Category: Childhood Obesity

Obesity is one of the challenges facing the current generation and most probably the young and growing children. According to Lobstein et al. (2015), obesity refers to excess body weights or body fats that might affect one’s health and are measured by the Body Mass Index (BMI). The challenges affect the children both mentally and physically and it is therefore important to both society and healthcare to help the growing children on how to avoid such challenges. In order to understand how to mitigate the challenge, it is vital to discuss the best and applicable alternative solution to the challenges. This essay will, therefore, major on the most vital and applicable solution to the problem and provide a response to the solutions.

There are various proposed solutions that can be used to mitigate the presence of obesity in childhood. These solutions may include but are not limited to changing food choices and eating behavior, physical activity, and weight loss surgery among others. Change of food choices and eating behavior among children is one of the common solutions to the obesity. Obesity is highly associated with poor food choices among the family members which on the other hand affects the child’s weight. With a change in food choices every day, it becomes easier for the body to have vital nutrients and proteins in the body. This reduces the chances of becoming overweight as there is a balance in the food nutrients required by the body. Behavior change also impacts obesity challenges. There are various ways in which behavior change could influence obesity such as snacking frequently after school period, skipping breakfast or lunch and having regular take away meals, or eating out (Simmonds et al., 2016).

Physical activity among children plays a vital role in balancing body weights. It plays a vital role by helping children sleep well at night, strengthening bones and muscles, burning calories, and staying alert during the day. With an increase in physical activities, the body fats, therefore, become less concentrated in the body which highly activates obesity among children. Moreover, weight loss surgery plays an essential role in the reduction of obesity. Most of the children who have experienced being overweight which may be difficult to reduce through the other obesity reduction methods have been handled through surgery. This type of solution is however allowed in case of any threat associated with obesity and where the other lifestyle changes have failed to solve the challenge. The solution is not highly encouraged due to various cons which outweigh the pros.

However, in addition to the three solutions, medication can be used as another alternative which also helps in the mitigation of the problem. However, there are various unanswered questions concerning the long-term effects that may result due to the frequent medication on weight loss and maintenance among the adolescence. Such as “disorientation, apathy, confused exhaustion, psychosis, depression, and damage to the brain including strokes and possibly epilepsy” according to Foundation for a Drug-Free World (2006-2019). One of the main stimulant drugs used to help control weight is Ritalin. Which is a “synthetic drug that stimulates the sympathetic and central nervous systems, used chiefly to improve mental activity in attention deficit disorder” (Oxford University Press et al., 2019). Therefore, medication is not always the answer. Take the case of a teenager—a long-term user of Ritalin—who collapsed one day while skateboarding. Dead of a heart attack (Foundation for a Drug-Free World et al., 2006-2019). The stress Ritalin puts on the heart can be fatal.

Although obesity is a challenge especially to the adolescence, it has several solutions for its mitigation. Food choices and eating behavior, physical activities, weight loss surgery as well as medications have been used as treatment measures. They have led to the reduction of obesity-related cases among children and those in the adolescent stage. It is therefore vital to both the society and the government to consider the mitigation solutions to end the presence of obesity among young and growing children.

Childhood obesity has steadily become a problem in the United States. Data from the Center for Disease Control and Prevention (CDC) show an increase of prevalence of obesity in children and adolescents. In addition, a decrease in level of education shows an increase of prevalence of obesity. A study by Rogers et al. (2015), stated childhood obesity is associated with obesity in adulthood and will have a higher rates of obesity risk factors, such as hyperlipidemia, or diabetes. In addition, the author states that race is not a significant correlation with obesity when income is taken into account. The purpose of this paper is to investigate the influence of nutrition education in preventing childhood obesity in low-income families.

Disease Overview

Obesity or overweight is defined as a weight above what is considered as healthy. It is often measured by the Body Mass Index (BMI). For a child to be categorized as overweight, he or she must have a BMI greater than or equal to the 85th percentile but less than 95th percentile. In addition, for a child to be considered as obese, he or she, must have a BMI greater than or equal to 95th percentile (Rogers et al., 2015). Over the years there has ben a steady increase of overweight/obesity in the United States. The prevalence of obesity from 2009-2010 was 18.4% for the ages 12 to 19 years old and from 2014-2016 there was an increased from 9.3% to 13.7% among child age two to five years old (Deavenport-Saman et al., 2019; Rogers et al., 2015).

Childhood obesity is greatly affected by socioeconomic status (SES). The SES is comprised of factors such as education, and income. According to Rodgers et al., 2015, an increase of 23-33% obesity prevalence from families with low SES, in 2003-2007. Challenges of families with low SES have are due to having low education level, low-income and communities they live in. If the parent has a lower level of education, they will be less aware of the impact of physical activity and healthy eating when providing a healthier lifestyle and model healthy behaviors for their children at home and realize that their child is overweight (Gibson et al., 2016; Rogers et al., 2015). Furthermore, Low-income families tend to live in low-income communities, where they have a reduce access to supermarkets and places to exercise (i.e. parks). Plus, they may have numerous access to convenience store and fast food chain, which promotes poor nutrition and little or no physical activity (Rogers et al., 2015).

