Abstract
Childhood obesity is a catastrophic condition in the 21st century affecting children and adolescents. It is the excessive and uncontrolled increase of body mass by fat tissues accumulation and metabolism failures, leading to the inability of their digesting. Given the technological advancements and the sedentary lifestyle embraced globally, this condition increases even further. Before, obesity was known as the problem of the developed countries, where technological advances enabled people to eat more and live without the necessity to move much.
In complex with typical urban problems such as lack of physical education, social inequity and other social issues, bad nutrition habits, and widespread mental issues, obesity becomes widespread among people of all ages. Today, it is common in developing countries as well, such as China, India, and Vietnam, where similar conditions emerge with their development. There is a need to study this condition and find how it can be prevented and treated before more children and adolescents are affected.
Obesity affects their health negatively, impacting their physical and mental development at a mainly formative stage in their lives. It stimulates the development of various diseases, both in adolescence and further in adulthood: hypertension and cardiovascular problems, diabetes and other metabolic failures, mental illnesses, and even cancers. In addition, it impacts their life indirectly: obesity usually decrease social status, and such children often become victims of bullying or social isolation, which worsens mental health problems. In that way, obesity is an actual problem of the modern world, and it is hazardous among children.
Introduction
Childhood obesity is growing at a distressing speed globally, especially in the US, where it is highly prevalent. It is defined as a body mass index (BMI) equal to or exceeding 95% of the expected BMI calculated by computing height and mass (Center for Disease Control, 2021). It is caused not by simple overeating, but its reasons are much more complex: primarily, the metabolic imbalance leads to the accumulation of fats. Severe obesity is the excessing of this index on 130% or even more. Such conditions are widespread worldwide, and the temps of its growths are considered a pandemic. One can call obesity a growth disease, as its spread is linked with technological and social progress, and the temps of obesity growth are high in developing countries.
There are different numbers about the obesity widespread in other sources, but all of them cause concerns. In 2017-2018 and for children between 2-19 years, the incidence was 19.3% and claimed 14.4 million patients in this age group in the US (Center for Disease Control, 2021). Obesity extent was 13.4% among 2- to 5-year-old, 20.3% among 6 to 11-year-olds, and 21.2% for those between 12 to 19 years. The high prevalence of childhood obesity is associated with the global life changes causing the adoption of sedentary lifestyles. The environment changes and the widespread of urban life is another cause, deeply intertwined with lifestyle changes. Such common problems as inequity, low access to healthcare and physical education, poor and wrong nutrition, and environmental pollution are all connected with obesity risks.
Causes
Lifestyle
Lifestyle issues are crucial in obesity development: as one can see, this problem is widespread in the urban regions of developing and developed countries, where sedimentary lifestyle becomes typical for many people. Children spend a lot of time watching TV and surfing on the Internet; while it is not bad when regulated, it can be rather dangerous when preventing children from physical activity and real-world social interactions (Dabas & Seth, 2018).
Along with high media consumption, children frequently tend to isolation in general, refusing to go outside. Sometimes it is due to dangers: cities, especially in developing countries, are often full of criminals and other threats while having a low number of sport and other facilities (Vargas et al., 2017). Another essential element is nutrition: children often eat only those food that is delicious for them, while it can be junk food, dangerous for the organism (Weihrauch-Blüher et al., 2018). Therefore, three critical lifestyle issues can lead to obesity: a lack of physical activity, wrong nutritional habits, and sedimentary lifestyle connected with high media consumption.
Environmental
The conditions of the child’s growth are one of the crucial factors in obesity risks, too. There is evidence that children with limited access to sport activity facilities and good nutrition are at higher risk. In urban communities, especially those with low income and limited access to healthy food, water, and physical education, obesity is more widespread (Poh et al., 2019). Children living in poverty are usually more prone to develop obesity. While they have less access to food in general, they have almost no access to healthy food and physical education (Vargas et al., 2017). In that way, they have fewer possibilities to prevent obesity and more risks due to wrong nutrition and sedimentary lifestyle.
