Childhood obesity is growing at an alarming pace presenting serious health and socio economic consequences. A multi-pronged approach involving parental guidance and school-based initiatives, is necessary for tackling this preventable problem from developing into an unmanageable healthcare crisis. This coordinated approach is the key to promoting healthy life style modifications in our children who are the future of our country.
Obesity is fast developing into a major healthcare threat for America. While the growing overweight concern among adults is a pressing issue what is more alarming is the developing trend of obesity and overweight condition among children. As per the 2007 National Youth Risk Behavior survey, around 13% of American high school children are obese [CDC] while 25% are clinically overweight. [Mashid et.al, (2005)] in fact, Obesity among children is a global concern. In the UK, for instance, one in every 10 children below that age of six is obese. [Science Daily] Improper food habits and inactive lifestyle are the two main causes for the surging obesity epidemic. The flourishing fast food industry and the indiscriminate eating practices induced by the fast life style have all contributed to the high levels of obesity and overweight conditions. Statistics indicate over 65% of the students did not meet the recommended level of physical activity and over 34% of students consumed soda and other junk food everyday. [Mashid et.al, (2005)] a brief overview of childhood obesity, its causes, effects and control measures would provide us a better picture into this growing health care crisis.
Understanding Obesity (Energy Balance and Obesity)
Carbohydrates, Fats, Proteins, Vitamins, Minerals and water are the six nutrient resources of the body. Of these, carbohydrates, proteins, and fats are important for their calorific value and provide 4, 4 and 9 calories respectively per gram. Carbohydrates constitute the main energy source of the body. Body weight is determined by ‘energy balance’, which is nothing but the difference between the calorie intake and the calorie expenditure. Normally, the body tries to maintain the energy balance by either increasing or decreasing the metabolic rate in relation to the increase or decrease in energy consumption. For example, an increase in carbohydrate or protein consumption would trigger oxidation of the respective nutrients, which stabilizes their levels. However, Fat oxidation is not so directly related to its intake resulting in its accumulation as adipose tissue. Consequently, fat consumption directly affects the energy balance and hence the weight. [FAO]
Another nutritionally related cause for obesity is the increasing consumption of food with high carbohydrate content, as in the case of most junk foods. Since, increased carbohydrate content in food spurts the blood glucose level, the body’s homeostatic response is to synthesize insulin to counter it. Insulin distributes this energy to the cells of the body while the excess is stored as fat. Further, increased carbohydrate consumption (fast foods) leads to increased carbohydrate oxidation, which indirectly increases the fat levels. (Low fat oxidation) This theory is the basis for the famous Atkins low carb diet, which prescribes reduced intake of carbohydrates to induce lyposis/ketosis mechanism. (Using fat as energy source). Thus, the amount food that is consumed and activity levels determine the energy balance of the body. [FAO]
It is found that only 20% of American people consume the recommended 5 servings of fruits and vegetables per day. The fact that almost 60% of American youth consume excess of fatty foods such as chips, cookies, soda, etc. is a clear indication of the fast changing dieting habits. [John Dorsey, 2008] the availability of junk foods at school canteens and other stalls promotes this unhealthy dieting trend. In fact, researchers have identified a direct link between Junk food advertisements and increasing obesity among children. In a collaborative study, researchers from the Harvard School of public health along with the Children’s hospital in Boston revealed that television viewing has other impact besides the physical inactivity. The researchers claimed that children who watched more TV were prone to consuming more of junk food and consequently have an increased chance of becoming overweight and obese. This study, which followed 548 students in the Boston region, concluded that every one-hour of TV watching contributed to an increase in consumption of around 167 calories derived from junk foods. This is attributed to the junk food advertisements on the TV. [Medical NEWS]
Growing Inactivity
Besides the changing dieting habits, the other important factor that has contributed to the obesity epidemic is the growing inactivity among children. Maintaining an active life style is the key to achieving a balance between the food consumed and the energy spent. A confirmed fact is the growing sedentary life style among the children of the world and in particular, children in the developed countries. The rising use of computers, the increased time spent watching television programs and the growing addiction to video games are all the reasons that are attributed to such a drastic downturn in physical activity among children. The national Institute of health reports that there is a direct relationship between TV watching time and Obesity among children with an observed high incidence of obesity among those who spend more hours watching TV. [John Dorsey, 2008] Studies show that an average child’s meal served at a typical fast food restaurant having roughly 785 kcal of energy would need atleast 1 to 2 hours of vigorous physical activity to be effectively counteracted. [Mashid (2005)] Thus, an increase in calorific consumption compounded by a decrease in physical activity, have together created the high risk factors for obesity among children.
