Introduction
Obesity has become a global epidemic much as a paradoxical contrast with the growing reports of starvation around the world. However, nowhere is it more prevalent than the United States of America. It can be seen everywhere, from schools, to offices, from malls to parks. And although one may be inclined to think that it is simply a cosmetic issue however it does not just affect our physical appearance. Obesity makes us prime candidates for medical complications such as heart diseases, diabetes, blood pressure problems and high cholesterol. However, it can be controlled and even stopped. And the solutions are simple: they begin at home in every little decision we take. What is more troubling than the increase in obesity amongst adults is the rise in children. And although it is extremely easy to recognize, if not treated early, can become extremely difficult to take care of. Not only that, children suffering from obesity are more prone to becoming overweight as adults unless their eating habits and physical exercise are maintained and improved.
What is obesity?
In order to truly understand this problem, it is important to identify what exactly obesity is. Having gained just a little bit of weight does not mean one is obese. However, it can indicate that you have a tendency to easily put on weight and that you may need to make some changes in your daily diet and exercise regime. A child will not be considered to be obese unless his/her weight is about 10% higher than what it should be for his/her height and body type. According to a paper by the American Academy of Child and Adolescent Psychiatry titled ‘Obesity in Children and Teens’, obesity most commonly starts when children are between the ages of 5 and 6 and that those children who are obese anytime between 10 and 13, have an 80% chance of becoming obese as adults.
Statistics
According to the American Heart Association, approximately one in three American children are overweight or obese, almost three times the number than in 1963. It has now become the number one cause of concern for parents in America, beating smoking and drug usage. Consequently, the health problems that children are facing now were problems that were always seen to be typically ‘adult’ problems, such as high blood pressure, advanced diabetes (type 2) and high cholesterol. There can also be emotional and psychological problems as children suffering from obesity are more inclined to suffer from low self-esteem, depression and body image issues. The most startling revelation on the topic has come from former Surgeon General Richard Carmona, “Because of the increasing rates of obesity, unhealthy eating habits and physical inactivity, we may see the first generation that will be less healthy and have a shorter life expectancy than their parents.”
A brief synopsis of the various statistics that exist regarding obesity in children can be examined to better understand the gravity of the situation, as per the Centers for Disease Control and Prevention (CDC):
• Childhood obesity has doubled in children and tripled in adolescents within the past 30 years. Children between the ages of 6 to 11 years in America who were obese increased from 7% in 1980 to nearly 18% in 2010 whilst adolescents between the ages of 12 to19 years who were obese increased from 5% to 18%.
• The definition of ‘overweight’ is having excess body weight than that which is recommended for a person’s height and body type; whilst obesity is having excess body fat.
• Suffering from being overweight or obesity is usually the result of a phenomenon called “caloric imbalance” which is when a person expends too few calories in comparison to the amount of calories consumed.
Calculating obesity in children
The BMI or the Body Mass Index is the formula used to determine obesity and to generally calculate weight in children and adults. But it is not easy to determine whether a child is overweight because all children have varying growth patterns.
BMI as a formula is the ratio of weight to height squared. And although it has been used to calculate weight in individuals for many years now, in 2005, the Institute of Medicine asked the federal government of the United States to develop a system of explanatory guidance to measure BMI in schools. After consultation with a panel of experts, the CDC presented a report to assist with BMI measuring programs.
The recommendations of the CDC suggested that in order to calculate BMI in children and adolescents, age specific and sex specific growth charts should be used by comparing their BMI to the age and sex appropriate BMI measurement. This measurement is an average of children of similar height and body type.
It is easy to get confused with all the varying and overwhelming numbers when it comes to calculating BMI, however, as per the American Heart Association, those children are considered obese whose BMI percentile is 95 or higher. Children whose BMI percentile is between 85 and 95 are overweight whilst those between 5 and 85 are seen to be normal. However, any BMI percentile under 5 is also seen to be alarming but for being underweight.
Causes of obesity in children
Causes of obesity in children can be varying and can range from genetic to biological and behavioral to cultural. Although medical conditions and problems can also be a reason for obesity in children, the incidence of such cases is less than 1%. Obesity in children and adolescents can be caused by any of the following factors:
• poor eating habits;
• overeating;
• no physical exercise;
• family history and genetics;
• medical illnesses;
• medications (for example, steroids);
• stressful changes in environment;
• family problems;
• self-esteem issues;
• psychological issues such as depression, etc.
But the most important reason remains the poor choices Americans are making when it comes to what they eat. Adults are consuming, and as a result making their children also consume, high caloric foods that do not meet necessary nutritional requirements.
Consequences of obesity
There are many problems that arise from obesity. Physical consequences include:
- High risk of heart disease;
- High blood pressure;
- Diabetes;
- Respiratory problems;
- Insomnia and other sleeping disorders.
- Depression, anxiety, and other emotional problems.