In addition, poverty is connected with high distress, which can be compensated by food consumption, leading to body mass accumulation. In that way, social inequity and other issues are crucial problems that lead to obesity development in children.
Social interactions are an essential part, too, as they influence the child’s attitudes toward themselves and the world. Obese children often have lower IQ and problems interacting with other kids (Poh et al., 2019). In that way, they lose the desire to care for themselves and cure their obesity, worsening the problem and often causing an even more severe weight increase. If the child tends to social isolation and rarely walks, preferring sitting at home, the risk for obesity increases.
Genetics
Several genes are known to correlate with obesity issues in children and adolescents. For example, the gene FTO, specifically the certain variations in its intronic region, influences the gene expression in a way that leads to obesity (Littleton et al., 2020). The tendency to obesity is inherited: children whose parents were obese are more likely to have excessive weight too. While genetics increase the risks of obesity, it is primarily an additional factor: in the case of reducing other factors, such as lifestyle and environmental issues, genetic factors are much less likely to cause obesity.
Impact on Child Development
Obesity has a profound negative impact on all areas of a child’s life: physiological, psychological, and social. These children are more predisposed to diseases and have poorly developed immune systems due to minimized exposure to microorganisms that prime the body’s immunity (Kelishadi et al., 2017). Childhood obesity also predisposes children to adulthood obesity and many adult diseases because they cannot combat and adopt a healthy lifestyle.
Physiological
Excessive fat accumulation leads to further failures in metabolisms, weakening the body. One of the worst impacts of obesity on the child’s organism is the immunity decreasing, which leaves the child unprotected from several diseases (Kelishadi et al., 2017). Tensions caused by fat tissue on the organism increase the risk of hypertension (Wühl, 2018). High cholesterol level leads to vascular diseases development, such as hypercholesterolemia (Weihrauch-Blüher et al., 2019). Thus, obesity becomes the reason for many comorbidities, which severely impact the child’s development.
Psychological
Obesity decreases self-esteem, further stimulates the child’s sedentary lifestyle and often leads to apathy and depression. Childhood obesity is implicated with various intellectual shortcomings such as low retention capacity, poor concentration, and diminished understanding of simple childhood concepts (Poh et al., 2019). Such children are more prone to attention-deficit/hyperactivity disorder (ADHD), poor self-esteem, and other behavioral disorders (Rankin et al., 2016). Apathy and depression are also common for them, which make them closed and even less active. Those problems worsen with time: adolescents with obesity suffer much more from psychological distress than minor children.
Social
As mentioned, obesity severs social interactions, which often lead to an isolated lifestyle, making it even more sedimentary. The minimized interaction with other children leads to poor development of social skills. Obese children and adolescents often cannot communicate effectively with other children (Poh et al., 2019). In addition, they undergo mocking and bullying frequently; they tend to lose their self-esteem and develop wrong and even self-destructive behavioral patterns (Rankin et al., 2016). Social and psychological impacts are deeply interconnected, and they both are dangerous for a child’s development.
Predisposition to Other Diseases
Cardiovascular Diseases
Hypertension is the constant problem of children with obesity, as the high level of adipose tissue causes continuous pressure on blood vessels. The high cholesterol content predisposes them to cardiovascular disorders like a cardiac failure and hypertension disorder (Wühl, 2018). They suffer from breathing difficulties such as asthma and sleep apnea that complicate the children’s ability to engage in physical activities, crucial for obesity prevention (Weihrauch-Blüher et al., 2019). Joint problems and muscular discomfort are also common due to fat deposition in the joints and around the muscles. In that way, cardiovascular and muscle issues are typical for obese children.
