Childhood Obesity Prevention

Introduction

Childhood obesity is one of the major public health challenges that nations are currently facing all over the world. This problem is affecting both the developed and the developing nations (Johns Hopkins Center for a Livable Future, 2007). According to Dehghan et al. (2005), childhood obesity has approached pandemic levels in developed nations. For instance, it is pointed out that 25% of the children living in the United States of America are overweight, and 11% of them have the obesity problem (Dehghan et al., 2005). It is also pointed out that childhood obesity prevalence has been increasing in developed nations beginning from the year 1971 (Dehghan et al., 2005). The highest prevalence for the childhood obesity condition has been in the developed nations; but on the other hand, the prevalence rates are also going up in the developing countries (Ogden et al., 2012). It has also been reported that in both the developed and the developing nations, “there are proportionately more girls that are overweight than boys, particularly among adolescents” (Dehghan et al., 2005, p.3). Obesity in children is likely to persist even when the affected ones become adults (Poskitt & Edmunds, 2008). This problem is also more likely to cause the children “to develop non-communicable diseases like diabetes and cardiovascular diseases at a younger age” (World Health Organization, 2012, par.2). However, obesity and overweight are largely preventable. This implies that to effectively deal with the problem of childhood obesity, high priority should be given to its prevention.

Purpose of the study

The purpose of this study is to evaluate if early intervention can be the most effective way of preventing childhood obesity.

Significance of the study

It has been found that the problem of childhood obesity is continuously increasing; therefore, it is important to be effectively dealt with. Obesity is likely to continue even when the children suffering from it become adults. Moreover, it is also more likely to cause the children to develop non-communicable diseases like cardiovascular diseases, among others, at an early age. This study is very important as it seeks to identify the best ways of preventing this dangerous condition. The children are the future, and they need to be protected in all ways.

Study datasets

In this research, the sample size is going to comprise 1600 infants. It is expected that the final assessment of this sample will make it possible to have higher level of accuracy when investigating the differences found in early intervention effect regarding pre-specified participant and intervention-level characteristics.

Annotated Bibliography

Fernandes, M., & Sturm, R. (2011). The role of school physical activity programs in child body mass trajectory. J Phys Act Health, 8(2), 174-181.

This peer-reviewed article is about how physical activity at school can aid in preventing and reducing obesity in children and adolescents from 2 up to 19 years old.

Hills, A. P., Anderse, L. B., & Byrne, N. M. (2011). Physical activity and Obesity in children. Br J Sports Med, 45, 866-870. Web.

This recent scholarly article gives an overview of physical activity about obesity in children.

Huberty, J. L., Siahpush, M., Beighle, A., Fuhrmeister, E., Silva, P., & Welk, G. (2011). Ready for recess:a pilot study to increase physical activity in elementary school children. Journal of School Health, 81(5), 251-258.

This is another primary research article that supports the findings of many other researchers who point out that engaging in vigorous physical activity for at least 60 minutes each day can help in lowering BMI among obese children.

Kriemler, S., Zahner, L., Schindler, C., Meyer, U., Hartmann, T., Hebestreit, H., et al. (2010). Effect of school based physical activity programme on fitness and adiposity in primary school chidren:cluster randomised controlled trial. BMJ, 340(785), Web.

This is an article that presents research findings of the effectiveness of physical activity programs in a school setting among young children.

Li, J.& Hooker, N.H. (2010). Childhood obesity and school’s evidence from the national survey of children’s health. Journal of School Health, 80(2), 96-103

This article explores the relationship between childhood obesity, school type, government-subsidized school diet and physical activity influencing children’s body mass index (BMI).

Llargues, E., Franco, R., Recasens, A., Nadal, A., Vila, M., Perez, M. J., et al. (2011). Assessment of a school-based intervention in eating habits and physical activity in school children:the AVall study. J Epidemiol Community Health, 65, 896-901. Web.

The article presents the findings of a study whose aim is to evaluate the efficacy of nutrition and physical activity interventions in school-going children.

