By Olor
INTRODUCTION
Childhood obesity is an issue that is increasing as regards the child’s health and wellbeing. It is defined as a body mass index (BMI) that is above or at the 95th or 98th percentile in children of the same sex and within same age range (Centre for Disease Control, 2009; Dietz, 1998). The BMI of children within the age of 2-19 and is plotted to check for the percentile that corresponds with the child sex and age (Chanfreau et al., 2016; Centre for Disease Control, 2009). Childhood obesity is however caused by an imbalance in energy expenditure; that is to say, ingestion or accumulation of more energy (usually through foods and drinks) than the energy expended through physical activities, which has various health benefits that includes strength of the bones & muscles, enhanced sleep quality, healthy weight maintenance, etc. (Start Active, Stay Active, 2011). To back this up, Public Health England in 2014 and Chanfreau in 2016 reported that physical activities and participation in school clubs and sports is related to improved academic performance (Public Health England, 2014; Chanfreau et al., 2016).
It is thus complicated to define obesity and overweight in children and adolescents because their height is still increasing likewise the change in the composition of their body overtime. However, various references and measurements such as “weight-for-height”, thickness of skinfold as well as percentiles of their Body Mass Index (BMI) have been in use (Huang & Chan, 2009; World Health Organization, 2000a). In recent time, there have been an increase in the acceptance of BMI as a credible indirect measurement of children and adolescent obesity (Cole, Bellizzi, Flegal, & Dietz, 2000; Wang, 2004).
Childhood obesity burden is more prevalent in children from backgrounds with low income and the rate of childhood obesity in this area most deprived is rapidly increasing (Health and Social Care Information Centre, 2015; Goisis, Sacker, & Kelly, 2015). Children within the age of 5 that hail from low-income regions/groups are however two times more likely to become obese as compared to those from the well-to-do regions/groups; and three times more likely to become obese at 11 years of age (Goisis et al., 2015).
Historical/Present Overview
Obesity generally has been an issue of public health, which globally has become an epidemic amongst children and adult. The World Health Organisation factsheet of 2009 stated that by the year 2015, about 2.3 billion people within the ages of 15 and above will be overweight. Also, globally they would be over 700 million people obese (World Health Organisation, 2009).
Countries such as Germany and United Kingdom that are developed have in the past era experienced a decline in the rate of the prevalence of obesity; the prevalence of obesity however remains on the rise in many other parts of the universe such as the United States and likewise regions of Asia Pacific (Gill, 2006; Low, Chin, & Deurenberg-Yap, 2009). For instance, the cohort studies of the Asia Pacific in 2007 revealed that the cumulative prevalence of obesity and overweight did increase by 43%, it was recorded that Japan from the year 1976-1980 had a 16.7% prevalence rate which increased to 24% in the year 2000 and a 414% increase recorded in China from 3.7% in the year 1982 to 19% in the year 2001 (Asia Pacific Cohort Studies Collaboration, 2007).
On the other hand, the studies of Mercedes, Monika & Elaine revealed that as at 2010, childhood obesity was estimated to affect 43 million children globally; 35 million of this population were in developing nations. 92 million of children were also estimated to be at risk of being overweight. The study further revealed that the prevalence of obesity and overweight in children has increased globally from 4.2% in the year 1990 to 6.7% in 2010. An increase of up to 9.1% is expected in the year 2020. In Africa, as at 2010, childhood obesity and overweight was estimated to be 8.5% and is expected to get up to 12.7% by the year 2020. Also, 4.9% prevalence rate was estimated in Asia in same year. The prevalence of obesity was believed to be lower in Asia than Africa but in Asia, the rate of children affected by obesity is higher and estimated to be up to 18 million (De Onis, Blössner, & Borghi, 2010).
Various studies such as the studies of Brown et al and Guh et al exhaustively described obesity and overweight as the key factors resulting in comorbidities which includes diabetes (Type II), various cancers (example cancers of the oesophagus, colon, pancreas, etc.), cardiovascular disease as well as some other health related issues which could result in mortality and morbidity (Brown, Fujioka, Wilson, & Woodworth, 2009; Guh et al., 2009).
This issues substantially impacts on the costs of related health care. Figuratively, various studies described this associated health care cost of countries such as the Unites States which accounted for 1.2% gross domestic product costs, linked to obesity (Yach, Stuckler, & Brownell, 2006); Europe has spent about 10.4 billion euros on health care relating to obesity and a relative economic burden of about 0.09%-0.61% gross domestic product was reported (Müller-Riemenschneider, Reinhold, Berghöfer, & Willich, 2008); China on the other hand attributed an overall medical cost of obesity and overweight to about 2.74 billion USD, which in 2003 accounted for an overall medical cost of 3.7% nationally (Zhao et al., 2008). Also, Canada attributed 66% of the estimated 6.0 billion USD total direct care costs to obesity which corresponds to the 4.1% total health care expenses in 2006. Also, if comorbidities related to obesity was included, the cost would increase by 25% (Anis et al., 2010).