Genetic Predisposition
Genetic predisposition is also an important factor responsible for obesity among children. A 10-year-old study that compared the genetic makeup of obese children and adults within the normal population has revealed three new gene mutations that increase the risk of obesity. The variations associated with the PTER gene, NPC1 gene and the MAF gene are found to influence appetite and metabolic rate and therefore contribute to overweight and obesity. The variation in the MAF gene in particular accounts for nearly 6% of childhood obesity and nearly 16% of adult obesity. As professor Philippe Froguel, the lead researcher of the study says, “Understanding the genetic basis of obesity is the first step towards helping these children. Once we identify the genes responsible, we can develop ways to screen children to find out who is most at risk of becoming obese. Hopefully we can then intervene with measures such as behavioral therapy, to make sure a child forms healthy eating habits and does not develop a weight problem,” [ScienceDaily] There is also a demographic disparity in obesity in America with the minority population more at risk. While Caucasian children have a 11.9% (boys) and 12%(girls) risk for obesity, the numbers are 17.6% for boys and 22.1% among girls for the African-American population. Even more disproportionately affected is the Hispanic population with almost 27.3% of boys and 19.6% of girls carrying a risk for obesity. Also, in general, the population in the lower economic group faces a high risk for obesity because healthy eating is not a priority among the low-income group. [John Dorsey, 2008]
Effects of Obesity
The effects of obesity are very significant. The medical complications of childhood obesity are diverse and potentially life threatening and severely compromise the quality of life. Let us have a brief overview of some of these conditions related to obesity.
Type2 Diabetes
The incidence of diabetes among the pediatric population has mainly been confined to the genetic variety of type 1 diabetes. But the situation has changed dramatically over the last two decades. The prevalence of overweight conditions and obesity among children has witnessed a dramatic increase in Type 2 diabetes and it involves almost 50% of the newly identified cases of diabetes among children. Children with early onset T2DM are at an increased risk for severe vascular complications such as diabetic retinopathy, neuropathy and nephropathy compared to normal diabetic adults. [Tamara et.al, 2005]
Pediatric Hypertension
Obesity is also known to be a key factor in pediatric hypertension. Obesity and diabetes together pose a significantly greater risk for pediatric hypertension. A recent study by Maggio et.al has confirmed that childhood obesity is a high risk factor for hypertension. This was a cross sectional study involving 44 obese and 22 lean prepubertal children with a mean age of 8.8 ± 1.5 years. Measurements for all the subjects pertaining to their casual BP and ambulatory BP were documented. Also using echocardiography the left ventricular mass and left ventricular mass index (LVMI) were also noted down. The researchers also used X-ray absorptiometry to calibrate the whole body lean tissue and fat mass. A comparative analysis of the data suggested that the 24-hour systolic Blood Pressure (124.8 ± 14.2 vs. 105.5 ± 8.8 mm Hg), diastolic BP (72.8 ± 7.3 vs. 62.7 ± 3.8 mm Hg), and the LVMI (36.1 ± 5.8 vs. 30.9 ± 5.7, g m?2.7) were considerably higher than that of the lean subjects. The fact that systolic ambulatory hypertension was observed in almost 47.6% of the obese children clearly suggests the role of obesity in hypertension. Also the correlation between LVMI and BP suggested higher risk for developing cardiovascular complications among the obese children. [Maggio et.al, 2008]
Coronary Heart Diseases
Childhood obesity is implicated as a chief risk factor for developing coronary heart diseases in adult life. As per a prediction by Bibbins-Domingo et al., the increased prevalence of childhood obesity among the current population will result in up to 16% increase in the prevalence of CHD by 2035. (involving an addition of up to 100,000 cases.) [David S. Ludwig, 2007] a recent Danish research studied the relationship between childhood obesity and the onset of adulthood CHD. For this study the researchers observed the BMI of 276,835 Danish school children taken from the national registers. It was observed that 10,235 men and 4318 women developed CHD and died. Using regression analyses to the data revealed a clear positive correlation between higher BMI in childhood and contracting CHD in adulthood and the association was much stronger among boys. Childhood obesity definitely increases the chances of developing cardio vascular complications in adulthood. [Jennifer et.al, 2007]
Psychological and Psychosocial Effects
