activity
Physical activity is highly encouraged in children and adults at large. This helps to burn out the excess calories in the body. It can be used as a measure to prevent and minimize obesity. Relative to minimizing childhood obesity, the obesity guidelines recommend a vigorous physical activity for at least 1 hour daily throughout the week. The UK guidelines based on the Department of Health recommend vigorous physical activity for children under the age of 5 years (Department of Health (DH), 2004). The physical activity should be enhanced from birth onwards using the ground, as well as water based activities. For infants and young children with the capability of walking alone, they should be subjected to 3 hours of physical activity regularly over the week. However, reports indicate that chances for children to involve in physical activities within the UK and the whole world are decreasing. This has been attributed to substitution of walking by car journeys. Many children travel to school by using cars. To improve the health of children by totally eliminating obesity, physical activity should be highly encouraged. This will involve family efforts, school and the entire society at large (Bouchard & Katzmarzyk 2010).
Medication of Childhood Obesity
Medical care can be a source of relief for obese children. Childhood Obesity medication has its own benefits and risks. All the obesity medications work to decrease the appetite. The benefits present is usually short term, and mainly include weight loss. This benefit is a big boost in eliminating health problems associated with obesity. Their impacts in the long run are not known. On the part of risks, obesity medications have side effects, which vary depending on the drug (Hearnshaw & Matyka, 2010, p. 947–957). Some have adverse side effects and are usually avoided. Appetite suppressants lower the appetite by raising the levels of brain chemicals, serotonin and catecholamine’s that affect the appetite and mood. They include meridia and phentermine. However, there are some other appetite suppressants to avoid due to their adverse effect such as fenfluramine and dexfenfluramine. These are closely related to drugs that affect the level of serotonin in the brain. Other potential risks include abuse and tolerance of the medication. Tolerance develops when a drug reaches its limit of effectiveness. Additionally, surgeries are also risky and are recommended as the last option when nothing else can be done, but they are totally prohibited for infants and young children. Bagchi (2010) elaborated that BMI measurements are relevant in helping one to choose the appropriate medication.
A study by Golan and Crow (2004) compared the efficacy of a family-based approach to the treatment of childhood obesity between different groups of children. Both studies focused on a change in lifestyle over a term of one year. In one group of children, their parents supported the children by acting as the children’s role models. On the other hand, the other group of children did not have their parent’s support as role models. The studies showed the reduction in the children’s weight was 29% in the parent-supported group as opposed to 8.1% of the children-only group. As a result, it is clear that parents play a key role in controlling obesity. Parents who set time with their children sit down for meals together can help integrate a healthy diet and encourage good eating habits. In addition, school-based BMI screening is also necessary to control childhood obesity. Additionally, a study done by Madsen (2011) asserted that notifying parents about their children’s BMI results played a part in reducing obesity.
Costs of Diseases Attributed to Obesity
Cases associated with obesity and overweight have consumed a lot of time and money to overcome. As mentioned above. There are many diseases amongst other disability related to childhood obesity. Several death cases have been experienced associated with childhood obesity. As of 2003, the cost of diseases associated directly or indirectly with obesity and overweight was £3.23 billion. Amongst this cost associated with diseases emanating from obesity, heart related diseases had the largest proportions. Ischemic stroke costs were £983 million, followed by coronary heart disease at £773 million, and hypertensive disease at £576 million. The other big costs were related to diabetes mellitus, which stood at £533 million (Andersen 2003).
In terms of the burden of diseases triggered by obesity and overweight, the heart diseases had the largest contribution. The coronary heart disease accounted for 2.3 percent of all disability adjusted life years (DALYs) recorded with ischemic stroke next with 1.8 percent. The burden of diseases-DALYs lost due to obesity was higher in women with 7.8 percent than among men at 6.9 percent. The huge difference between them was brought by cancer of which breast cancer and uterus cancer where the main burden among women. The burden of disease amongst women and men was also high. In fact, for women with type 2 diabetes, stroke, hypertensive disease and osteoarthritis, it was higher than the others. However, men recorded higher burden of disease in respect coronary heart disease than women. In considering the rates for the disease burden due to obesity using the 2003/04 mortality figures, over 203,000 deaths were witnessed in the UK attributed to diseases related to obesity and overweight either directly or indirectly. Furthermore, of the estimated deaths of 66,737 deaths were directly linked to obesity. Here, over half (54 percent) of these deaths were attributed to coronary heart disease while 31percent of stroke (Great Britain, 2004).
Conclusion
Childhood obesity remains an issue of great concern globally. A considerate number of infants and young children are obese or overweight. This is caused by various factors attributed to lifestyle and behavioral issues. The majority of children becomes obese due to poor eating or feeding habits and patterns, especially during the critical weaning period. Moreover, physical inactivity is also at the center stage of enhancing childhood obesity. Children’s parents besides other stakeholders are held responsible for childhood obesity. BMI is a necessity in measuring the degree of childhood obesity as well as initiating its control and medication. BMI plotting is significant in the identification of trends regarding the childhood obesity. Lifestyle change through healthy dietary and physical activity has more benefits than harm. First of all, there are no side effects involved. Nevertheless, it calls for considerable attention in terms of time and money. Parents play a key role in controlling obesity, but most of them are held by their busy schedules and tend to forget their children. Setting time with children can help integrate a healthy diet and encourage good eating habits, as well as physical activity. In addition, lack of funds to buy natural foods limits lower income earners to poor unhealthy diets. Incorporating BMI in lifestyle changing can help one determine the quantity of food to consume, and the extent of physical exercises.
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