Recent statistics have reported the increasing prevalence rate of obesity and other lifestyle-related diseases such as diabetes and cardiovascular diseases in both developed and developing countries (De Onis et al., 2010). Albeit, considered to be lifestyle-associated in etiology, the occurrence of these diseases is solely evident among adults but alarmingly also among children.
The World Health Organization (WHO) has documented the increasing prevalence of childhood obesity worldwide. In 2010, 43 million children were diagnosed to be overweight or obese. A significant number (35 million) of these children lived in developing countries. The worldwide prevalence rate of obesity among children significantly increased from 4.2% in 1990 to 6.7% in 2010. According to WHO, the prevalence rate is anticipated to increase to 9.1% (60 million) in 2020 (De Onis et al., 2010).
In Japan, there have been increasing incidences of eating disorders such as anorexia and obesity increase among schoolchildren; thus there has been a rising concern in the development of lifestyle-related diseases. Statistics in 1994, 1998 and 2008 reveals a gradually increasing rate of obesity in the country. In fact, approximately one-third of Japanese over the age of 20 years had already become obese in 2004. Presently, the occurrence of having metabolic syndrome is suspected among 8.9% and 23% of women and men population, respectively. Further, 7.8% of women and 23% of men are reported to be in the preliminary stages of the syndrome (Nakamura, 2008).
In the United States, on the other hand, Briefel et al. (2009) reported that approximately 25 million of American children have been diagnosed as either overweight or obese. Further, approximately one-third of school-aged children in the country are reported to be overweight or obese. This occurrence among school children further predispose them negative health consequences concomitant with their state of health. These negative health consequences include type-2 diabetes (Insulin Dependent Diabetes Mellitus) and other cardiovascular diseases in spite of their young age (p. 91).
In England, the prevalence rates of childhood obesity have significantly increased from 2.0 fold to 2.8 fold over a decade. The disease has been considered epidemic in distribution and has significantly affected a wide range of people – in varying ethnicity and economic status.
Epidemiologically, childhood obesity is considered to be multi-factorial in etiology and can potentially cause negative health consequences which encompass both the physical and psychological health of a child afflicted with the condition. In parlance, it is a health condition brought about by the interplay of both intrinsic and extrinsic factors. (Ebbeling et al., 2002).
Comparable with the adults, childhood obesity can significantly cause chronic inflammation, increased blood clotting tendency (i.e., decreased prothrombin time), endothelial dysfunction, dyslipidemia, and hypersinsulinemia or diabetes mellitus. The combination of the previously enumerated cardiovascular risk factors is known as the insulin resistance syndrome has been reported in other studies to be present in children as young as 5 years of age (Ebbeling et al., 2002).
In addition to the debilitating health consequences concomitant with the occurrence of obesity, findings of numerous studies have also reported psychosocial consequences that the obesity may also bring along.
On the social aspect, the obese children are stereotyped as academically unsuccessful, lazy, socially inept, unhealthy and unhygienic. Ironically, some of healthcare practitioners who are specializing or dealing with obesity treatment have been found to share the same negative stereotypes to a certain degree among obese children. With these social stereotypes, a negative self-image can be developed among children who are as young as 5 years old. Furthermore, obese adolescents have been observed to manifest declining degrees of self-esteem that can significantly associated with high-risk behaviors (i.e., addiction), loneliness, nervousness, and sadness (Ebbeling et al., 2002).
As previously explicated, the negative physical and psychosocial consequences concomitant with obesity among children can be viewed as multi-factorial in etiology. Typically, the problem on obesity can be viewed as a problem on the disequilibrium between energy intake and energy expenditure. Thus, any factor that increases energy intake or decrease the expenditure of energy by a small fraction may potentially lead to the occurrence of obesity on a long term basis. In addition to the energy intake and expenditure imbalance, other factors may essentially contribute to predisposing a child to obesity. Some of these factors are genetic predisposition, environmental factors, physical activity and diet (Ebbeling et al., 2002).
Genetic predisposition can have an essential effect on the occurrence of obesity; nevertheless, increasing prevalence rates among genetically stable populations posit that both environmental and perinatal factors may also influence the epidemic on childhood obesity (Ebbeling et al., 2002).
