Advanced Perspectives of Public Health and Social Policy of Childhood Obesity
Childhood obesity has evolved into a major health and social issue in the modern society. It is one of the leading causing of deaths in the United Kingdom today, directly and indirectly.
This paper takes a closer look at 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 as some of the proposed solutions and an evaluation of the costs of diseases attributed to obesity.
Childhood obesity is one of the most common health problems affecting most children in the world today. The prevalence of childhood obesity has been increasing considerably since the 1990s particularly in the United Kingdom. Most notably, UK is leading with a population with obesity ranging from children to adults amongst the developed countries, Europe and the whole world. This increase is attributed mostly to multifactorial interaction between family lifestyle and behavioural issues. Childhood obesity is prevalent in children as far as two years of age. As of 2009, 23.1per cent of children, 4–5 years old were obese or overweight whereas 33.3 per cent of children, 10–11years old were also obese. The numbers increases when we focus on teenagers and adults. This implies that obesity is developed during childhood and carried on as they grow. In addition, this epidemic is affecting all children worldwide regardless of sex, race, and ethnic linage. In this respect, what is childhood obesity? 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, solutions as well as intervention of childhood obesity.
Childhood obesity is determined using the body mass index (BMI) (Bagchi 2010). 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 issues, it is interestingly becoming important for all stakeholders in the health care and the society at large to take this health issue with utmost attention. In addition, managing of this public issue requires attention from the children, their parents and the entire family at large. Therefore, those managing childhood need to appreciate to incorporate and appreciate the complexity of behavioural issues, causes, and effects of childhood obesity.
First and foremost, according to the vast majority, obesity regardless of the age is attributed to long term energy imbalance. This is the overall energy input from the consumed foods and drinks exceeding the total energy output through physical activity amongst other activities. The growth and development of infants from the womb and inception are key consideration for obesity later in the childhood. This paper will examine all the aspects of childhood obesity on children, 0-5 years of age.
Causes of Childhood Obesity
Childhood obesity is caused by several factors majority of which are related to lifestyle issues. Aside from this, others factors also contribute to childhood obesity like the genetic factors, socioeconomic status and physical inactivity. To begin with, eating or dietary habits play a crucial part in childhood obesity. This starts from birth and continues in the child lifestyle. Currently, parents of new born infants are limiting the breastfeeding period and in turn introduce solid foods. There have been imbalances associated with consumption and calorie intake. Children are regularly consuming more calories above the recommended daily requirement hence making them prone to becoming obese if the situation is not reversed over time. This is attributed to many children significantly changing their diets. The traditional healthy foods such as whole grains, vegetables and fruits have been abandoned in exchange of fast foods, processed snacks and sugary drinks (Kazaks, A & Stern 2012). These foods contain more calories and are less nutritious. Apart from consumption and calories intake, several eating patterns contribute to childhood obesity. These include feeding/eating whenever a child is not hungry, overeating and eating while undertaking sedentary activities like watching TV, 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 more calories due to lack of proper balanced diet. On other hand, children from high income are associated with fast foods hence consume more calories. Moreover, they are prone to eating while undertaking sedentary activities. In regards to genetics, childhood obesity is linked with heredity, that is, it runs in families. A child associated with family affected by obesity either parent, brothers/sisters has a high likelihood of becoming obese. Nevertheless, genetics factors alone has insignificant contribution to childhood obesity, other factors have to come along. Although, the genetics factors rarely cause childhood obesity, children under the age of 2 having rapid gain in weight are at a severe obese risk and becoming hyperphagic (Kipping, Jago, & Alawlor p. 984-989).
Relative to physical activity, most children all over the world spend almost their entire lifestyle dormant (Bouchard, & Katzmarzyk 2010). They are tied in sedentary activities rather than physical activities. Physical activities are beneficial in burning of the excess calories consumed. Physical inactivity is attributed to advancement in technology and parents and schools negligence. Technology has led to 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 recently pointed out that children spend averagely three hours daily in sedentary activities mainly video games. This has also affected their eating habits and patterns. Parents do not engage their children in physical activities where this altitude is transferred to their children. Additionally, parents expose children to sedentary activities which will require little intervention due lesser risks of physical injuries and limit child disturbance. Schools have also neglected children in terms of dietary and physical inactivity contributing to children becoming obese. Schools are the second place where children spend most of their times (Stanley 2008). Currently, majority of parents enrol their children in schools or child care centres at an early age. Besides the above causes, body functioning and medical issues also causes 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 paediatric endocrinologist in order 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 in 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 to type 2 diabetes. From ancient times, this type of diabetes was only prevalent in adults (Hearnshaw, & Matyka p. 947–957). However, prevalence of childhood obesity has caused type 2 diabetes a common health problem in children (Hearnshaw, & Matyka p. 947–957). In regards to heart problems and failures in children, obesity has been termed as a major contributor. 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. As a result, the blood flow rate in the heart is affected leading to heart failure and diseases in children. As for breathing complexities, childhood obesity contributes by affecting the growth and development of children breathing systems more so 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 effect on the puberty/menstruation periods. Also, it can contribute to metabolic syndrome, 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 behaviour (Davies, Fitzgerald and Mousouli 2007).