Ogden, C. L., Caroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA, 307(5), 483-409. Web.

This highly insightful scholarly article offers statistics of trends in obesity prevalence in the United States since the 1980s.

Perez, A., Hoelscher, D. M., Springer, A. E., Brown, S., Barroso, C. S., Kelder, S. H., et al. (2011). Physical Activity, watching TV, and the risk of obesity in students,Texas ,2004-2005. Prev Chronic Dis, 8(3), 666-671.

This peer-reviewed research article compares physical activity or inactivity and the risk of developing obesity.

Spiegel, S. A., & Foulk, D. (2006). Reducing overweight through a multidisciplinary school-based intervention. Obesity, 14(1), 88-97.

This scholarly research publication presents a study undertaken to evaluate the effectiveness of a mixed intervention comprised of a diet and physical activity in reducing BMI.

Wright, N. K. (2011). Influence of BMI, Gender, and Hispanic Ethnicity on Physical Activity in Urban Children. J Spec Pediatr Nurs, 16(2), 90-104. Web.

This scholarly article presents the findings of a study that sought to expound on the influence of BMI, gender, and ethnicity on the physical activity of urban children.

Literature Review

According to the Robert Wood Johnson Foundation (2010), within a period of the last forty years, the rate of childhood obesity has increased to significant levels in all the age groups; and this rate has even quadrupled among the young children aged between 6 and 11 years. Indeed, according to the Center for the Study of Social Policy (2011), in the current day, “32 percent of American children are obese or at risk of becoming obese” (p.2). Childhood obesity has an impact on all children; but on the other hand, “it is disproportionately impacting children of color (38.2 percent of Latino children and 35.9 percent of Black Children ages 2 to 19 are overweight or obese, compared with 29.3 percent of White children)” (Robert Wood Johnson Foundation, 2009, p.10).

It is pointed out that “at its most basic level, obesity is often thought of as an energy imbalance” (Johns Hopkins Center for a Livable Future, 2007, p.5). Individuals add on weight when they take in more calories than they are able to burn up, implying that variations in calorie intake and physical activity are probably the basic factors that are responsible for the global trends in the increasing cases of obesity (Johns Hopkins Center for a Livable Future, 2007). In the case of young children as well as adolescents, this theory is appealing, considering that the current studies indicating the present-day levels of physical activity as well as nutrition leave much to be desired (Robert Wood Johnson Foundation, 2009). For instance, only about 23% of the adolescents and children “meet the government guidelines for one hour of physical activity per day and only about one-fifth eat the recommended five servings of fruits and vegetables each day” (Johns Hopkins Center for a Livable Future, 2007, p.5). On the other hand, researchers have failed to succeed in identifying a simple link between weight gain and energy consumption providing some evidences, for instance, giving a suggestion that overall energy intake of children has not adequately risen in the last thirty years to give an explanation to the present-day patterns in obesity (Johns Hopkins Center for a Livable Future, 2007). The findings like these have compelled researchers to make their scope wider in order to consider a broad range of the biological as well as environmental and psychological factors that may be in operation (Robert Wood Johnson Foundation, 2009).

It is pointed out that “the resulting picture of childhood obesity causality is dauntingly complex” (Johns Hopkins Center for a Livable Future, 2007, p.5). Considering the individual level, the hormonal and genetic factors are responsible for undertaking regulation of the process of metabolism as well as hunger, and such processes may eventually undergo modification through the aid of behaviors that may range from “sleeping patterns to even using air conditioning” (Johns Hopkins Center for a Livable Future, 2007, p.5). The emotional and cognitive factors also assist in determining the way individuals respond to their biological composition (Robert Wood Johnson Foundation, 2009; Kriemler et al., 2010). Wider cultural and social norms are also other main indicators; “family level factors are particularly important for children given that much of how they live is dependent on their adult caretakers” (Johns Hopkins Center for a Livable Future, 2007, p.5).