Although most people do not consider obesity to have any effect on a person’s life beyond physical and emotional health, there are serious consequences for a person’s finances as well. An overweight person is more expensive for the healthcare system. In the past decade, the costs of dealing with obese patients have doubled from $78 billion in 1998 to $147 billion in 2008.
How to deal with obesity in children
Parents:
Parents are the best source for dealing with their children’s obesity. According to Tulane University physician Gerald S. Berenson who is studying 145,000 children and adolescents for thirty years as a part of his Bogalusa Heart Study, “It all starts in childhood”, which is why it is under control of parents to oversee and monitor what their children eat.
Interviews and surveys:
In order to better understand the dynamics of how parents think and act when it comes to their children’s health and eating habits, it was important to speak directly to them. It is not possible to advise parents or to formulate any recommendations or suggestions unless and until there is extensive interaction with them. Therefore, in lieu of this endeavor, 9 sets of parents were surveyed and then interviewed about their children’s daily routines in terms of the food they eat and their physical activity. These 9 sets of parents were all from different ethno-socio backgrounds, with a varying number of children. The breakdown of the research is as follows:
- 1 White Caucasian set of parents between the ages of 25-30 with two children in the income bracket of $40-$50,000 annually
- 1 White Caucasian set of parents between the ages of 35-45 with three children in the income bracket of $70-$90,000 annually
- 1 African American set of parents between the ages of 30-35 with one child in the income bracket of $20-$30,000 annually
- 1 Hispanic set of parents between the ages of 25-35 with three children in the income bracket of $15-$20,000 annually
- 1 Asian set of parents between the ages of 30-35 with two children in the income bracket of $80,000+ annually
- 1 single White Caucasian mother in the 45-55 age bracket with two children with an annual income between $20-30,000
- 1 single African American father in the 30-40 age bracket with three children with an annual income between $15-20,000
- 1 single Hispanic mother in the 20-25 age bracket with one child with an annual income between $15-$20,000
- 1 single White Caucasian mother in the 20-25 age bracket with two children with an annual income between $20-$30,000
These parents were asked the same set of questions and their answers revealed a lot of important information. When asked how important it was for them to eat healthy, approximately 66% said ‘somewhat important’ whilst 33% said ‘very important’. When asked how they would describe their children’s weight, approximately 77% said ‘about right’, whilst 11% each said ‘slightly underweight’ and ‘slightly overweight’. A number of other questions were asked which will be further examined during the course of this paper.
Basic do’s and don’ts:
According to various experts in the field, there are certain basic do’s and don’ts for how to deal with children when managing their weight. It is suggested to not let children eat whilst watching television because they end up taking in more calories in front of a TV. The Journal of Nutrition Education and Behavior reports that families who watch television whilst having dinner tend to eat more fatty foods. Parents interviewed for this paper were asked how many hours of television their children watch on a school day. Whilst nearly 44% said ‘less than 1 hour’, nearly 33% said ‘3-4 hours’. And many of them indicated that these hours include meal times as well. The parents were also questioned how easy or difficult it was for them to feed their children vegetable. Nearly 55% said ‘somewhat easy’ whilst approximately 22% said ‘very difficult’. Furthermore, a study conducted by students in St. Paul-Minneapolis concluded that children who ate regularly with their families tend to consume more healthy foods such as fruits and vegetable. In furtherance of this finding, the parents were also questioned how often their children get involved in the preparation of meals at home, as that indicates that they eat their meals together. Approximately 44% said that their children get involved a couple of times a week whilst 33% said barely ever.
It is also suggested by experts that children who have regular physical exercise in their daily routine are not as likely to be overweight as children who do not. A study carried out by Purdue University discovered that the most physically active children were usually those who had friends being physically active with them. So just like in all other spheres of a child’s life, the company he/she keeps is extremely important.
A common complaint amongst many parents interview for the purposes of this paper is that their children are ‘fussy eaters’. That they enjoy sweets and snacks but are troublesome when forced to eat something else. Even 44% of the parents interviewed suggested that their children eat from a very small range of food on a regular basis. To deal with this problem, nutritionist Susan Roberts suggests a “rule of 15,” which basically means that parents should not give up when attempting to feed their children ‘healthy’ foods and should try at least 15 times.
Parents need to speak to their children about the choices they make when eating and when deciding what to eat and why. When parents force their children to think about the food they consume, there is automatically an emphasis on eating right. Nearly 44% of parents interviewed suggested that they only discuss food with their children ‘a bit’. Children tend to imitate their parents. This is true for eating patterns as well. Parents who set an example by having a healthy lifestyle are more likely to influence their child’s behavior for the better.