Intervention of Childhood Obesity
Measuring of the 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 pertaining child wellbeing associated with her/his weight.
Afterwards, they are recommended to discuss this issue with children’s parents and other stakeholders like child care facilities and schools. Evidence has revealed that majority of parents lack the ability to recognize weight problems in the infants and young children. This is attributed to negligence, little knowhow or little time with the 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 care givers and also enrolled early into 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 advice parents in a sensitive, empathetic and non-judgemental way. This is because parents react different about the results of their children health particularly obesity. Some of the parents may be shocked finding their children are obese. As Reid (2009) revealed that certain terminologies used to describe childhood obesity and overweight like unhealthy weight give most parents relief while discussing the child wellbeing with health practitioners. In addition, parents dislike topics which are judgemental or point at mostly on parenting like dietary issues. It is crucial that the medical practitioners handling infants and young children know the management services and referral criteria besides weight and obesity knowhow. On the other hand, parents and child care givers should be acquainted with healthy lifestyle knowhow in order to be good role models to the children they are raising up.
Diagnosis of Childhood Obesity
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 generally calculated by dividing weight in kilograms over height in square metres. Nevertheless, this measure when used for children has clear meaning when calculated correctly based on age and sex profiles in the centile charts. In the UK, all the medical practitioners dealing with childhood obesity must 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 use of World Health organization (WHO) growth charts in diagnosing of children from 0-4 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. Likewise others methods, this WHO BMI method of obesity diagnosis is 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 plays a crucial role in the health development of infants and young children. As earlier mentioned, malnutrition has contributed mostly in 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 regards 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 her life. This would help to optimize the maternal health and minimize the risks associated to birth defects, substandard foetus development, chronic problems that may occur in the first and subsequent offspring’s. Generally, a good healthy lifestyle based on pregnancy era is characterised by: consumption of balanced nutritional diets and safe handling as stipulated by the Food Standards Agency (FSA) (2008a) appropriate and timely intake of mineral and vitamin supplements like vitamin D, gaining appropriate weight and adequate physical exercise. Relative to the early child’s life, a balanced diet coupled with good feeding habits/patterns is core to his/her healthy growth and development. The nutrition status of a child has been seen as beneficial to the health wellbeing both in the early child years and the future. On the contrary, recent studies have revealed that majority of infants worldwide are not entitled to balanced diets that provide the required nutrients adequately. This is in turn 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 per cent had stunted growth, 14 per cent muscle loss while 20 per cent were at risk of secondary malnutrition triggered by metabolic stress.
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 his/her life (Underdown, A 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 appropriately for the recommended duration of first six months have high chances of becoming obese (Underdown, A 2007). As a result, the child is prone to suffering from health problems like colic, constipation, diarrhoea and much more diseases related childhood obesity. Breastfeeding helps build up infants immunity thus prevent development of certain diseases like diabetes (Hearnshaw, & Matyka p. 947–957). However, there are no proves that breastfeeding helps to minimize the incidences of cancer and leukaemia. In addition, there is no correlation that has been shown to exist between cognitive development and breastfeeding. Further to this, 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 infants’ 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 front 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 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 formula 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 to a survey in the UK, 78 per cent of mothers breastfeed their babies immediately after birth onwards but the number decreases to 50 per cent as the sixth week approaches (Underdown 2007). This number goes down because of the lower maternal age, educational attainment and socioeconomic status respectively. To overcome this massive campaigns by health practitioners, peers educators is required to sensitize mothers about breastfeeding for the recommended first six months.
In regards to transition to transition from breastfeeding to solids 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, first six months are over. On the contrary, weaning can be considered from the fourth month if the breast milk is not meeting or satisfying the child’s appetite and nutritional status. In such cases, it is required for parents to first seek advice before incorporating solid foods. Weaning is strictly prohibited for premature babies or those that are below three months old. This is attributed to the fact that weaning at this time can result to adverse consequences on the health of the child particularly the immune system. In turn, this makes the child most vulnerable to diseases. Emerging studies have challenged the idea of introducing solids strictly after the six months. Instead, these studies emphasize introduction of solid food in smaller portions gradually when a child is four months old onwards rather than the larger amounts after the breastfeeding period is over. 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 at the specified stages of weaning vary depending on the child’s developmental requirements. For example, solids food requiring chewing and biting are crucial in helping the child develop muscles relevant for speech. On the other hand, introduction of the solid food s 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 month old is dangerous and can lead to feeding problems like food refusal and fussiness (FSA 2008b). The FSA recommends use of home cooked solid foods during the weaning period. However, commercial foods may also been incorporated. The type of food incorporated should correspond to the family lifestyle.
