Han et al. (2010) identified that the global prevalence of childhood obesity has significantly increased over the last ten years. Story et al. (2009) note that adolescent obesity as a significant global challenge for health in the 21st century, noting that the prevalence in the United States had ‘quadrupled from 1966 to 2003-2006’. In the United States, the Centre for Disease Control postulates that the American society has become ‘obesogenic’ (CDC website). Moffat (2010) notes that as early as the beginning of the twenty first century the ‘obesity epidemic’ was legitimately acknowledged as both a medical and societal problem. Health professionals continue to sound the alarm that obesity is a serious health concern for children and adolescents and places them at risk for a myriad of health problems, not only during their youth but also as adults. Freedman et al. (2007) posit that childhood obesity increases the risk for cardiovascular disease during adolescence and adulthood. Further to that, they went on to argue that outside of the health risks that childhood obesity poses, the magnitude of the problem is often overlooked from the economic costs perspective. Trasande and Chatterjee (2009) noted that in 2009 in the United States, increased health-care and utilization and expenditures were concentrated among adolescents. They went on to underscore that the ‘immediate economic consequences of childhood obesity are much greater than previously realized’ and emphasized that there needs to be continued concerted efforts made to reduce the burden of this major co-morbidity. The burden is not isolated to just childhood and adolescence as Serdula et al. (1993) purport the view that obese children and adolescents are more likely to become obese as adults, a view later reinforced by Whitaker et al. (1997). In one study they identified that it was estimated that eighty percent (80%) of children who were overweight at aged ten to fifteen years were obese adults at age twenty-five. In a subsequent study Freedman et al. (2001) found that twenty-five percent (25%) of obese adults were overweight as children.
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Moffat (2010) notes that a number of studies conducted in the United States indicate that there exists an association between childhood obesity and low household income and food insecurity. As a result, she notes that children of low socio-economic status are the ones who bear the brunt of the obesity epidemic. It is also well documented that there is a higher prevalence of childhood obesity among ethnic minorities and immigrant children. Gordon-Larsen et al. (2003) and Sorof et al. (2004) noted that the prevalence of obese children was higher among Hispanics and African-Americans, who predominantly made up the low socio-economic status bracket of the United States.
Poverty in the United States is highest among children, 20% of all children in the United States live in poverty, Kotch (2005), and consequently if poverty serves as a risk factor for obesity, they are going to be the population most affected. It is important to note that while at-risk populations are relatively easily identified, the very factors contributing to the obesity epidemic remain complex and not well understood.
Basch (1999) identifies poverty as the single underlying cause for most diseases in the world today. Kumanyika & Grier (2006) argue that low income communities or households may find it increasingly difficult to provide the resources or funds needed to provide children with nutritious meals or opportunities for sufficient exercise. The availability, affordability and appeal of foods that are low in nutritional value, but high in fat, sugar and calories, means that those in the lower socio-economic bracket find it easier to afford that meal plan. Further to that, persons in the low socio-economic bracket do not have access to food stores that sell healthy foods. In the United States, Powell and Chaloupka (2009), note that while the prices for low nutrition foods have been decreasing over the past few decades, the cost for healthy foods has been increasing, directly impacting the food options for the poor.
Poverty affects not only the eating habits of minority groups but also influences their physical activity. Children, who live in poor households, normally live in poor or low income communities with crowded streets, marked by a lack of safe outdoor space or facilities in which they can play, Dwyer et al. (2006) and Franzini et al. (2009). A lack of physical activity or even a decrease in physical activity, coupled with increased fat and calorie intake are factors that can influence weight and lead to obesity in children.
Other researchers, while they concur with the view that low socio-economic status is a determinant of childhood obesity, they go to note that other cultural and environmental factors exist, (Gordon-Larsen et al. 2003; Wang et al. 2007). Culture as a contributing factor must be considered in terms of its ability to influence behavioural patterns. Earlier arguments posited on stigmatization of excess body fat. However, children and adolescents in ethnic minorities find excess body fat and obesity to be less stigmatizing and less associated with a dissatisfaction of body types, Stice et al. (2006). Further to that, among Hispanics for example, a situation with which we can identify in the Caribbean, children who are small are considered to be sick or malnourished. In other low-income communities, such as African Americans, thin is associated with drug addiction or poverty, Jain et al. (2001). Here we see the stigma being attached to thin or small body types, creating an environment where obesity is acceptable, even preferred.
Further to that, societal changes have also led to an adoption of sedentary lifestyles; a lifestyle that often times appear to be more pronounced among the minority groups. They are found to own more televisions than non-ethnic minority children and consequently spend more time watching television, and being exposed to advertising for high fat diets, Kain et al. (2004) and Kumanyika and Grier (2006).
Having had discourse on the causes and aetiology of obesity in children and adolescents, identifying it as epidemic in the United States with long term implications for health, the question on prevention becomes more pertinent and leads to the identification of interventions. From the ongoing debate it seems that prevention of childhood obesity needs to incorporate a change in societal status, change in behavioural and cultural patterns as well as addressing the biological factors of obesity.