Being obese affects not only the physical well-being of the person but also has psychological and psychosocial implications. As Professor Philippe Froguel who was the main researcher in a longitudinal genetic study of obesity among children says, “When young children become obese, their lives can be affected in a very negative way. Sadly, obese children are often unfairly stigmatized and they can suffer heart and lung problems, painful joints, diabetes and cancer as they grow up. ” [ScienceDaily] Several studies have focused on the link between child obesity and depression. A study by Sarah Mustillo et.al found that childhood obesity was associated with a high risk for the development of depression. This study involved 1000 children from North Carolina between the age group of 9 and 16. The children were followed up annually and were subjected to psychiatric evaluations based on their height, weight disorders and how they reacted to such disorders. The researchers gathered from the study that boys who were obese were four times more likely to develop depression compared to leaner boys. As Sarah Mustillo the main researcher of this study says, “We were looking at clinically significant depression, which is not the same as feeling blue. Overall, boys have lower rates of clinical depression, and this is what we found in the other groups. But chronic obesity in boys was associated with an elevated risk of depression.” [WebMed]
Possible Solutions
Parental Guidance (Teach by example)
Childhood obesity presents a serious concern for the individual, family as well as the society at large so it is necessary to implement appropriate intervention strategies aimed at controlling the condition and thus reducing its impact. As primary caretakers of children, it is incumbent upon parents to inculcate good dieting habits in them. For this to happen they must be nutrition conscious and make their children knowledgeable about healthy eating.
Nationwide Interventions
Increasing nutrition awareness among the school kids is the first and foremost step in our fight against childhood obesity. Including nutrition programs as part of the school curriculum is an important approach to this end. Though the U.S. government has implemented the nutritional standards program for the school meals programs it does not cover the availability of foods outside of the program. More recently the number of states with ‘nutrition standards program’ for foods outside the ‘school meal program’ have increased from 6 to 27 indicating growing awareness and positive improvements. Data from a comprehensive survey by the CDC indicate that the number of schools that do not supply soda pop, candy and other junk foods have increased in 37 of the 40 states. [CDC] However these data are restricted only to the public schools and no information is available regarding the private schools. Though these results are encouraging, more work needs to be done to ensure that children do not have access to any kind of junk food inside the school campus. The UK is a case in point. The British government has enacted a ban on junk food advertisements targeting children under 16. This national regulation essentially bans food advertisements for products that are rich in Fat, salt, sugar in the national TV programs.[Commercial Alert ] it is high time a similar initiative is taken in our country.
The recent efforts by Bill Clinton and the American Heart Association to eliminate the sale of all carbonated drinks at schools and to permit only water and unsweetened juice is a good initiative. As per the deal with Kraft Foods Inc., Mars Inc., Campbell Soup Co., Groupe Danone SA and PepsiCo Inc., the calories derived from fat and saturated fat are limited to 35% and 10% respectively in all the products that are supplied in the school vending machines or snack bars. As Dr. Raymond Gibbons, president of the American Heart foundation puts it, “By working with schools and industry to implement these guidelines, we are helping to give parents peace of mind that their kids will be able to make healthier choices at school” [Wordpress]
Another important aspect from the schools’ perspective is to increase the physical fitness programs and make mandatory more hours of physical training. So along with a comprehensive nutrition policy, programs pertaining to physical activity should also be concurrently implemented. The implementation of junk food restrictions along with ‘physical activity programs’ has found lot of support from the parents as well as the student community as professor Marg Schwartz of the university of Alberta says, “We have found children to be very responsive to healthy eating and physical activity when the whole school is involved. it’s very encouraging. Kids need healthy schools to help turn the tide on many chronic diseases that are starting at younger and younger ages..” [Paul Veugelers]
Conclusion
Childhood obesity is growing at an alarming pace presenting serious health and socio economic consequences. Changing dietary habits, fast food addiction and a sedentary life style marked by prolonged TV viewing and video games have compromised our children’s health. A multi-pronged approach involving parental guidance and school-based initiatives is necessary for tackling this preventable problem from developing into an unmanageable healthcare crisis. Good habits begin at home and so parents have all the responsibility in making children understand healthy eating habits. Parents should also enforce more discipline in children and limit the TV watching hours by encouraging more outdoor sports activities. Implementation of School-based mandatory physical training programs and nutritional standards program are indispensable in the efforts to prevent obesity. This coordinated approach is the key to promoting healthy life style modifications in our children who are the future of our country.