Data suggest that obesity in childhood is associated with a high likelihood of obesity in adulthood, about 70% chance a child to remain overweight or obese as an adult. Furthermore, if the child continues to remain to be overweight/obese they are at a higher chance of acquiring one or more of these medical conditions: hypertension, diabetes, hyperlipidemia and higher incidence of stroke, myocardial infarction, which is why it is important to address this health disparity to prevent children in acquiring these medical conditions that may affect their quality of life in adulthood (Rogers et al., 2015).

CARS Article 1

The article by Rogers et al. (2015) was published on December 2015 in the Childhood Obesity journal, a peer-reviewed health journal focused on real-world obesity prevention. There are twelve authors responsible for the information presented in this article; eight authors are affiliated with the University of Michigan Health system; three authors are associated with Massachusetts Department of Public health and one author is affiliated with the University of Michigan School of Nursing. The article provided contact information for Kim A. Eagle MD, to address any correspondence regarding the article. There are 42 supporting articles listed in the reference list, which 39 of the resource does not meet the five-year mark and that makes it ineligible to be recognized as a credible source. This article explores the connection on how low-income status and race/ethnicity affects childhood obesity. Furthermore, the study is based on 2009 summarized data from 68 Massachusetts school district.

CARS Article Two

The article was published on February 2018 in the Maternal and Child Health Journal, a peer-reviewed medical journal covering maternal and child health. There are six authors responsible for the information presented in the article. Five of the authors is affiliated with Teachers College, Columbia University. One is affiliated with the Department of Community and Family Heath, College of Public Health, University of South Florida. All the authors hold a high educational degree (PhD, MS, or MA) and four of them specialized in nutrition. The article provided contact information for all the authors in email form. In addition, the article provided a disclosure that the authors had no conflict of interest in this work. There are 45 supporting articles listed on the reference list, which 42 of the resource does not meet the five-year mark and that makes it ineligible to be recognized as a credible source. The article explores the challenges and facilitators in promoting a healthy environment at home. In addition, the study conducted focused group interviews involving 16 low-income parents of elementary school children.

CARS Article 3

The article is based on a community-academic partnership which covers childhood obesity in low-incomed families. The article is published in the American Journal of Public Healthy on April 2019 issue. The authors Deavenport-Saman, Piridzhanyan, Solomon and Yi are affiliated with the Department of Pediatrics, Children’s Hospital Los Angeles, Keck School of Medicine of the University of Southern California, Phillips is with the office of Women’s health, Los Angeles County of Department of Public Health and Tony Kuo is with the Division of Chronic Disease and Injury Prevention, Los Angeles County Department of Public Health. The contact information for the authors is not provided in the article but they are available respectively at the organization they are affiliated with. A disclaimer was provided that the authors had no conflict of interest in this study. Furthermore, the Institutional review board approval was obtained from Children’s Hospital Los Angeles. There are seven supporting articles listed in the reference list. Two of the resources does not meet the five-year mark that makes it ineligible to be recognized as credible source.

Nursing Level Intervention

According to a study by Fisher et al. (2019), influencing childhood behaviors of developing healthy eating habits is critical. Accordingly, it is crucial to provide education to both the patient and family member, especially to parents of young children, is a key aspect of preventing childhood obesity. The nurse plays an important role when it comes to giving education and providing the right tools to patients’ and their parent’s in order to be successful. Before the nurse take the next step providing education, the nurse needs to assess the barriers that may hinder promoting a healthy food environment such as their socioeconomic status, race, and health literacy (Rogers et al. 2015). Furthermore, according to Luesse et al. (2018), assessing the parent and the child’s, perception about healthy habits or home-food environment is important to be promote healthy eating habits.

According to study by Luesse et al. (2018), parents are aware of the significance in displaying good behavior to form good habits in their children, especially regarding their eating habits, by increasing vegetable consumption. However, parents may face the challenge of having a child who dislike vegetables, which makes food preparation frustrating and exhausting with time and financial burden. Although, a study by Fisher et al. (2019, p3-9), provided insight in giving education about solid fats and added sugars and labeling high empty caloric foods (candy, chips, etc.) as “WHOA” food and low empty caloric foods (water, fruits, vegetable, etc.) as “GO” foods to parents, which help decrease their child’s intake of high empty caloric food by 91kcal/day which has not been statistically significant but it is “clinically significant within the context of obesity prevention.” In addition, adding the authoritative food parenting to promote structure in eating habits, such as setting limits, establishing eating routines and providing children with guided choice, has been successful in reinforcing good behavior and eating habits. Respectively, nurses play an important role in providing information on how to reduce the risk of childhood obesity by providing example of food to increase (vegetables, fruits, whole grains etc.) and food to decrease (candy, chips, soda etc.).

Organization Level Intervention

Interventions tailored for children coming from low-income family at an organizational level, requires program to reduce food insecurities, improve nutrition and physical activity. In a study by Hoelscher et al. (2015), examined multiple level of interventions of preventing childhood obesity, which includes community organizations, family and environment. At the organization level Hoelscher et al. (2015) examined early care and education centers and schools and their impact in preventing obesity. Coordinated Approach to Child Health (CATCH) is one of the programs available in Texas, which includes child nutrition services, physical education, classroom curricula, and family outreach, and has proven to be appropriate for low-income families and is effective in preventing obesity (p.76). Another organization level intervention that has been used in school is U.S. Department of Agriculture (USDA) ChooseMyPlate dietary guideline, help promote and teach children and parents on eating a balanced meal, which has been effective in providing information about the food groups and their nutrient content. Both organizations have spread awareness when it comes nutrition education.