Lastly but not least, it is also pointed out that the economic, physical, organizational and policy environments are very vital in dictating “the health resources to which people have access, healthy foods and high-quality grocery stores, facilities that promote physical activity, safe neighborhoods, or simply the free time and money needed to engage in healthy behaviors” (Johns Hopkins Center for a Livable Future, 2007, p.5).In order to make sense out of the several causal influences that have been looked at, the researchers in the field of public health as well as practitioners in this field often make use of the “social ecological” framework which is a model for “thinking about casual factors by their levels of influence” (Johns Hopkins Center for a Livable Future, 2007, p.5). According to the Center for the Study of Social Policy (2011), the obesity rates are generally higher in those communities that have high levels of poverty and low income. These families are found to be underserved by the grocery stores, and they most often have few places that are secure enough for the kids to play there (Center for the Study of Social Policy, 2011). Considering the issue of communities being underserved by grocery stores or having limited access to fresh vegetables and fruits, one study found that the consumption of vegetables, as well as fruits among the Black families, went up by 32% for every new supermarket introduced within the local community (Morland et al., 2002; Wright, 2011).

The increasing childhood obesity prevalence in a large number of populations across the globe is a matter of critical concern as well as the reason behind that the social, physical and psychological consequences of childhood obesity are extensive (Waters et al., 2011, Fernandes & Sturm, 2011). It is pointed out that the increasing obesity prevalence has moved hand in hand with “a more rapid increase in the severity of obesity with more children becoming severely obese, indicating that obesity-related medical conditions will rise at least as rapidly as the overall obesity prevalence rate” (Waters et al., 2011, p.20). In addition, while these children move with that risk of being overweight into adulthood, the effect of obesity on chronic disease management will go on growing, while the pandemic gains momentum (Poskitt & Edmunds, 2008; Spiegel & Foulk, 2006).

It is reported that it is generally agreed among health researchers as well as clinicians that prevention of childhood obesity could be the main strategy for controlling the current obesity epidemic (Dehghan et al., 2005). The preventive measures may include “primary prevention of overweight or obesity itself and secondary prevention or avoidance of weight gains following weight regains after weight loss” (Dehghan et al., 2005, p.6). To this day, a larger number of approaches have put focus on changing the behavior of individual diet as well as exercise, and it seems that these strategies have had a very small impact on the increasing level of the obesity epidemic (Llargues et al., 2011; Dehghan et al., 2005).

In most cases, children are considered to be a priority population for intervention strategies, and this is for the reason that losing weight during adulthood is quite hard, and there are several possible interventions for the children (Hills et al., 2011). Such settings as pre-school institutions as well as after-school care services will offer the same kind of opportunities for action (Dehghan et al., 2005). This implies that it would be more reasonable to engage in initiating obesity prevention in childhood. Childhood obesity prevention may be realized through undertaking various measures which may be linked to diet and physical activity.

It is pointed out that the challenge that lies ahead is how to identify “obesogenic environments and influence them so that healthier choices are more available, easier to access and widely promoted to a large proportion of the community” (Dehghan et al., 2005, p.6). The main setting that can be utilized for intervention is the locality. It includes the recreation open spaces, cycling and walking networks (Li & Hooker, 2010). The school and the wider community play a very significant role in giving shape to the physical activity of the children. Moreover, “the home environment is also very important in relation to shaping children’s eating behaviors and physical activity patterns” (Dehghan et al., 2005, p.6).

An evaluation was carried out by Stone and his fellow researchers regarding the impact of school-based interventions on physical activity knowledge and behavior (Stone et al., 1998). A larger number of “the outcome variables exhibited remarkable improvements for the intervention” (Perez et al., 2011). In the United States, there was featuring of a curriculum-based approach by one interdisciplinary intervention program to influence the eating patterns, “reduce sedentary behaviors and promote higher activity levels among children of school grades 6 to 8” (Dehghan et al., 2005, p.7). After an evaluation, there was an indication of a decrease in obesity prevalence among girls but not in boys (Dehghan et al., 2005). It is also pointed out that the increase in active transport modes to and from school including walking, cycling and public transport would call for policy changes at the government as well as school levels. There would also be a need to have support from the community as well as from parents (Dehghan et al., 2005; Huberty et al., 2011).

