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Abstract
Obesity is a condition of having more than average fatness, and it is defined by the Body Mass Index (BMI) of 95th percentile or more. Obesity epidemic is not only affecting the people from underdeveloped and developing countries but also affecting the people of developed countries. Particularly, minorities in developed countries are facing the problem more commonly as compared to the other population. During the last few decades, it has not only affected the adults but also children even at very young ages. Therefore, for the betterment of future generations, it is important to work on reducing the prevalence of obesity in children, especially children from minorities. Several factors are found to be involved in increasing the prevalence of childhood obesity in minorities such as pregnancy-related factors, cultural factors, and communication gaps in people living in those minorities. In order to deal with the problem of childhood obesity in minorities, lifestyle changes and behavioral interventions including family-based and community-based behavioral interventions can be utilized. This paper deals with the prevalence, factors, interventions, and future recommendations for childhood obesity in minorities.
Obesity is a condition of having more than average fatness. It is considered as a condition of having Body Mass Index (BMI) of 95th percentile or more (Shubrook Jr, 2011). In the past 30 years, the problems of obesity and overweight have increased in not only adults but also in children. Especially, underdeveloped and developing countries have more problems of obesity and overweight. Developed countries are also facing these problems as, for example, it has been reported that the prevalence of obesity and overweight in children and adolescents have reached one-third. These problems are also not sparing even the youngest children (Dixon, Peña, & Taveras, 2012). Nearly, 1 in 7 preschool children from low-income families are obese (Shubrook Jr, 2011).
Research shows that obesity epidemic is disproportionately affecting the children from racial/ethnic minorities, i.e. children of American Indian, Asian American, Alaska Native, black, Hispanic,African American, Native Hawaiian, Latino, or other Pacific Islander (Seo & Sa, 2010). This problem of obesity epidemic in minorities is especially considerable in developed countries.
Factors for childhood obesity
Researchers believe that not only early childhood periods, but infancy and prenatal periods are also important in the development of obesity, prevention of obesity, and its consequences. That is why it is thought that the factors responsible for increase in the number of obese people may start acting in the prenatal period and some of the factors keep on working till infancy and childhood. These factors may include socio-environmental factors (macro factors), behavioral factors, and physiological and genetic factors (micro factors). Some of these factors may also interact with each other, thereby increasing or decreasing their severity. Some factors also work at a certain period known as “sensitive period” - before or after this period, those factors have no influence on the health (Dixon et al., 2012).
Pregnancy-related risk factors have been found more commonly in black as well as Hispanic women as compared to white women. For example, Hispanic and black women are more likely to start their pregnancies while they are overweight or obese and they gain less weight during their pregnancy. Moreover, Hispanic women have higher chances of getting gestational diabetes (Dixon et al., 2012).
Minorities have different levels of risk factors since their prenatal period and childhood. For example, children of people belonging to minority groups are exposed to several obesity risk factors as compared to white children. Particularly, Hispanic and black children have more chances of antenatal depression, using solid food before 4 months of age, increase in weight during infancy, watching television in bedrooms in the early ages, restrictive maternal feeding, and utilization of fast food and sugar-related beverages. Moreover, those children have lower chances of getting protective factors such as breastfeeding and sleeping for more than 12 hours per day during infant stages. Physical activity of Hispanic and black youths is also lower than white youths. These findings show that minorities may have more chances of developing obesity (Dixon et al., 2012).
Culture and acculturation also have an important role in the obesity prevalence in minorities. Acculturation can result in changes in traditional diet components across generations, thereby resulting in different health outcomes. Research shows that the diets of Latinos have changed a lot across generations as compared to whites as, for example, they have started consuming fewer vegetables and fruits, and drinking more soda. On the other hand, Hispanic immigrants have started using high-sugar and –fat foods, which is not the part of traditional Hispanic diet; thereby, affecting the children’s preferences of foods. Studies also show that US-born Hispanic and Asian American adolescents have more than 2 times chances of becoming obese as compared to adolescents, who were born in foreign countries (Dixon et al., 2012).
Culture can also influence the prevalence of obesity in children. Mothers from some cultures may consider thinness as a sign of weakness; thereby, promoting heaviness of children. For example, some evidences show that Hispanic mothers think that children can be healthier only if they are heavier; therefore, they may promote more eating in children. Moreover, Hispanic mothers may think that it is a worrisome condition, if their children are “not hungry”. Similarly, some parents may not think that their children are obese. In a study, researchers worked on African-American children in the age range of 5 to 10 years. Researchers found that nearly 90% of boys and about 80% of girls in those children were either obese or very obese, but only 30% of parents thought that their children are obese or very obese (Dixon et al., 2012).