Furthermore, in the United Kingdom according to the estimated National Health Service (NHS) healthcare costs by Scarborough (2001), an expenditure of 5.1 billion pounds was recorded in relation to obesity and overweight as at 2014 and 2015 (Scarborough et al., 2011).
AETIOLOGY (CAUSES) OF CHILDHOOD OBESITY
The aetiology of overweight and obesity is multifactorial and involves complicated interactions amongst genes & hormones as well as various factors that are either social or environmental (Who & World Health Organization, 2003; World Health Organization, 2000b).
Nutrition transition (a shift in the dietary pattern of individuals) is considered a key cause for the epidemic of obesity due to wealth and urbanization as documented by various literatures (Popkin, 2001; Who & World Health Organization, 2003). Globally, the key dietary changes in recent time includes diet high in energy density, that is high in fat and added sugar, more intake of saturated fat from animal sources, less consumption of carbohydrates (complex) and fibre (dietary) as well as low consumption of fruits and vegetables (Madanat, Troutman, & Al-Madi, 2008; Popkin, 2001; Who & World Health Organization, 2003; Zhai et al., 2009). This change in nutrition is associated with change in the lifestyle of the individual, thus the lack of physical activity at leisure time (Popkin, 2001; Poskitt, 2009). Again, a lack of physical activity in an individual is a vital risk factor of obesity in people of all age groups (Baba, Iwao, Koketsu, Nagashima, & Inasaka, 2006; Brock et al., 2009; Yang et al., 2007), as physical activities have been over shadowed by viewing of television, playing video games etc. (Popkin, 2001; Poskitt, 2009).
Further drivers of obesity are numerous, with complex issues and they include: Individual behaviours, environments, cultures, as well as hereditary which is as a result of energy imbalance (Chanfreau et al., 2016).
Individual Behaviours
Some individual behaviours can lead to childhood obesity. For instance, children tend to consume more energy from sweetened foods and beverages of which the calories gained are not appropriately utilized via physical activities, thus resulting in weight gain due to the energy consumed being greater than that expended (Chanfreau et al., 2016; Center for Disease Control and Prevention, 2009). The Center for Disease Control and Prevention (CDCP) further explained that a sedentary lifestyle is a key factor of obesity generally. Because various children spend more time watching Television and eating more food and beverages high in energy and packed with sugar than involving in physical activities such as walking, biking, etc. Also, television advertisements of most energy rich foods and sugar rich beverages affects their choice of a healthier diet; obesity and overweight therefore becomes the result of their unhealthy food choices (Chanfreau et al., 2016; Center for Disease Control and Prevention, 2009).
Hereditary/Genetic
Obesity in in children can also be caused by certain factors that are genetic. This factors increases the susceptibility for a child to be obese by influencing the body’s metabolism through the change in the content of the body fat, energy intake and energy expended. Also, inheriting parents’ obesity influences childhood obesity (Chanfreau et al., 2016; Center for Disease Control and Prevention, 2009; Pérusse & Bouchard, 1999).
Environmental
This is a factor that surround the child as well as influences their choice of food and drinks, likewise their physical activities (Chanfreau et al., 2016; Mercedes, Monika & Elain, 2010; Center for Disease Control and Prevention, 2009). Environmental factors occur in places such as homes, schools, places of worship and the community.
HEALTH ISSUES ASSOCIATED WITH CHILDHOOD OBESITY
Various health issues are related to childhood obesity which at adulthood results in health hazards. Associated health issues of obesity in children are not just physical, they are also social and psychological issues (Chanfreau et al., 2016; Griffiths et al., 2010; Huang & Chan, 2009).
POLICIES/ STAKEHOLDERS
To develop and implement sustainable prevention strategies for obesity, related interventions should be able to target risk factors that contributes to obesity as well as target the barriers of change in lifestyle at individual, cultural and environmental levels. Also, stakeholders should be involved at various levels (Chan & Woo, 2010). To this regard, Sacks (2009) proposed a framework suggesting that policy actions for developing and implementing an effective public health strategy to prevent obesity should include:
- Targeting environments such as food (so as healthy food choices becomes an easier choice), socioeconomic and physical activity (so as to decrease sedentary lifestyle by facilitating high levels of physical activities).
- Influence behaviour directly aimed at influencing physical activity and eating behaviours in an individual, and
- Supporting medical interventions and health care services (Sacks, 2009).
Furthermore, policies such as fiscal food policies, implementing and labelling for food and nutrition as well as the restriction of the advertisement and marketing of unhealthy (Dietz, Benken, & Hunter, 2009; Sacks, Swinburn, & Lawrence, 2009; Swinburn & Egger, 2002); transport, organizational and urban planning policies (Khan et al., 2009; Sacks et al., 2009); school base intervention policy, home environment policy to reduce television viewing time, contrarily encouraging physical activity (Foster et al., 2008; Katz, O’Connell, Njike, Yeh, & Nawaz, 2008); increasing the number of nutritionists and dieticians in the hospital, provision of trainings and hospital support as well as providing financial encouragements (Frank, 1998; Sacks et al., 2009; Villagra, 2004), were set to influence Sack’s (2009) proposed framework.