Diabetes and Other Metabolic Issues
Troubles with metabolism and physiology are typical for obesity: as one can see, the obesity itself is caused by the metabolic problem, and after developing, it worsens them even more. The condition of obesity predisposes children to compromised glucose metabolism, which leads to type 2 diabetes (Lee & Yoon, 2018; Weihrauch-Blüher et al., 2019). The more prolonged obesity continues, the higher the risk for diabetes: each additional two years adds as much as 14% to diabetes development.
In addition, as obesity affects the organism’s physiology negatively and causes metabolic failures in general, it leads to other difficulties. Obesity damages the immune system severely, making the child vulnerable to infectious diseases (Kelishadi et al., 2017). It leads to changes in the immune response: for example, it increases the activity of macrophages but decreases the number of T-helpers and T-killers, immune cells responsible for detecting and killing pathogens. There is evidence that obese children are more vulnerable to viral and bacterial diseases, such as tuberculosis and flu. The immune response to vaccines is hindered, which makes it harder to protect such children from diseases.
Mental Issues
Obesity is often linked with different mental health issues, such as depression or anxious behavior. It is due to two main reasons: direct physiological effects and social troubles, as children with obesity often become aims of bullying and social stigmatization (Rankin et al., 2016). They suffer from mental diseases, and they tend to worsen obesity even more (Lee & Yoon, 2018). As mentioned, they have impaired cognitive abilities, usually, show much less interest in active living, and often have suicide tendencies (Poh et al., 2019). In that way, both physical and mental health issues are typical for obese children.
Long-Term Risks
Childhood obesity is a prerequisite for adult diseases, sometimes severe, which can be developed if the obesity will not be appropriately treated. While it is already a terrible condition, it greatly increases cancer risks in adulthood (Weihrauch-Blüher et al., 2019). Up to almost forty percent of cancer cases in the places where fat tissues are known to accumulate, such as the larynx, esophagus, stomach, gall bladder, or pancreas, are connected with obesity. In addition, adolescents who engage in physical activity and avoid obesity are also much less prone to have other cancers, such as kidney cancer or breast cancer in women.
Prevention and Treatment Strategies
Physical Activity
As the sedimentary lifestyle is the main reason for obesity development, its changing will prevent the problem. There are different options for encouraging physical activity in kids. For example, according to the research of Nemet (2017), the game Pokémon Go, which uses augmented reality for showing and capturing pokemons via the smartphone’s camera, helps to reduce obesity risks. Children are forced to catch pokemons to win the game, and they are usually happy to do this. Children who actively play in Pokémon Go are, on average, 25% more active than those who do not play.
Schools and urban communities are responsible for providing proper access to physical education for all children. There is evidence that schools that have more physical education facilities, such as free access to the gym, swimming pool, basketball court, and football field, have less obesity rates among students (Ip et al., 2017). The more such facilities are available in school, the lower rates: schools with no facilities have the largest obesity rates. The situation in the city community is no less critical: safety on the street, developed infrastructure, and community sports grounds are crucial for preventing obesity (Vargas et al., 2017). In that way, when children are encouraged to move outside, and there are no obstacles to do this, they are much less prone to obesity development.
Nutrition
Along with physical activity, proper nutrition is crucial for obesity prevention. Wrong food consumption habits are one of the leading causes of it. Prevention of childhood obesity should involve adopting healthy eating habits focused on consuming the correct number of calories. As the essential source of children’s education, schools are responsible for providing healthy and acceptable food of high quality.
However, schools usually pay little attention to their food environment and cannot efficiently teach children to choose their diets (Nga et al., 2019). In the study of Elbel et al. (2019), conducted in New York City, researchers have shown that the neighborhood’s closeness to junk food sources increases the chances of obesity development in children living there. According to Weihrauch-Blüher et al. (2018), the ban of such advertising will positively influence decreasing the spread of child obesity. Examples of such sources are fast food restaurants, which often have advertising targeted at children.