Policy Level Intervention

According to Gunderson (2019, p91), food assistive program such as Supplemental Nutrition Assistance Program (SNAP or food stamp), the National School Lunch Program and the School Breakfast Program has been successful in “reducing food insecurity among low-income children.” These programs may have been successful in decreasing food insecurity among low-income families, but these programs are not designed to reduce childhood obesity. The SNAP program was established in 1964 as the Food Stamp Act to aid individuals and families who are low- to no-income and to be eligible at the federal level, the “household must have a net income below the poverty line” and “household assets must add up to less than $2000” some sources such as a house is not taken into account (Gundersen 2015, p94). There has been a slight increase on the countable assets to $2250 and $3500 based on if a family member is age 60 or older or is disabled (USDA 2019). Gunderson (2019) explores the idea of restricting SNAP purchases and concludes it may have negative consequence instead of reducing the consumption of unhealthy foods. Even though SNAP program is not effective in providing resources and information regarding informed decision when it comes to food, programs such as Early Care and Education (ECE) policy has been successful in preventing or childhood obesity (Hoelscher et al. 2015)

Summary

Overall, providing nutrition education to parent is important when it comes to preventing childhood obesity. It is done by making parents aware of food choices and help establishing good eating habits for their children. Decreasing obesity outcome is lower if improper and untailored nutrition education is provided, since children and parents from low-income does not have enough time resources to provide an adequate and balanced meal. While appropriate education to children and parents from low-income household produce desirable outcomes. A nurse can provide education related to nutrition and parental guidelines to support and promote good eating behaviors. In addition, a nurse can provide resources such as MyPlate to increase food knowledge of both the child and parents. A nurse can also connect patient and family members to vital resources such as dietician/nutritionist, who can help increase patient knowledge in health and nutrition and help identify other barriers that may be preventing children in receiving acceptable assistance.

References

1. CDC. (2019) Childhood obesity facts. Retrieved from https://www.cdc.gov/obesity/data/ childhood.html.
2. Deavenport-Saman, A., Piridzhanyan, A., Solomon, O., Phillips, Z., Kuo, T., & Yin, L. (2019). Early childhood obesity among underserved families: A multilevel community–academic partnership. American Journal of Public Health, 109(4), 593–596. https://doi-org.tacomacc.idm.oclc.org/10.2105/AJPH.2018.304906
3. Fisher, J. O., Serrano, E. L., Foster, G. D., Hart, C. N., Davey, A., Bruton, Y. P., . . . Polonsky, H. M. (2019). Title: Efficacy of a food parenting intervention for mothers with low income to reduce preschooler’s solid fat and added sugar intakes: A randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity, 16 doi:http://dx.doi.org.tacomacc.idm.oclc.org/10.1186/s12966-018-0764-3
4. Gibson, L., Allen, K., Byrne, S., Clark, K., Blair, E., Davis, E., & Zubrick, S. (2016). Childhood overweight and obesity: maternal and family factors. Journal of Child & Family Studies, 25(11), 3236–3246. https://doi-org.tacomacc.idm.oclc.org/10.1007/s10826-016-0485-7
5. Gundersen, C. (2015). Food Assistance Programs and Child Health. Future of Children, 25(1), 91–109. Retrieved from http://search.ebscohost.com.tacomacc.idm.oclc.org/ login.aspx?direct=true&AuthType=ip,uid&db=c8h&AN=107785909&site=ehost-live
6. Luesse, H. B., Paul, R., Gray, H. L., Koch, P., Contento, I., & Marsick, V. (2018). Challenges and facilitators to promoting a healthy food environment and communicating effectively with parents to improve food behaviors of school children. Maternal & Child Health Journal, 22(7), 958–967. https://doi-org.tacomacc.idm.oclc.org/10.1007/s10995-018-2472-7
7. Rogers, R., Eagle, T. F., Sheetz, A., Woodward, A., Leibowitz, R., Song, M., … Eagle, K. A. (2015). The relationship between childhood obesity, low socioeconomic status, and race/ethnicity: Lessons from Massachusetts. Childhood obesity, 11(6), 691–695. doi:10.1089/chi.2015.0029
8. U.S. Department of Agriculture. Start simple with MyPlate. Retrieved from https://www.choosemyplate.gov/eathealthy/start-simple-myplate
9. USDA (2018). A short history of SNAP. Retrieved from https://www.fns.usda.gov/snap/short-history-snap.
10. USDA (2019). SNAP eligibility. Retrieved from https://www.fns.usda.gov/snap/recipient/eligibility

In the United States, the percentage of children and adolescents affected by obesity has more than tripled since the 1970’s. There are many reasons for this increase, but the most impactful causes are usage of modern technology, unhealthy eating patterns, and lack of exercise. Although there are many ways young children can prevent obesity, they still continue with unhealthy habits. Many kids would rather stay home and play video games than go on a hike, play outside, or run around with their friends. Changing a diet or being physically active for 60 minutes a day, can change the a child’s life style that could impact them later years with a healthy lifestyle as adults..