Researchers have also found that obesity in ethnic minority children is increasing as the families of those children have limited or no access to preventive care. Moreover, gaps in collaboration about childhood obesity in ethnic minority communities are also increasing the prevalence of obesity in children. For example, absence of collaboration between parents, community leaders, and spiritual leaders is a major problem in increasing the prevalence of childhood obesity in minorities (Aidoo, 2015).
Prevalence of obesity in children
Reports show that children from minorities have an unequal share of the burden of obesity and other related problems. Obesity is highly prevalent among ethnic/racial minority children having less than 6 years of age. Children, especially Mexican American boys and non-Hispanic black girls from preschool years are clearly showing the obesity prevalence in racial/ethnic minorities. According to a report presented in the years 2007-2008, non-Hispanic black children in the age range of 2 to 19 years have more prevalence of having a BMI of more than or equal to 95th percentile as compared to non-Hispanic white children, i.e. 20% and 15.3% respectively. Similarly, Mexican American children have higher prevalence of obesity as compared to non-Hispanic white children. Another survey by the CDC (Centers for Disease Control and Prevention) Pediatric Nutrition Surveillance System in the year 2008 showed that obesity prevalence was highest in American Indian/Alaska Native (21.2%) and Hispanic (18.5%) preschool-aged children as compared to non-Hispanic white children (12.6%), non-Hispanic black children (11.8%), and Asian/Pacific Islander children (12.3%) (Dixon et al., 2012).
Prevalence of severe obesity (BMI greater than or equal to 97th percentile) also varies among children from racial/ethnic minority. Hispanic boys and non-Hispanic black girls had almost two times more chances of getting severely obese as compared to non-Hispanic white children in the years 2007-2008. Another study checking the obesity in children from the year 1976 to the year 2006 showed that in children from 2 to 19 years of age, non-Hispanic black girls had a very high prevalence (9.1%) of getting severe obesity as compared to Hispanic girls (5.1%) and non-Hispanic white girls (3.5%). In the same way, non-Hispanic black boys had higher prevalence (7.1%) of getting severe obesity as compared to non-Hispanic white boys (4%) (Dixon et al., 2012).
Outcomes of obesity in children
The outcomes of obesity are also more commonly found in children from racial/ethnic minorities. One of the most commonly encountered problems is the increased chance of obesity in adulthood, and research shows that obese black children are much more likely to remain obese in adulthood as compared to obese white children (Dixon et al., 2012).
Increase in the rates of obesity in children is also increasing the rates of diabetes, especially type-II diabetes in older ages. Reports from the National Health and Nutrition Examination Survey (NHANES) show that children from minority groups have a greatest burden of getting problems as a result of obesity. Studies show that poor glucose control is one of the most important factors in the development of type-II diabetes mellitus, and Hispanic and Black children can easily develop diabetes as they have worse control. In a study of glucose tolerance status in obese youth, it was found that 71% of non-Hispanic white children showed good-control, whereas children from other communities showed less control. For example, 59% of African American children, about half of Hispanic children, less than 50% of Asian/Pacific Island children, and only 34% of American Indian children showed good control. Moreover, Hispanic children from Mexican heritage reported the highest risk. Lower income status also increased the risk of diabetes, and girls in the age range of 10 to 14 years were found to have peak incidence of diabetes (Shubrook Jr, 2011).
Children born in 2000 in the U.S. have more than 30% chances of developing diabetes, and these chances increase in people of color (Shubrook Jr, 2011). The percentage of type-II diabetes in the children and adolescents in the age range of 10 to 19 years was found higher in American Indians (76%) and lower in non-Hispanic whites (6%). Percentage of type-II diabetes in children and adolescents was 22% in Hispanics, 33% in African Americans, and 40% in Asian/Pacific Islanders (Dixon et al., 2012).
According to reports from the years 1999 and 2000, African American children and Mexican American children in the age range of 8 to 17 years had higher levels of blood pressure as compared to non-Hispanic white children. Higher adiposity was found to be responsible for the increased blood pressure. Children from racial/ethnic minorities also showed the problems of fatty liver associated with obesity. In a study, about half of Hispanic obese children in the age range of 2 to 19 years had fatty liver disease, 35% of obese white children of that same age range had fatty liver disease, and 10% of obese black children had fatty liver disease (Dixon et al., 2012).