McClaskey (2010) notes that with the increasing prevalence of childhood obesity in the United States, efforts at prevention must aim at protecting children, especially the vulnerable groups. She noted that some health centres in the US, are employing the use of a modified version of the national obesity programme ‘We Can’, to implement childhood obesity clinics, in an effort geared at reaching an underserved patient population. From the literature reviewed, it seems that while physicians are aware of the growing epidemic and its implications for health, Hall (2010) found that few actually initiated interventions on weight management with children. The impact of obesity among children and adolescents on morbidity, mortality and cost for healthcare, means that there is a need to engage not only the at-risk groups, but physicians as well on the need to overcome barriers to the resolution of this public health concern. Foremost in prevention and intervention is the need for education as relates to the development and management of obesity. Healthcare professionals can and should be used in health promotions.
The Institute of Medicine recommends that prevention of obesity should be encouraged in children and adolescents by ‘tracking patients’ BMI, providing evidence-based counselling, and having healthcare teams act as role models’, (IMO, 2005). This they argued, provides the opportunity to identify persons at risk and to provide opportunistic lifestyle advice, as well as provide pro-active care such as referral to a nutritionist or other actions geared at improving the nutritional and physical activity habits of the identified children.
Hebebrand (2010) notes that efforts aimed at prevention should seek to incorporate the schools as ‘school settings have proven important for health behaviour interventions.’ Such interventions in the US have seen the removal of vending machines from school compounds as well as prohibiting sale of sodas to reduce the consumption of sugar-sweetened beverages. The food industry in the United States has also responded to the need to modify diets by making products lower in caloric density. They have also developed foods with components claimed to assist in weight loss, (Gaullier et al. 2005)
Roberto et al. (2010) noted in a study conducted, that children’s snack preferences can be influenced by the use of licensed characters such as Elmo being placed on the packages. As a result, they concluded that as a means of reducing childhood obesity, licensed characters to advertise junk food to children should be restricted.
One of the most notable arguments for prevention indicates a need for prevention to begin in the early stages of the life of a child. Aranceta et al. (2009) underscore the need for the adequate nutritional status of the mother during pregnancy. At the community level, education on nutrition has been incorporated into the maternal care given to women. It serves to ensure their nutritional health as well as the future nutritional health of the infant.
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In 2009, First Lady Michelle Obama joined the campaign to fight childhood obesity. Her Let’s Move Campaign is seeking to raise the nutritional level of school meals and improve access to healthier foods in deprived communities. That campaign has seen the inclusion and use of mobile food markets, in states such as Virginia. Further to that, parents are encouraged to enrol their children in extra-curricular activities. President Obama has also called for an additional one billion dollars to fund child nutrition programmes.
Champions for Change, another campaign group, is advocating making changes in kitchens, homes, schools and neighbourhoods across America. It purports the need for ‘more fruits and vegetables, more activity, which means less television, and more voices raised for healthy changes’.
Against this backdrop, from a public health perspective primary prevention of childhood obesity requires a population-wide approach that is multifaceted and that aims at promoting healthier eating practices, an active lifestyle and access and provision of care to children to ensure early detection of risk and thereby increase prevention.
In 2004 the WHO approved the Global Strategy on Diet and Physical activity, encouraging all of its member states to develop and implement national action plans aimed at a reduction in obesity rates.
Obesity, as previously noted, can have adverse health, social and emotional effects. It also increases the risk among adolescents for disability and premature death as adults. Story et al. (2005) notes that there are metabolic and physiological abnormalities associated with adolescent obesity, hypertension, dyslipidemias, orthopedic problems and type 2diabetes. Cowie et al., (2006) Ogden et al.(2006) and Reininger et al. (2009) have all documented findings that postulate that in the United States, underprivileged Hispanics have excessively higher rates of type 2 diabetes, obesity, cardiovascular disease, and cancer as compared to whites; diseases for which obesity has been noted to be a risk factor. The life-long consequences of this rising epidemic are or should be a serious concern for health planners. Increased morbidity means increased utilization of health service, increased supply of health care for example pharmaceuticals, which translates into increased cost of healthcare and notably, the at-risk population is the one least likely to be able to afford access to the required health services. That places an additional burden on social security.
Research suggests that obesity-related chronic diseases previously found in adults such as hypertension and osteoarthritis are now appearing in minority children (Frenn et al., 2003; Kumanyika & Grier, 2006; McCarthy et al., 2008). Therefore, addressing obesity during childhood, particularly in ethnic minority populations, is a priority in preventing escalating co-morbidities in adulthood and the adverse health outcomes associated with such co-morbidities.
A review of the plethora of literature that deliberates on the topic childhood and adolescent obesity presents not solutions to this growing epidemic but points to a need for continued research aimed at identifying effectual prevention interventions for that age group. It highlights a void in the data on socially accepted, sustainable, and culturally appropriate interventions for the at-risk population, minority groups. All of these possible interventions, if they are to be successful, can only be integrated into mainstream society if they are a part of a coordinated system that includes multi-sectoral participation and involvement of all of the stakeholders.
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