First, the advances in technology is affecting the unhealthy over weight of the youths. Excessive television watching and being on social media causing a sedentary lifestyle has been a major issue. According to the American Academy of Pediatrics, they have estimated that the average child spends upwards of seven hours watching television, browsing the Internet and playing video games each day. Young adults who watch a great deal of television and don’t exercise, may start to experience the effects of unhealthy habits resulting in loss of memory, difficulty problem solving, and retraction for social activities as early as midlife. In addition, many children are addicted to video games. Not only can this create vision problems, but also it is taking up valuable time from cardiovascular exercise. They spend so much time on video games it’s unbelievable! Gaming has been becoming bigger more and more everyday because of battle royale and shooting games available, which brought 100s of millions of gamers. It also resulted in children becoming addicted easily because trying to win the game.

Many youngsters stopped hanging out with family, skip eating a regular and balance meal, and as a result gained weight. To wrap up on how technology made ⅔ of children lazy, commercials advertising delicious junk foods are incorporated into their diet. The advertising has a big impact on people because watching a short clip of a McDonald’s meal can “flip the switch” and make an adolescents mood change to devour one or two burgers. According to a report in the Journal of the American Dietetic Association in 2008, 9 out of 10 food advertisements shown during Saturday morning children’s programming are low-nutrient foods that are high in fat, sodium and added sugars. This is unacceptable, these child focused programs should stress eating a healthy meal and balanced lifestyle lead to a happier and healthy future.

Next, unhealthy eating patterns can affect the health and body of a person. Processed foods are anything that has no nutritional value. They mainly consist salt, sugar, fat and preservatives – all of which create a combination of different sensations in the mouth. The brain is involved as well, too. “Foods that rapidly vanish or ‘melt in the mouth’ signal to the brain that the person isn’t eating as much as they actually are.”-Shayna Komar. In other words, these foods literally tell the brain that the eater is not full and in need for more food. It sounds fine, but it’s not fueling the body. It is burdening it to work very hard to metabolize junk food. Cheap and quick fast-food restaurants is another reason why kids are eating unhealthy. Processed foods have extra salt, sugar, fat and preservatives, which are a lead reason why people get heart disease and obesity. Our society can help prevent the amount of people buying these deadly foods by lowering the price of healthy alternatives. It’s nearly impossible to find a salad that is cheaper than a burger at McDonald’s. In addition, fast food is all over America, having more than 200,000 buildings serving these foods. If healthy eating was around the same price of these foods, a lot more people would join the healthy side. Lastly, are the big portions of high fat foods during dinner. Unfortunately, most Americans don’t balance out what they eat.

Alissa Rumsey says that greasy or high-fat meals ‘will digest slower and can cause issues with reflux or heartburn.’ Also, eating a big dinner should be reduced because minimal calories are burned after in the evening, especially eating late. Therefore, weight gaining is the result. The final topic that needs to be discussed is lack of exercise. Many kids and adolescents start to lose the excitement and the energy to shoot hoops, run, and workout. As doing physical activities decreased dramatically over the years, going on the internet, social media and playing video games increased at the same rate. Lets face it, nobody in this world is perfect, most Americans have an unhealthy habit or craving. Majority of the youngsters can’t control the urge to play games all day or go on social media. There is a public study that if a person does a muscular strength workout (lifting weights) one hour each week, it can reduce the risk of getting a heart disease by 70%.

Another reason why kids are lazy is because of playing games on the internet and talking to friends on the phone. It’s not a bad idea to talk on the phone with a friend, but there’s a better alternative choice. Doing fun activities like going ice-skating can benefit the health of a person and burn more calories. Plus, the exercise is enjoyable and fun, as well. Friends have a huge influence on decision making whether it’s positive or negative. If many friends made a switch and decided to workout an hour every other day, chances are high of an adolescent would tag along and join. The last thing to be covered about exercise is the excuse making. The most common excuse is “ I don’t have enough time,” but really adding all the time surfing the web and watching television, surely there is enough time. In addition, many people say the gym is ‘too expensive’, but what about doing squats, planks, or yoga at home. One can satisfy the internet addition exercising along with YouTube videos. Additional workouts like these only require the person workout without driving or purchasing equipment.

Therefore, this concept is a quick and cost effective way to stay healthy while using things a person already has around the house. In conclusion, obesity is a problem and can be reduced. In the United States, majority of the population is overweight. There are many reasons for this, but sedentary lifestyle caused by increased technology, unhealthy eating patterns, and lack of exercise are things that can be easily changed with a little effort and change in behavior. Being motivated and inspired to get up and put in the work for a summer body is worth it in the long run.