Bibliography
1) a Maggio, Y. Aggoun & L. Marchand et.al (2008), ‘ Associations among Obesity, Blood Pressure, and Left Ventricular Mass’, the Journal of Pediatrics, Volume 152, Issue 4, Pages 489-493
2) CDC, “The Obesity Epidemic and United States Students,” retrieved Oct 7th 2009, from, http://www.cdc.gov/HealthyYouth/yrbs/pdf/yrbs07_us_obesity.pdf
3) CDC, ‘Availability of Less Nutritious Snack Foods and Beverages in Secondary Schools -Selected States, 2002 — 2008’, Retrieved Oct 9th 2009, from, http://www.cdc.gov/mmwr/preview/mmwrhtml/mm58e1005a1.htm
4) Commercial Alert, ‘Junk Food Ad Ban Comes into Force in Britain’, retrieved Oct 9th 2009, from, http://www.commercialalert.org/issues/health/international-public-health/junk-food-ad-ban-comes-into-force-in-britain
5) David S. Ludwig (Dec 2007), ‘Childhood Obesity: The Shape of Things to Come’, NEJM volume 357:2325-2327, Number 23. Retrieved Oct 9th 2009, from http://content.nejm.org/cgi/content/full/357/23/2325#T1
6) FAO, ‘Carbohydrate Food Intake and Energy Balance’ retrieved Oct 8th 2009, from, http://www.fao.org/docrep/w8079e/w8079e0m.htm
7) Jennifer L. Baker, Ph.D., Lina W. Olsen, Ph.D., and Thorkild I.A. Sorensen, M.D., ‘Childhood Body — Mass Index and the Risk of Coronary Heart Disease in Adulthood’, NEJM, Volume 357:2329-2337, No 23, retrieved Oct 9th 2009, from http://content.nejm.org/cgi/content/abstract/357/23/2329
8) John Dorsey & Jeanne Segal Ph.D, ‘Childhood and Juvenile Obesity’, retrieved Oct 7th 2009, from http://helpguide.org/mental/childhood_obesity.htm#causes
9) Mashid Dehghan, Noori Akhtar Danesh & Anwar T. Merchant, (2005), ‘Childhood Obesity, Prevalence and Prevention’, Nutrition Journal 2005, 4:24, retrieved Oct 8th 2009, from, http://www.nutritionj.com/content/4/1/24
10) MedicalNews, ‘Direct Link Between Childhood Obesity and Junk food Advertising’, retrieved Oct 9th 2009, from, http://www.news-medical.net/news/2006/04/24/17556.aspx
11) Paul Veugelers, ‘Study Shows Parents Back Junk Food Ban in Schools’,
retrieved Oct 9th 2009, from, http://www.physorg.com/news173362954.html
12) Science Daily, ‘Childhood Obesity Risk increased by newly discovered Genetic Mutations, Says Study’, retrieved Oct 7th 2009, from, http://www.sciencedaily.com/releases/2009/01/090118200638.htm
13) Tamara S. Hannon, MD, Goutham Rao, MD and Silva a. Arslanian, MD, (2005), ‘Childhood Obesity and Type 2 Diabetes Mellitus’, PEDIATRICS Vol. 116 No. 2 August 2005, pp. 473-480
14) WebMed, ‘Mental Illness Common in Childhood Obesity: Defiance, Depression cited in Study’, retrieved Oct 9th 2009, from, http://www.webmd.com/mental-health/news/20030407/mental-illness-common-in-childhood-obesity
15) Wordpress, ‘Junk Food Banned in Schools’, retrieved Oct 9th 2009, from, http://www.fitnesstipsforlife.com/junk-food-banned-in-schools.html
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