Schools:
As important as it is to look out for children and their dietary habits at home, it is their schools that have the most impact on their health and lifestyles. Schools can make sure that students are surrounded by an environment that is supportive of their efforts in maintaining a healthy lifestyle. They can put policies in place that encourage healthy eating and physical exercise whilst teaching them about such practices and the benefits of managing their dietary habits. And it is obvious from the answers of the parents interviewed for the purposes of this paper that they are not satisfied by the efforts being put in by schools on this matter as nearly 60% of them thought the food provided by schools to their children is of poor quality. Furthermore, almost 78% of them felt they were very knowledgeable about the food education their child gets in school and were unsatisfied by it.
The CDC carried out extensive research on the matter that will aid our analysis immensely as well. It formulated nine guidelines with the help of the Dietary Guidelines for Americans, the Physical Activity Guidelines for Americans, and the Healthy People 2020. With these guidelines, schools can and indeed have been developing and implementing policies to encourage healthy eating and practices involving physical activities.
A summation of the CDC’s guidelines is important to truly grasp the influence and importance of schools in dealing with obesity in children:
GUIDELINE 1
Representatives from different sectors of schools and the community, including parents and students, should work together to maximize healthy eating and physical activity opportunities for students. This way a concerted effort and combined approach can lead to the formation of various helpful policies.
GUIDELINE 2
Schools should create an environment that encourages students to eat healthy and partake in physical activities throughout their time spent at school.
GUIDELINE 3
The most important aspect of these guidelines is ensuring that the food schools offer students is up to the standards of being healthy. They must only provide foods with high nutrition values and should immediately stop the provision of junk food that is high in caloric content. This food should then not only be provided in the school cafeterias but at all school events and areas, including vending machines and snack bars.
GUIDELINE 4
Schools need to overhaul their physical education programs and make sure that all students are taking part in 60 minutes or more of any physical activity each day. Providing access to fun and appealing methods of physical activity is essential in getting children to become fit.
GUIDELINE 5
It is absolutely essential that schools provide extensive and detailed health education to students. It is necessary that children have the knowledge that is required to make the right decisions when it comes to their eating habits. Unless and until children themselves take active part in their health and what affects it, all other efforts will continue to be futile.
GUIDELINE 6
Schools are responsible for students’ physical health, mental health, and safety during the school day. Therefore, they must make sure that there is complete access to counseling and guidance for all and any issues that children may be having regarding their physical and mental health and well-being. A big part of that must be the provision of information and help in dealing with eating disorders.
GUIDELINE 7
Related to the first guideline, this one also suggests that schools and communities including parents should work together to promote healthy lifestyles.
GUIDELINE 8
GUIDELINE 9
And finally, in conjunction with the guideline on providing counseling and support to students, it is of the utmost important that schools employ certified and qualified individuals who have experience in dealing with children and their nutrition.
Interview with school staff
Having analyzed the CDC’s recommendations and guidelines on how to make schools in to a healthier environment for children in extensive detail, it was important to get a first-hand perspective from a school which has implemented these guidelines. When interviewing the principal and other members of staff of a local Washington state middle school, it became apparent that the guidelines certainly work. She stressed on the fact that since the school employed the CDC’s guidelines, the attitude of children towards their health and more specifically what they eat has improved. Not only have parents become more involved but children are also willing to talk about issues concerning their diets.
Conclusion:
Childhood obesity is truly an epidemic and battling it head-on is not going to be easy. All the aforementioned suggestions in this paper and the compilation of recommendations by the CDC and various esteemed academics and professionals make it seem very easy- encourage children to eat right, exercise daily and make parents get involved. But it is not as easy as it seems. The causes of childhood obesity are so vast and all-encompassing that this paper or any other scholarly expose cannot possibly delve in to all of them.
There are so many factors at play from sociological, economic, and genetic to environmental. And most importantly, a factor that almost always gets ignored- the child involved. Children can be molded to think and behave a certain way but they cannot be forced; which is why it is excessively difficult to work with them, for them.
However, all the aforementioned suggestions and analysis has not only proven to be effective over long-term studies but can decrease the increased incidence of childhood and adolescent obesity if these methods are consistently stressed on and implemented.
Bibliography
American Academy of Child and Adolescent Psychiatry . "Obesity in Children and Teens." Facts for Families March 2011.
American Heart Association. "Understanding Childhood Obesity." 2010.
Centres for Disease Control and Prevention. Adolescent and School Health- Childhood Obesity Facts. 2013.
—. "Body Mass Index Measurement in Schools." 2010.
—. "Guidelines for Schools to Promote Healthy Eating and Physical Activity." 2011.
Meyers, James E. Missourifamilies.org Food and Fitness 'Teaching Life Long Health Skills to Our Kids'. 5 May 2009.
Roberts, Susan B and Melvin B Heyman. "How to Feed Babies and Toddlers in the 21st Century." 2000.
Taylor F. Eagle, BS, Anne Sheetz,MPH, Roopa Gurm, MS, Alan C. Woodward,MD, etc. "Understanding Childhood Obesity in America." American Heart Journal (2012).
U.S Department of Health and Human Services. "Overweight and Obesity Statistics." 2012.