References

1. Boyers, Lindsay. “Obesity in Children and Technology.”
2. Lindsay Boyersn.d. NaN. https://www.livestrong.com/article/561008-the-physical-impact-of-technology-on-childre n/?ajax=1&is=1.
3. Gavin, Mary, ed. “Kids Health.” Mary L.Gavinn.d. NaN. https://kidshealth.org/en/parents/exercise.html
4. Jaaskelainen, Liisa . “Fast Food Industry – Statistics & Facts.”
5. Liisa Jaaskelainen. 2016. ://www.statista.com/topics/863/fast-food/
6. Kofman, Jamie. Acid Reflux in Children: How Healthy Eating Can Fix Your Child’s Asthma, Allergies, Obesity, Nasal Congestions, Cough and Group. New York: Jamie Kofman2018
7. Smith, Melinda. “Childhood Obesity and Weight Problems.” Melinda Smith, M.A. and Lawrence Robinsonn.d. NaN. https://www.helpguide.org/articles/diets/childhood-obesity-and-weight-problems.htm.
8. Unknown, Unknown. “Why Is Junk Food so Addictive?” Thomas F. Chapman Family Cancer Wellness. 2018. https://www.piedmont.org/living-better/why-is-junk-food-so-addictiv

Did you know that 1 in 10 children in Singapore and 41 MILLION children worldwide are overweight? What’s worse is that 7 in 10 of these children grow up to be obese as adults as well! Did these figures alarm you?! I hope they did! Fret not however, as I am here to provide you with a solution that is… swimming! Here are 6 reasons why swimming can reduce child obesity.

Swimming is more fun and less daunting than other forms of exercise

To the parents reading this article, ask yourselves, how often have you started on a new fitness routine only to find yourselves unable to garner perseverance and stick with it? The same applies to your kids! Compared to other forms of exercise such as running or doing bodyweight exercises, children tend to view swimming as a more fun means of keeping up with their fitness. Choosing a fun activity for your kid is important to maintain their interest especially in the long run. On top of that, it would also lead to a higher chance of your children not wanting to drop out half-way.

The amount of calories burnt by swimming is high

The basic rule of thumb for anyone wanting to lose weight is for your calorie expenditure to be higher than your calorie intake. In simple terms, you should burn more energy than you consume. The term for this is being in a calorie deficit. This same explanation applies to children. Well, here’s some great news in that regard: swimming burns a high amount of calories! Just an hour of swimming side strokes leads to an impressive 368 calories burnt! (That’s more than the calories in a Filet-O-Fish burger from McDonald’s!)

Swimming is a full body workout

Did you know that swimming requires using almost every muscle in your body? This is why swimming is said to be one of the most effective means of working out your whole body, which ties in with the fact that swimming is the best for weight loss! While different strokes use more or less of some muscle than others, most muscles are engaged in all strokes. Your arms thread through the water, your core helps your body stabilise and remain aligned while your legs and glutes, without mention, do most of the work pushing you forward. It is no surprise swimming burns so many calories! Building muscular strength also leads to losing fat.

Swimming has a lower risk of injury

I’m sure as parents, your children’s safety is your utmost concern. Well, you need not worry as swimming poses less chance of injury as compared to land sports such as basketball, badminton and netball. This is because the weight of objects in water is less than on land. Send your children to swimming lessons with no worries of a scratched or bruised knee! To further decrease your child’s chances of injury, do instill the importance of warming up before each session.

Swimming improves self-esteem

If your child suffers from obesity, you ought to already know that it is common for overweight children to have low self confidence. Most times, this is due to school bullying or discrimination. While schools provide overweight children with more opportunities to exercise before or after school, this in itself adds on to the low self-esteem that they grapple with. Therefore, having a safe space such as a swimming session with their parents and a trustable coach around would do wonders. In a space where children feel accepted and willing to learn, they will be more eager to partake in physical activities and eventually lose some extra weight. Since water provides buoyancy which gives the illusion of feeling lighter, your child will struggle less swimming than running on land as well.

Swimming is easy on the joints

While encouraging your kids to engage in activities such as running or jumping could lead them to shed off some extra pounds, it could also lead to the wearing down of joints in the long run. Fortunately, swimming is a low impact activity. This means that even if your child is overweight, he or she will not be experiencing joint pains after swimming. Hooray!

Conclusion

While swimming can definitely help reduce child obesity, it is important for you, the parents and children, to keep in mind that physical activities are only half the battle won. The other half of the battle happens in the kitchen. This means that while it is extremely time efficient to bring your children to fast food chains, it is good to keep it at a minimum! Introducing healthy and portioned meals would make all the difference in whether or not your child manages to lose a few pounds.

If you are wondering where to start or what you should do to gradually introduce the idea of swimming lessons to your children, fret not! Here are 7 simple tips to prepare your kids for swimming lessons and what to do when your child is afraid of swimming. And, no, children do not magically lose their extra pounds growing up. So, please, do not wait to take the first step in enrolling your child to a swimming class here at SwimRay!