Preventing childhood obesity may also be realized through limiting TV viewing (Perez et al., 2011). Fast foods are among the products that are mainly advertised on TV, and the children are mostly the ones that are targeted (Perez et al., 2011; Dehghan et al., 2005). Reducing the immense volume of “marketing of energy-dense foods and drinks and fast-food restaurants to young children, particularly through the powerful media and television, is a potential strategy that has been advocated”(Dehghan et al., 2005, p.7).

Moreover, the food prices have a clear influence on “food-buying behavior” and, as a result, influence nutrient intake (Dehghan et al., 2005). The use of the wrong foods may be discouraged by imposing some tax on the high-volume foods that have low nutritional value. Taxes like these are imposed in some countries as Canada and the United States. Moreover, labeling foods and using the nutrition ‘signposts’ like logos, which give an indication that a particular food meets certain set standards, might assist the food consumers to engage in making choices to consume healthy foods (Dehghan et al., 2005).

Perhaps, a suggestion presented by Askie et al. (2010) may offer a solution to getting the best way of effectively preventing childhood obesity. They raise an important issue on the way childhood obesity prevention studies have been conducted. They point out that so far, these studies “have largely targeted older children in school community settings, and have had limited effectiveness, partly due to design and methodological issues” (Askie et al., 2010, p.1). The researchers give some examples of the studies that have been conducted, and one of them is the “2005 Conchrane Review of interventions for preventing childhood obesity” (Askie et al., 2010, p.1) which involved twenty-two quality trials. They report that out of these, only three of them included children who were less than five years old (Askie et al., 2010). It is also reported that a more recent review undertaken systematically on the intervention effects on the children’s weight status (between 0 – 5 years old) found that only seven out of twenty-two studies included the children below two years (Askie et al., 2010). Moreover, just two out of the seven studies offered the growth data, and therefore, “the majority of the studies in preschool-aged children provide impact evaluation rather than outcome evaluation of the direct effect of interventions on weight status” (Askie et al., 2010, p.2).

There are several reasons as to why initiating interventions in order to ensure childhood obesity prevention early enough in a child’s life may be quite effective. According to Askie et al. (2010), “rapid early weight gain before two years of age is associated with increased risk of overweight in later childhood, and most of the age gained before puberty is gained by the age of five years” (p.2). Several potentially modifiable factors which operate in early life are as well likely to be connected to later obesity or to behaviors that are linked to promoting obesity. These may include the eating habits and dietary patterns, the parental early feeding practices, physical activity, sleep patterns, TV viewing practices, and parenting style, among others.

Research Design

The main research questions that were dealt with in this study are:

  1. How do the early intervention programs designed to ensure childhood obesity prevention provide clinically significant benefits as compared to the usual care? (These benefits were in terms of higher prevalence for breastfeeding, lower BMI z scores at one and a half to two years of age, less television watching time, the better quality of diets for children and higher prevalence for feeding practices as well as parenting styles according to the effectual self-regulation and healthy weight development).
  2. “How do the effects of childhood obesity prevention early interventions vary consistent with a child’s as well as family’s risk profile in regard to maternal BMI, birth weight and maternal education?”

In this research, the sample size consisted of about 1600 infants. The main outcomes involved the collection of the weight and height of the infants, based on those factors, the BMI was computed. Determination of the BMI was undertaken according to the growth standards of the World Health Organization (World Health Organization, 2012). The measurement of the primary outcome was the BMI z score, and this was basically at the age of eighteen months to two years. On the other hand, the secondary outcomes included the duration of breastfeeding, obesity or overweight prevalence, the time of child TV watching, sleeping patterns, the feeding practices, and physical activity measurement.