Since weaning takes place gradually, the child develops to eat 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 should be added in small quantities (Kazaks, A & Stern 2012). Honey is totally prohibited to children till they are past one year of age. Honey is termed to contribute to food poisoning (Kazaks, A & Stern 2012). High sodium intake on the other hand contributes to hypertension risk in children. For salt requirement, utmost 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 using 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 more so iron hampers cognitive development.
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. This the period when the child acquires the taste and food preferences which he/she accommodates during the growth period. The controversy about introducing solid foods related to low fats is of primary concern. This is because 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 regards to fluid’s intake, no other extra liquid apart from cooled boiled water is required for a breastfeeding infant.
Parents are the forefront in developing food preferences as well as energy intake for their children. Evidence have revealed that parents who apply force in determining what and how the children feed enhance 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 behavioural habits they possess later in life. Like other behaviours, feeding/eating habits and patterns are also developed during from schools. In the UK, there are mandatory the set standards for food served in schools. In this respect, 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 in their care, (O’Brien p. 103-105). Most of evidence based on research has proved that awarding a nutritionally balanced diet throughout childhood help in improving both behaviour 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. Guidance is therefore provided both to parents and schools from the School -Food Trust (2007).
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 the above for children of 5 years and below (DH 2004). The physical activity should be enhanced from birth onwards using ground as well as water based activities. For infants and young children with capability of walking alone should be subjected to 3 hours of physical activity regularly over the week. However, reports have indicated that chances for children to involving in physical activities in the UK and whole worldwide are decreasing. This has been attributed to substitution of walking by car journeys. More of the children travel to school by using cars. To improve the health of children by totally eliminating obesity, physical activity must highly be 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 to obese children. Childhood Obesity medication has its own benefits and risks. All the obesity medications work to decrease the appetite. The benefits present are usually short term, and mainly include weight loss. This benefit is a big boost in eliminating health problems associated with obesity. Their impact on the long run is not yet known. On the part of risks, obesity medications have side effects, which vary depending on the drug (Hearnshaw, & Matyka 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 which 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 closely related drugs which 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 there are totally prohibited for infants and young children. Likewise, 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 for 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, while 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% in 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 to 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 costs associated with diseases emanating from obesity, heart related diseases had the largest proportions. Ischaemic stroke costs were £983 million, followed by coronary heart disease £773 million, and hypertensive disease £576 million (Andersen 2003). The other big costs were related to diabetes mellitus, £533 million (Andersen 2003). In terms of burden of diseases triggered by obesity and overweight likewise heart diseases had the largest contribution. The coronary heart disease accounted for 2.3 per cent of all disability adjusted life years (DALYs) recorded with ischaemic stroke next with 1.8 per cent. The burden of diseases-DALYs lost due to obesity was higher in women with 7.8 per cent as opposed to men, 6.9 per cent. The huge difference between them was brought by cancer of which breast cancer and uterus cancer were the main burden among women. In comparison to other diseases, the burden of disease amongst women and men was also higher for women in type 2 diabetes, stroke, hypertensive disease and osteoarthritis. However, men recorded higher burden of disease in respect coronary heart disease than women. On 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, 66 737 deaths were directly linked to obesity where half (54 per cent) of these deaths attributed to coronary heart disease while 31per cent from stroke (Great Britain 2004).
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 causes attributed to lifestyle and behavioural issues. Majority of children become obese due to poor eating or feeding habits and patterns more so during the critical weaning period. Moreover, physical inactivity is also at the centre stage of enhancing childhood obesity. Children parents besides other stakeholders are hold responsible for childhood obesity. BMI is a necessity in measuring the degree of childhood obesity as well as initiating its control and medication (Bagchi 2010). BMI plotting is significant in identification of trends regarding the childhood obesity. Lifestyle change through healthy dietary and physical activity has more benefits than harm (Hearnshaw, & Matyka p. 947–957). First of all, there are no side effects involved or whatsoever. Nevertheless, it calls for more 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 your children can help integrate a healthy diet and encourage good eating habits as well as physical activity. Also lack of funds to buy natural foods limits the low income earners to poor unhealthy diets. Incorporating BMI in lifestyle changing can help one determine the quantity of food you need to consume, and also the extent to which you should exercise.
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