According to the World Health Organization (2018), overweight and obese individuals are those with “excessive fat accumulation that may impair health,’ and this occurs as a result of a positive energy balance i.e. energy intake is greater than energy expenditure. An individual is classed as overweight if they have a BMI (body mass index) of 25-29.9 kg/m2, and obese if they have a BMI of 30 kg/m2 or more. However, these values differ for children due to the rapid growth and development they experience during their childhood years. For children, BMI is calculated to produce a percentile value, which is then compared to children of the same age and sex in order to determine their level of obesity. A child is considered overweight if they are above the 85th percentile, and obese if they are in the 95th percentile (Lannelli, 2019). Although obesity may be caused by genetic factors, there are other modifiable risk factors such as diet, physical activity and sedentary behaviour (Sahoo, et al, 2015), with this essay focusing on the use of physical activity. According to the NHS (2016), 1 in 4 adults are obese which is a major problem as obesity can lead to the development of cardiovascular diseases, type 2 diabetes, some cancers, and many other conditions. However, childhood obesity is becoming more prevalent in the UK affecting 1 in 5 children (aged 10-11 years old). In addition to the conditions mentioned previously, childhood obesity can also cause other complications such as cholelithiasis, orthopaedic complications, early puberty, depression and a low self-esteem (Kuźbicka and Rachoń, 2013).

Obesity is linked to a decrease in vascular function. Specifically, it can cause endothelial dysfunction and reduced arterial compliance (Brook, 2006). The endothelium is imperative as it controls the blood vessel diameter by releasing vasoactive substances such as nitric oxide to allow vasodilation and endothelin to allow vasoconstriction. When there is an imbalance of vasodilators and vasoconstrictors, endothelial dysfunction occurs (Davignon, 2004) which can be evaluated by measuring flow-mediated dilation (FMD). Based on guidelines produced by Thijssen et al (2010), FMD is measured using ultrasound to assess blood vessel diameter (usually the brachial artery). A cuff is placed around the arm distally to the brachial artery and a resting measurement of the diameter is taken, followed by a 5 minute cuff occlusion period. Once the pressure in the cuff is released, there is an increase in blood flow and sheer stress along the brachial artery, leading to an increase in the diameter. The peak diameter is measured and FMD is calculated as the percent increase from baseline to the peak diameter. Being able to identify endothelial dysfunction at an early stage is important as this plays a key role in the development of atherosclerosis which in turn, leads to cardiovascular disease (a leading cause of death globally). Childhood obesity increases the risk of obesity throughout adulthood, which increases the risk of vascular dysfunction; for that reason it is important to treat or prevent obesity at an early age in order to improve vascular function and this can be achieved through physical activity/exercise. Regular physical activity that imposes sheer stress can lead to an increase in endothelial cell nitric oxide synthase (eNOS) gene expression which increases the production and bioavailability of nitric oxide (Kelly et al., 2004). This combined with vascular remodelling (increased vessel diameter) and a decrease in free radical degradation of nitric oxide improves endothelial function in obese/overweight individuals.

There is a substantial amount of evidence to support the use of exercise interventions to improve vascular function by reversing endothelial dysfunction. However, these interventions differ in terms of the frequency and duration, and the type of exercise included in the program. Farpour-Lambert et al (2009), and Murphy et al (2009) both studied the effects of exercise on vascular function using interventions lasting 12 weeks in total. Murphy et al (2009) used a home-based aerobic exercise program using Dance Dance Revolution. Thirty-five overweight children aged 7-12 years old took part in the study, with 23 children allocated to the exercise group, and 12 children allocated to the control group. The exercise group were encouraged to use Dance Dance Revolution 5 times a week, starting off at 10 minutes for week 1 and progressing to 30 minutes for weeks 5-12. In order to determine vascular function, FMD was measured in the brachial artery. The results showed that the exercise group significantly increased FMD by 5.6% (which may be related to decreased low density lipoprotein and total cholesterol). This is quite a large increase when comparing to results of other studies; however, the ultrasound scans were performed by a trained vascular sonographer and repeated by a trained, blinded observer, therefore it can be assumed that this measurement is accurate. The control group showed an increase of 0.3% but this may be due to the fact they were instructed to continue their current levels of physical activity throughout the duration of the study. As this was a home-based program, all children wore a pedometer to record their activity levels, with those in the exercise group recording their steps and exercise duration in daily logs. Although self-reporting always raises questions in any study, the parents had to assist and sign off the child’s activity logs everyday which helps to eliminate any false or inaccurate reports from the children. The intervention was successful at improving vascular function using a home-based exercise program which is an advantage because this closely represents a real life environment, therefore continuation after the program should be easier. An additional long term follow up could have provided more information to see if those who normalized endothelial dysfunction were able to maintain the benefits.

On the other hand, Farpour-Lambert et al (2009) also used a 12 week exercise intervention but showed conflicting results to Murphy et al (2009). Forty-four obese children (BMI over 97th percentile) were recruited for the study, with 22 assigned to the exercise group and 22 assigned to a control group. There were also twenty-two lean children recruited for baseline comparison. The intervention group took part in exercise 3 times a week for 60 minutes; 30 minutes of aerobic exercise (e.g. ball games, swimming), 20 minutes of strength training, and 10 minutes of stretching. When comparing obese and lean children at baseline, the obese children have a significantly lower FMD, indicating endothelial dysfunction at baseline. After 12 weeks, the group of obese children showed a decrease in FMD by 0.59% whereas the control group showed an increase of 0.13%, but these changes were non-significant. However, this study did not mention any restrictions placed on subjects prior to FMD measurements. There are a number of factors that can affect FMD such as exercise, diet, and drugs (Corretti et al, 2002) therefore these should be controlled in any study measuring FMD. This was evident in the study by Murphy et al (2009) mentioned above in which subjects were instructed to fast for 12 hours, and had to abstain from caffeine and exercise 24 hours prior to FMD measurements. Another weakness of the study by Farpour-Lambert et al (2009) was the unequal ratio of males to females, therefore gender may have played a role in the decrease in FMD after 12 weeks. Although Farpour-Lambert et al (2009) looks at pre-pubertal children, a balanced male to female ratio becomes more significant when looking at vascular function in obese adolescents as this specific group usually experience puberty throughout this time. As a result of this, the effects of estrogen on FMD should be considered. Estrogen can increase the bioavailability of nitric oxide (Moreau et al, 2013) and therefore improve endothelial dependent dilation. In females, estrogen levels fluctuate throughout the menstrual cycle, therefore; not only is the male to female ratio important, but the stage of the menstrual cycle in females is another important factor to consider.