In contrast to the nature versus nurture phenomenon, the causation of obesity among children may be viewed to be an inter dependence between environmental factors or the extrinsic variables (i.e., culture, economic status) and biological attributes or the intrinsic variables (i.e., heredity). In a study of Ravelli et al. (1976) it was found out that the epidemic on obesity could accelerate or passed on through successive generations. In parlance, maternal obesity, birth weight, and obesity later in childhood have been concluded to be sequential in order and directly correlational. Interestingly, a negative direct correlation has been noted between maternal undernourishment to childhood obesity or obesity later in life.
In addition, to the interdependence of maternal attributes and childhood obesity, the dietary practices of children may significantly predispose them to the disease. Children who were bottle fed are posited to be more at risk in developing obesity as compared with children who were breastfed. This conclusion may construe with the explanation that permanent physical changes may be correlated to intrinsic factors inherently present in human milk (i.e. immunoglobulin A) or to some psychological factors (i.e. locus of control over feeding rate, taster preference) (Ebbeling, 2002).
The other factor may could lead to obesity is the child’s physical activity. In a study of Andersen et al., (1998), it was concluded that a lifestyle that is characterized by insufficient or lack of physical activity or exercise inactivity (i.e., television viewing) may essentially cause childhood obesity. Unlike the genetic predisposition, the effects of physical inactivity on the occurrence of obesity may be considered reversible or labile in nature. In fact, it was found out that an hour per day of moderate-to-vigorous physical activity has been found out to decrease obesity risk by 10%. In contrast, a 12% increase of obesity risk can be correlated to every hour of television viewing (Ebbeling, 2002).
The dietary habits of a child predispose him to obesity and other lifestyle-associated metabolic disorders. These habits include eating food choices rich in saturated fat, carbohydrates and frequent consumption in fast foods. It has also been found out that the intake of partially hydrogenated (trans) fat, commonly found in commercial bakery products and fast foods can potentially lead to obesity and increase one’s predisposition to cardiovascular diseases and type 2 diabetes mellitus. Further, the consumption of meals composed of high glyceamic index, such as breads, ready-to-eat cereals, potatoes, soft drinks, biscuits and cakes, can significantly increase postprandial (i.e., after meal) blood glucose concentrations thus could further lead to an increase in appetite and subsequently predisposing children to overeating of the said kinds of food (Ebbeling et al., 2002).
Another dietary habit of significance among children is the consumption of sugar-sweetened soft drinks. Studies have found out that total energy intake is about 10% greater among school-age children who consume soft drinks than in those who do not. In addition, a 60% increase in the obesity predisposition is noted among middle-school children for every additional serving of sugar-sweetened soft-drinks.
Programs to address childhood obesity
With the aforesaid scenarios in mind, it is essential that programs are established and implemented to address the surging prevalence of obesity and other related diseases across the populations with special emphasis to the children. Health infrastructures, in the form of social institutions, play a vital role in the establishment and implementation of these health and nutrition-focused programs; some of these are the academic institutions. Schools are the institutions where school-age children mostly spend their time and their energies in. It is in a school where children consume a significant fraction of daily caloric intake in. Briefel et al. (2009) reported that almost one-third and half of children’s food intake and energy are spent and consumed in schools, respectively. Thus, schools can make significant contributions to the improvement in children’s food and nutrient intakes (Condon et al., 2009).
The institution of programs on alleviating or preventing obesity in a school setting can be recognized as an effective mechanism to address the disease prevalence among children. Veugelers and Fitzgeral (2005) concluded that school-based healthy eating and physical activity programs provide a great opportunity to improve the health and well-being of children since these programs may reach almost majority of these children and may: improve learning; provide social benefits; improve health during the period of growth and maturation; lessen the risk for occurrence of chronic diseases later in adulthood; and, help to establish healthy behaviors at an early age that will lead to long healthy habits among children.
With the aforementioned rationale, various organizations have promulgated legislative reforms and various programs have been instituted to address the growing number of overweight and obese children in schools. Some of these programs are the school breakfast and lunch programs (Nakamura, 2008).