Data Analysis

There was continuous analysis of the outcomes, and this was carried out by using the linear models. The analysis of the binary outcomes was carried out using suitable generalized linear models and having adjustments for the baseline values where appropriate. There was a selection of models that allow for the “non-independence” of interpretations in the treatment as well as trial groups to make adjustments for such with a “modeling framework” (Askie et al., 2010). The analysis of the “any time to event endpoints” was carried out by using suitable models that allow for censored data. It also enabled for performing further analysis on the main outcomes that make adjustments for significant standard proofs. This is usually undertaken as a sensitivity analysis (Askie et al., 2010).

There was carrying out of the subgroup evaluations of the “participant-level” as well as “intervention-level” characteristics on the primary results in order to evaluate whether the intervention effect is different between particular groups. At the participant level that was to be undergoing evaluation, those characteristics encompassed the BMI of the mother and the weight of the child at birth, among the others. The variances that exist concerning the treatment effects in subgroups have undergone examination through considering the meaningfulness of the subgroup by involvement relations term in the model. There was also reporting of the missing data, and the causes of this were examined. This is among the necessary actions, when undertaking data analysis (Askie et al., 2010).

The primary analysis was carried out at the “0.05 significance level”. Moreover, there were also the secondary analyses at the same significance level to supplement the conclusions made on the basis of primary analysis. The interpretation of this was undertaken suitably within the same context, putting into consideration the available evidence’s totality (Askie et al., 2010).

Connection between Research Questions, Literature Review and Analysis

The analysis showed that the children fed on breast milk had considerably lower obesity levels than the formula-fed ones. The types as well as the texture of the foods given to the infants, as they undergo the transition from feeding on breast milk to the foods eaten by the family; greatly determine early food preferences, dietary quality as well as intake patterns, which children carry along with them as they grow older and which are linked to the obesity risk. It was also found out that the parenting style is connected to the early feeding habits, the child’s eating behavior and weight (Askie et al., 2010).

It was also established in the study that the parental feeding practices have a strong influence on the eating behavior of their children. The parental feeding habits determine the exposure of the infants to the food amount, type as well as frequency and encompass responses to infant eating behavior. The level of parental influence on child feeding is linked to the child’s feeding behavior and weight status (Askie et al., 2010).

It has also been found out that children who watched television for over two hours each day had higher chances of becoming obese if their dietary pattern was not healthy as well and they had low physical activity. A large number of children go beyond this threshold and patterns like these, of sedentary behavior, go on in the course of their entire childhood (Perez et al,.2011).

Still in this research, other factors were found to contribute to children becoming overweight or obese, and these factors might have subsequently facilitated modification of responses to the interventions for obesity prevention. These factors were found to be birth weight, which involved low as well as high weight; lower socioeconomic position, the maternal BMI, and maternal habit of smoking in the course of the pregnancy period (Poskitt & Edmunds, 2008).

In general terms, there exists very strong evidence that having interventions that begin at an early age of a child can be very effective for the prevention of childhood obesity. However, based on the literature presented in this paper, it has been found out that as Askie et al. (2010) point out, less effort has been made to put in place measures or interventions for childhood obesity prevention during the early age of children’s lives. As mentioned in the literature, such measures as eating fruits and vegetables, physical activity and reduced intake of sweetened drinks and beverages are found to be the best preventive measures for childhood obesity (Johns Hopkins Center for a Livable Future, 2007). This is true but the most effective way is to start introducing healthy habits early enough in the child’s life rather than waiting until it might turn out to be too late (Askie et al., 2010).

Conclusion

It has been found that childhood obesity is currently a major challenge that nations across the world have to deal with. However, the good news is that this condition is largely preventable. Prevention seems to be the best measure to be taken to deal with childhood obesity effectively. In general, prevention of obesity can be easier among children as compared to adults. This is because it is quite hard for one to lose weight during adulthood. Moreover, there exist more possible interventions for children as compared to adults. Some measures are effective in dealing with childhood obesity, and these include eating fruits and vegetables, physical activity and reduced intake of sweetened drinks and beverages. However, in general terms, these may not actually be the best and most specific measures. According to what has been established in this study, the most effective way to prevent childhood obesity is to have early interventions in the child’s life, especially by considering prevention for children who are below two years old. This can be realized through child breastfeeding, parental feeding practices, TV watching time, and physical activity, among others.