Watts et al (2004) supported the findings by Murphy et al (2009) with a shorter exercise intervention of 8 weeks. Fourteen obese children were recruited for the study and 7 lean children were recruited for comparison. Both groups were assigned to an exercise program consisting of 3 one hour sessions of whole body exercise including soccer, tag, and other continuous activities. As shown by Murphy et al (2009), this study also shows impaired FMD at baseline for obese children compared with the lean children. With exercise, FMD significantly increased from 6.00% to 7.35% for the obese group, however, their resting brachial artery diameter remained unaltered. Although the study showed an increase in FMD, the sample size is quite small, therefore another study should be conducted with a larger sample size to ensure that it truly represents the population, and to ensure the increase of 1.35% is accurate as this may be over or under exaggerated.

Another 8 week intervention was conducted by Kelly et al (2004) to investigate the effects of exercise on inflammation, insulin and endothelial function in overweight children and adolescents. Twenty overweight subjects were randomly assigned to an exercise group or a control group. The exercise group consisted of stationary cycling 4 times per week, starting at 50-60% of VO₂ peak for 30 minutes and gradually increasing the intensity and duration of exercise each week. This study differed from the previous studies mentioned as endothelial function was determined by FMD AUC (area under curve) rather than FMD peak percentage which is interesting. Kelly and colleagues established this was the best method as it enabled changes in the brachial artery diameter to be seen over a period of time rather than one specific time point which is more appropriate for children due to their changes in FMD over the time course. The results showed that FMD AUC significantly increased as expected from 746%•s to 919%•s, hence an improvement in vascular function. A strength of this study was that it also measured endothelium-independent dilation using nitro-glycerine unlike the other studies mentioned. This is important as it helps to distinguish if changes in FMD are due to endothelial dependent dilation or increased smooth muscle sensitivity.

Nitro-glycerine was also used in a study by Woo et al (2004) to investigate epithelium independent dilation in addition to endothelium dependent dilation. This included 2 groups; a diet plus exercise group, and a diet only group. FMD improved after a 6 week exercise intervention, but these changes were greater in the combined group. Also, there was a significant decrease in arterial wall thickening and an increase in vascular function in those who continued to train for 12 months after the intervention. Although Woo et al (2004) produced the smallest increase in FMD (0.56%) when compared to each study mentioned so far, this result may be the most representative as it includes a much larger sample size, a balanced number of males to females, and a 12 month follow up. Results from the follow up showed that overweight/obese children who continued to train were able to maintain their vascular benefits, whereas these benefits were lost in those who decided to discontinue exercise. After reading this study, it would be interesting to include an exercise only group and a non intervention group in future research to provide more information.

Overall, it is clear that Murphy et al (2009) produced the greatest improvements in endothelial function using Dance Dance Revolution which was performed 5 days per week, therefore proves to be an excellent intervention in improving vascular function. However, with each study using different exercise interventions, it leads into the question of the frequency, mode, and duration of exercise when seeking to improve vascular function in this specific population, and serves to be a potential topic for further research. FMD proves to be a sufficient method to assess endothelial function, but only when the guidelines regarding restrictions (diet, exercise, caffeine intake and drugs) are followed to ensure FMD measurements are valid and reliable. Based on the studies mentioned, exercise interventions are successful at improving vascular function in obese/overweight children, however, according to Woo et al (2004), it is important to continue to exercise in order to maintain the benefits associated with vascular function.