Interventions
The following interventions amongst many others have been put in place by most organisations in different countries as a sustainable means of dealing with and reducing the burden of obesity in childhood.
Introduction of a Levy on Soft Drinks Industry
To help reduce the issues and burdens of childhood obesity, Public Health England (PHE) in association with the Scientific Advisory Committee on Nutrition (SACN), introduced a levy on soft drinks industry as it believes that children consume too many calories and particularly sugar. They went ahead to conclude that the consumption of sugar elevates calories intake, which poses a risk of type II diabetes and is linked to increased weight gain in children (Carbohydrates, 2015; England, 2015; Brooks et al., 2010).
Intervention Based on the Lifestyle of Families
In moulding a child’s behaviour, the family bond is a strong structure. This is so because the siblings or parents of a child can greatly influence the child’s lifestyle and behaviour (Carraro & Cebrián, 2003). To this regard, an effective intervention in the family would be of great benefit to improve a child’s unhealthy life style. Family intervention such as enhancing physical activities, control over the child’s choice of food and the quantity of food eaten are measures being put in place for the child in order to ensure that the likelihood of overweight in adulthood is reduced to the barest minimum (Ben‐Sefer, Ben‐Natan, & Ehrenfeld, 2009; Carraro & Cebrián, 2003). However, for a family based intervention in controlling obesity to be sustainable, parents should be provided with good support as well as various strategies to aid the course (Pott, Albayrak, Hebebrand, & Pauli‐Pott, 2009).
Interventions Based in Schools
The school plays a vital role in a child’s life as most of their time is being spent in school. Schools have several intervention strategies put in place for children, of which nutrition based, (aimed at serving a more healthy and balanced meal for school children whilst in school), and physical activities (aimed at reducing a sedentary life style) are the mostly used (Hutchinson, 2010; Rahman, Cushing, & Jackson, 2011).
Interventions Based in the Community
The community to this regard refers to the child’s environment, reflecting factors such as race, geographical location, socioeconomic status as well as ethnic groups (Economos & Irish‐Hauser, 2007). The community provides interventions strategy programmes such as provision of safe playgrounds with play groups, bikes paths, in a safe neighbourhood. With this, physical activities are enhanced in children as time spent watching TV and other sedentary lifestyle habits are reduced. The community could likewise influence local entertainment or the media as a way of promoting healthy programmes to educate both parent & children (Kanekar & Sharma, 2009; Stamatakis, Wardle, & Cole, 2010; Tucker, Irwin, Sangster Bouck, He, & Pollett, 2006).
Problems/barriers faced by interventions.
Potential barriers to the interventions are possible, some of which will challenge the improvement of physical activity or choice of food in children. Amongst these barriers are:
Financial Constraints
It is crucial to invest financially in all interventions as they need to be monitored for progress and sustainability overtime, which could be expensive. In recent time, due to economics burdens, there is limited funding for intervention programmes (Hutchinson, 2010; Karnik & Kanekar, 2012). Intervention programmes that are school and community based are more likely to face challenges of financing as much effort to make plans and budget is required due to enormous cost to provide facilities/infrastructure in carrying out physical activities as well as to educate teachers about intervention programmes. The community on the other hand, challenged by providing suitable facilities, organising events and provision of a safe neighbourhood for kids to play (Hutchinson, 2010; Karnik & Kanekar, 2012).
Stigmatisation of Overweight and Obese Kids
Children that are overweight are highly discriminated against by their peers and others, this stigma is potentially a challenge that results in the victim’s withdrawal from participation in health beneficial programmes and could further lead to a mental barrier (Hutchinson, 2010; Kanekar & Sharma, 2009; Kelishadi et al., 2009).
Conclusion
Childhood obesity is an issue of public health which does not only have an effect on individuals but the society and economy of the various countries it affects as well. It is a global issue that affects children of all races, ethnic groups, socioeconomic status etc. Due to the various health risks, it poses on children, there is need for everyone including the government, schools, parents, communities etc. to work together in order to eradicate or minimize the burden of obesity in children. Potential and sustainable policies and interventions play a vital role in developing and implementing strategies that cut across behavioural, family, school as well as hospital-based interventions to help curb the issue of childhood obesity. Since the prevalence of obesity is ultimately dependent on individual behaviours, educating parents and children on the benefits of a healthy nutrition, likewise encouraging them to adopt a physically active lifestyle would be beneficial in reducing the epidemic of obesity in children and adults as well. Also, sustaining the interventions set is a major factor for children to adopt a lifetime healthy behavioural practice and live healthily which will in turn result in a healthy future for children globally. Family based interventions thus is the most effective intervention ever listed as earlier stated that children greatly influenced by family members.
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