While school is an important source of nutrition habits, the child’s family is an equally important one. Parents should focus on ensuring their children have the essential nutrients in their diet, including carbohydrates, proteins, and vitamins, instead of concentrating on specific weight goals (Ash et al., 2017). There is also evidence that the number of studies for family-based obesity prevention is limited, especially in the case of ethnicities other than White. According to the U.S. study, breastfeeding reduces obesity rates: mothers who preferred breastfeeding for their children at least one month reduced the risk of obesity by more than 20% (Wang et al., 2017). In that way, people need to be familiar with good nutrition and have high health literacy in general to prevent childhood obesity.
Behavioral Therapy
To ensure that children adopt a healthier lifestyle, there is a need for education and even therapy, as children are often unwilling to change their lifestyles. They include influence on children that encourage them to behave appropriately: increase their activity and introduce right eating habits (Dabas & Seth, 2018). For example, the proper diet can be adjusted based on scientific knowledge. A pediatrician can prescribe a meal plan that categorizes the amount of food allowed in unlimited or limited amounts, based on their composition and calories. The drinking of more clean water is also good to decrease obesity. Psychotherapy would be beneficial in most cases, as psychological issues worsen obesity and are more (Lee & Yoon, 2018). In that way, it is crucial that children can see that their problems are the consequence of their wrong lifestyle, and by changing it, they can feel better.
Compared with environment-based prevention, behavioral therapy is more likely to solve short-term issues and to teach children how to care for themselves and stop the development of their obesity. However, environment-based prevention is still necessary to ensure that children can access everything they need for a healthy lifestyle (Weihrauch-Blüher et al., 2018). Behavioral therapy and environment are deeply interconnected: for example, schools that provide good access to physical education and proper nutrition have fewer children who suffer from obesity (Elbel et al., 2019; Ip et al., 2017). As mentioned, games that require physical activities, including ones installed on the smartphone, are beneficial for obesity prevention (Nemet, 2017). Thus, if children can understand which nutritional habits they should have and feel fun during physical activity, they are much less prone to obesity.
Medical Treatment
Direct medical treatment can be used in some cases to impact the child’s metabolism and change it to the desired direction. Children with obesity often suffer from different mental and physical issues, and medications can help them. There is evidence that behavioral therapy is often unable to help in cases of severe health failures (Wühl, 2018). There are medications that help cope with obesity, described in the article of Dabas & Seth (2018): examples are Orlistat which inhibits gastric lipase, and Phentermine which is mainly used for adults and stimulates dopamine secretion. The former, in that way, inhibits the appetite and facilitates weight loss, but it is effective only in the case of long-term treatment.
Latter is an anorexiant agent, which also leads to weight loss and increased general activity. However, all such treatments have notorious side effects, such as cardiovascular or gastrointestinal ones, and dopaminergic stimulants are known to cause psychological disorders such as sleep problems and dizziness. In addition, their effectiveness is often limited too.
In the worst cases, surgery options can be applied to remove the excessive adipose tissue from the organism, called bariatric surgery. They are restricted for children who have severe psychological problems and extremely high body mass indices (BMI more than 35-40 kg/m2) (Dabas & Seth, 2018). Bariatric surgery reduces the risk of cardiovascular diseases, type 2 diabetes, and the short-term complications rate is less than 10%. However, the long-term consequences of such surgery are still mostly unknown (Weihrauch-Blüher et al., 2019). Similar to direct medical treatment, bariatric surgery is not recommended for the vast majority of obese adolescents, only for those who already suffer from severe comorbidities or if the behavioral therapy were unsuccessful.
Conclusion
As one can see, childhood obesity is an actual health menace due to its effect on future adults and the health complications that accompany it. The condition causes delayed physical and mental developments in its patients and must be handled to secure the lives of those children. In addition, those delays are worsening with time: the more obesity continues, the worse existing problems are, and new problems emerge as well. Obesity increases risks of diabetes, infectious and cardiovascular diseases, joint and muscle complications, breathing difficulties: mental illnesses, and cancers. Combating the condition should essentially involve prevention strategies such as adopting a healthy diet and lifestyle; medications can be used in the most severe cases.
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