Strategies to deal with the problem of obesity in children
Several studies show that interventions that can modify the early life risk factors and change lifestyles can help in improving the prevalence of obesity and other related problems in children of minorities. However, few strategies have been developed to prevent obesity in children from prenatal stages. In order to decrease the early life risk factors for obesity in minorities’ children, public policies and social programs can be developed (Dixon et al., 2012). One of the most useful strategies in decreasing obesity prevalence in children is the use school lunches having reduced sugar and fat content along with a appropriate nutritional standards (Paulson, 2012).
Another strategy to decrease obesity prevalence in children from minorities is the use of biomedical science and evidence-based medicine. In this regard, studies can be done on the etiological and physiological differences in minorities, thereby developing therapeutic strategies accordingly (Dixon et al., 2012).
In a study, researchers found that family-based behavioral group treatment program can help the obese children from urban minorities having low-income. In the study, researchers worked with more than two hundred families and enrolled them in a 12-week program. Researchers offered family-based behavioral group treatment program to those families, and found significant outcomes in child BMI z-score (zBMI). They also found that children who were available for assessment for 1 year maintained that BMI (Davis et al., 2013).
In another study, researchers reported that the Children’s Healthy Living (CHL) Program can be used to increase the chances of identification and promotion of the best methods that can help in promoting not only health but also well-being of the children from underserved minority populations in the Pacific area. This program has several objectives including (Wilken et al., 2013)
the training of professionals and para-professionals in the prevention of obesity;
developing a data management and evaluation system for nutrition and physical activity;
conducting a community-based environmental intervention to reduce or prevent the obesity in children;
evaluating the environmental intervention; and
starting a obesity prevention policy.
Several other programs similar to CHL can also be started in other areas to decrease the problem of childhood obesity in minorities. These programs can also help in decreasing the gaps in collaboration between minorities; thereby, improving the health of children.
In a meta-analytic review, researchers reported that therapeutic interventions considering three or more strategies such as nutrition, physical activity, counseling, and reduction in sedentary behavior have more effective outcomes as compared to the use of one or two strategies. Moreover, it is important to use lifestyle interventions that are according to the culture of minorities to improve the efficacy of programs as those lifestyle interventions show more success as compared to non-lifestyle interventions. It has also been found that therapeutic strategies in which parents are involved have more effective outcomes in reducing the prevalence of obesity in children as compared to the interventions in which parents are not involved. Therefore, healthcare experts have to involve the children as well as their parents in an intervention rather than children alone. Research also shows that interventions have to be implemented for a sufficiently larger period of time as interventions of shorter duration are less efficacious as compared to interventions of longer duration (Seo & Sa, 2010).
Concluding Remarks
Obesity is among the most problematic health-related issues of the modern world, and this issue becomes more serious in case of minorities. Obesity is not only affecting the life of adults but also affecting the life of children even at very young ages. Several factors such as pregnancy related factors, behavioral factors, and socio-environmental factors are found to be involved in increasing the issue of obesity in children. Obesity in childhood can result in several other problems such as diabetes, high blood pressure, and fatty liver diseases in older ages. Lifestyle changes and behavioral modifications can help in dealing with the problem. However, very few studies deal with the childhood obesity in minorities. Reports for prevalence rates in childhood obesity in minorities are not up-to-date. Therefore, further studies have to be done and reports have to be developed to improve the health of children belonging to minorities.
References
Aidoo, J. F. (2015). A qualitative emancipatory phenomenological study of childhood obesity in the ethnic minority community. UNIVERSITY OF PHOENIX.
Davis, A. M., Daldalian, M. C., Mayfield, C. A., Dean, K., Black, W. R., Sampilo, M. L., . . . Suminski, R. (2013). Outcomes from an urban pediatric obesity program targeting minority youth: the Healthy Hawks program. Childhood Obesity, 9(6), 492-500.
Dixon, B., Peña, M.-M., & Taveras, E. M. (2012). Lifecourse approach to racial/ethnic disparities in childhood obesity. Advances in Nutrition: An International Review Journal, 3(1), 73-82.
Paulson, A. J. (2012). Childhood Obesity: The role of nutritional school lunch interventions in lowering minority children’s BMI.
Seo, D.-C., & Sa, J. (2010). A meta-analysis of obesity interventions among US minority children. Journal of Adolescent Health, 46(4), 309-323.
Shubrook Jr, J. H. (2011). Childhood obesity and the risk of diabetes in minority populations.
Wilken, L. R., Novotny, R., Fialkowski, M. K., Boushey, C. J., Nigg, C., Paulino, Y., . . . Kim, J. (2013). Children’s Healthy Living (CHL) Program for remote underserved minority populations in the Pacific region: rationale and design of a community randomized trial to prevent early childhood obesity. BMC Public Health, 13(1), 944.