References

Askie, L. M. et al. (2010). The early prevention of obesity in children collaboration – an individual patient data prospective meta-analysis. BMC Public Health, 10(1), 758.

Center for the Study of Social Policy. (2011). Results-based public policy strategies for preventing childhood obesity. Web.

Dehghan, M. et al. (2005). Childhood obesity, prevalence and prevention. Nutritional Journal, 4(24), 1 – 16.

Fernandes, M., & Sturm, R. (2011). The role of school physical activity programs in child body mass trajectory. J Phys Act Health, 8(2), 174-181.

Hills, A. P., Andersen, L. B., & Byrne, N. M. (2011). Physical activity and Obesity in children. Br J Sports Med, 45(1), 866-870.

Huberty, J. L., Siahpush, M., Beighle, A., Fuhrmeister, E., Silva, P., & Welk, G. (2011). Ready for recess: a pilot study to increase physical activity in elementary school children. Journal of School Health, 81(5), 251-258.

Johns Hopkins Center for a Livable Future, (2007).Perspectives on Childhood Obesity Prevention: Recommendations from Public Health Research and Practice. Web.

Kriemler, S., Zahner, L., Schindler, C., Meyer, U., Hartmann, T., Hebestreit, H., et al. (2010). Effect of school based physical activity program on fitness and adiposity in primary school children: cluster randomized controlled trial. BMJ, 340(785), Web.

Li, J.& Hooker, N.H. (2010). Childhood obesity and school’s evidence from the national survey of children’s health. Journal of School Health, 80(2), 96-103

Llargues, E., Franco, R., Recasens, A., Nadal, A., Vila, M., Perez, M. J., et al. (2011). Assessment of a school-based intervention in eating habits and physical activity in school children: the A Vall study. J Epidemiol Community Health, 65, 896-901. Web.

Morland, K, Wing, S, Diez, Roux A, & Poole C. (2002). Neighborhood characteristics associated with the location of food stores and service places. American Journal of Preventive Medicine, 22 (1), 23-9.

Ogden, C. L., Caroll, M. D., Kit, B. K., & Flegal, K. M. (2012). Prevalence of obesity and trends in body mass index among US children and adolescents, 1999-2010. JAMA, 307(5), 483-409.

Perez, A., Hoelscher, D. M., Springer, A. E., Brown, S., Barroso, C. S., Kelder, S. H., et al. (2011). Physical Activity, watching TV, and the risk of obesity in students, Texas ,2004-2005. Prev Chronic Dis, 8(3), 666-671.

Poskitt, E. & Edmunds, L. (2008). Management of childhood obesity. New York, N.Y: Cambridge University Press.

Robert Wood Johnson Foundation (2010). Childhood Obesity. Princeton, NJ: Robert Wood Johnson Foundation.

Robert Wood Johnson Foundation (2009). Childhood Obesity. Princeton, NJ: Robert Wood Johnson Foundation.

Spiegel, S. A., & Foulk, D. (2006). Reducing overweight through a multidisciplinary school-based intervention. Obesity, 14(1), 88-97.

Stone, E.J, McKenzie T.L, Welk GJ, & Booth M.L. (1998). Effects of physical activity interventions in youth. Review and synthesis. Am J Prev Med, 15(1), 298-315.

Waters, E. et al. (2011). Preventing childhood obesity: Evidence policy and practice. New Jersey, N.J: John Wiley & Sons.

World Health Organization, (2012). Childhood overweight and obesity. Web.

Wright, N. K. (2011). Influence of BMI, Gender, and Hispanic Ethnicity on Physical Activity in Urban Children. J Spec Pediatr Nurs, 16(2), 90-104.

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