In Japan, school lunch program was implemented under the “School Lunch Act” enacted in 1954. This was done in response to the increasing prevalence of malnutrition among Japanese school children after the World War II. This act was subsequently revised and enacted (Condon, 2009; Nakamura, 2008). The program ushered in western influences in the eating habits of Japanese such as eating more high protein and high calorie sources (e.g. meat) than consumption of the traditional carbohydrate-rich rich. Imported flours and skimmed milk from the United States were distributed to academic institutions for their lunch programs. Further, with the flourishing economic status of the country in the 1960’s, supermarkets had been influential in food distribution. These two events have subsequently resulted in the increased prevalence of obesity among Japanese school children (Nakamura, 2008; Tanaka and Miyoshi 2012).Thus, in 2008, “The School Lunch Act” was revised and its objective was altered to advocating “Shokuiku”. Shokuiku is the facilitation of knowledge on food and nutrition and the development of healthy food choices among school children. This school program has also created an avenue for school children to develop healthy eating habits and positive behavior. Registered dietitians played a significant role in the program. Their roles include the provision of education and guidance on health eating habits among children and family, and taking into account the significance of these habits on the prevention or control of lifestyle-related diseases such as obesity. Thus, the roles of dietitians have been revolutionized from being diet supervisor to becoming educators and counselors (Nakamura, 2008; Tanaka & Miyoshi, 2012). As of 2009, approximately 10 million school children participated in the Shokuikuprogram. Upon the program’s implementation, a positive impact on the awareness and interest among diet teachers and guardians was noted in schools with diet and nutrition teachers. Through the incorporation of Shokuiku in Japan’s early educational system, the proportion of children skipping breakfast has decreased and thus the health of these children has essentially improved (Tanaka and Miyoshi, 2012).
In the United States, on the other hand, the Child Nutrition and WIC Reauthorization Act of 2014 mandates local education institutions to address obesity among school-aged children by creating wellness programs that include nutrition guidelines for foods available in all schools in the country. In addition to this, the Institute of Medicine (IOM) has emphasized the role of schools as primary agencies for instituting environmental and policy changes that could significantly result to improved dietary and physical behavior among school children (Briefel et al., 2009). Furthermore, following the said advocacies is the institution of School Breakfast Program (SBP) and the National School Lunch Program (NSLP) in which all US public schools participate in the latter and approximately 80% of schools participate in the former (Condon, 2009). The SBP and NSLP serve as avenue to incorporate healthy eating habits through the provision of healthy food choices among school children particular those with ages 10-12 years or those who are in elementary schools. The programs specifically aim to provide children with high nutrient, energy dense, high calorie and low in sugar dietary choices. However, approximately one-sixth of elementary school children consume low nutrient, sugar-sweetened beverages such as soft drinks which can be accounted for an average of 100 kcal. The consumption of these beverages has been increasing throughout the years and has been posited to be influenced by the “fetishized” nutritional habits of young Americans (Kluger, ). Furthermore, two-thirds of all state-funded school children, which include elementary school children, consumed a significant amount of low-nutrient, energy-dense foods such as baked goods, dairy-based desserts, and French fries. Majority of these food and beverage choices were made available in schools can be accounted for 176 kcal among school children (Briefel et al., 2009). On the consumption of fruits and vegetables, Briefel et al. (2009) documented that 50% of all public school children reported consuming some type of fruits and vegetables they obtained from their schools.
In England, on top of the nutrition programs instituted in schools with objectives that are comparable to Japan’s and the US’s, is the media that plays a pivotal role in the reduction of obesity most specifically among children. The program is entitled, “Fighting Fat, Fighting Fit” and has been spearheaded by BBC, a UK-based media company. The program has resulted into an increased awareness on obesity and measures to prevent and control such (Wardle et al., 2001). This program is relevant to the study of Andersen et al., (1998), which concluded that a lifestyle that is characterized by insufficient or lack of physical activity or exercise inactivity (i.e., television viewing) may essentially cause childhood obesity. In fact, it was found out that an hour per day of moderate-to-vigorous physical activity has been found out to decrease obesity risk by 10%. In contrast, a 12% increase of obesity risk can be correlated to every hour of television viewing (Ebbeling, 2002).
Childhood obesity control: WHO recommendations
Having been recognized to be a global epidemic in distribution, childhood obesity necessitates a collective global action with a unified aim – to promote healthy and sustainable eating behaviors among children. In relevance to this, various organizations have raised recommendations to address the public health concern.
The World Health Organization (WHO) has recommended that interventions to promote healthy behaviors should be taught and instituted during the earliest periods in the life of a child (i.e., birth to 24 months) as these behaviors are most likely to persist in adult life. WHO also has posited these interventions are also most likely to succeed should they be introduced in the early growth and maturation period of a child. The organization has also reiterated to put an emphasis on developing measures to address childhood obesity, not only in developed countries, but also in developing ones as well. This is in relevance to the previously-discussed correlation between maternal undernourishment and childhood obesity (De Onis & Blossner, 2003).
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