References

1. Who.int. (2018). Obesity and overweight. [online] Available at: https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight [Accessed 25 Mar. 2019].
2. Lannelli, V. (2019). How Do You Calculate Your Child’s Body Mass Index (BMI)?. [online] Verywell Fit. Available at: https://www.verywellfit.com/bmi-calculators-3879979 [Accessed 25 Mar. 2019].
3. Sahoo, K., Sahoo, B., Choudhury, A. K., Sofi, N. Y., Kumar, R., & Bhadoria, A. S. (2015). Childhood obesity: causes and consequences. Journal of family medicine and primary care, 4(2), 187-92.
4. Kuźbicka, K. and Rachoń, D. (2013). Bad eating habits as the main cause of obesity among children. Pediatric endocrinology, diabetes, and metabolism, 19(3), pp.106-10.
5. Brook, R. (2006). Obesity, Weight Loss, and Vascular Function. Endocrine, 29(1), pp.21-26.
6. Davignon, J. (2004). Role of Endothelial Dysfunction in Atherosclerosis. Circulation, 109(23_suppl_1), pp.III-27-III-32.
7. Thijssen, D.H., Black, M.A., Pyke, K.E., Padilla, J., Atkinson, G., Harris, R.A., Parker, B., Widlansky, M.E., Tschakovsky, M.E. and Green, D.J., (2010). Assessment of flow-mediated dilation in humans: a methodological and physiological guideline. American Journal of Physiology-Heart and Circulatory Physiology, 300(1), pp.H2-H12.
8. Corretti, M.C., Anderson, T.J., Benjamin, E.J., Celermajer, D., Charbonneau, F., Creager, M.A., Deanfield, J., Drexler, H., Gerhard-Herman, M., Herrington, D. and Vallance, P., (2002). Guidelines for the ultrasound assessment of endothelial-dependent flow-mediated vasodilation of the brachial artery: a report of the International Brachial Artery Reactivity Task Force. Journal of the American College of Cardiology, 39(2), pp.257-265.
9. Moreau, K.L., Stauffer, B.L., Kohrt, W.M. and Seals, D.R., (2013). Essential role of estrogen for improvements in vascular endothelial function with endurance exercise in postmenopausal women. The Journal of Clinical Endocrinology & Metabolism, 98(11), pp.4507-4515.
10. Kelly, A., Wetzsteon, R., Kaiser, D., Steinberger, J., Bank, A. and Dengel, D. (2004). Inflammation, insulin, and endothelial function in overweight children and adolescents: The role of exercise. The Journal of Pediatrics, 145(6), pp.731-736.
11. Woo, K.S., Chook, P., Yu, C.W., Sung, R.Y., Qiao, M., Leung, S.S., Lam, C.W., Metreweli, C. and Celermajer, D.S., (2004). Effects of diet and exercise on obesity-related vascular dysfunction in children. Circulation, 109(16), pp.1981-1986.
12. Murphy, E.C., Carson, L., Neal, W., Baylis, C., Donley, D. and Yeater, R., (2009). Effects of an exercise intervention using Dance Dance Revolution on endothelial function and other risk factors in overweight children. International Journal of Pediatric Obesity, 4(4), pp.205-214.
13. Farpour-Lambert, N.J., Aggoun, Y., Marchand, L.M., Martin, X.E., Herrmann, F.R. and Beghetti, M., (2009). Physical activity reduces systemic blood pressure and improves early markers of atherosclerosis in pre-pubertal obese children. Journal of the American College of Cardiology, 54(25), pp.2396-2406.
14. Watts, K., Beye, P., Siafarikas, A., Davis, E.A., Jones, T.W., O’Driscoll, G. and Green, D.J., (2004). Exercise training normalizes vascular dysfunction and improves central adiposity in obese adolescents. Journal of the American College of Cardiology, 43(10), pp.1823-1827.

Childhood obesity has become a complex health concern for public health officials. Obesity in children has reached its peak with more than one- third of children being either overweight or obese. (Salem Press,2014). Childhood obesity can be defined as when a child is above the normal weight and height for his or her age. The excess weight may come from either bone, fat, muscle, water or a mix of all four. (Davidson, 2013). It is also suggested that this can also occur when a child is above his or her recommended Body Mass Index (BMI). Body Mass Index is a calculation that is used to determine an individual’s body fat. This is done by calculating the height and weight. An individual is considered overweight if one’s BMI is between 25.5 and 29.9. However, in calculating a child’s BMI, age and gender are taken into account, unlike adults. Children’s BMI is compared with age and gender-based growth chart which are called BMI-for-age-percentiles. (Davidson, 2013).

Children’s below the 5th percentile are considered underweight, between 5th and less than the 85th percentile are considered healthy, between 85th and less than the 95th percentile are considered overweight, and 95th percentile and above are said to be obese. (Davidson, 2013 & Frisco, 2009). According to a research done by the National Health and Nutrition Examination Surveys, it was gathered that the chances of obesity has doubled among boys and girls ages 2 to 5 and tripled among boys and girls 6 to 11 between the periods of early 1970 to 2000. (Frisco, 2009). In reference to data that was collected from the National Center for Health Statistics (NCHS) by CDC in 2008, it was gathered that obesity growth among children 2 to 5 has increased from 5.0% to 10.4%. Among ages 6-11, obesity has increased from 6.5% to 19.6%. (Salem Press, 2014).

Effect of nutrition on Obesity Nutrition is one of the key factors resulting in childhood obesity. Much research has shown that in most homes, parents are not providing their kids with proper nutritional diets. Therefore, denying the kids a balanced and nutritious diet. Parents tend to not understand how much food their child should eat at a particular age. (Davidson,2013). Research has also shown that most of these parents are not exposed to the kind of information that will allow them to prepare the type of nutritious meal for their families. One of the ways in which these problems can be addressed is through our public health system by enhancing policies to decrease the possibilities of children being overweight. One way this can be done is by creating awareness for parents to encourage a healthy eating habit for their kids at an early age.

Teaching kids how to eat a healthy diet sets a framework for their eating habits throughout their lives. (Davidson,2013). For example, limiting sugar intake, initiating fruits and vegetables into their diet, limiting sodium intake, balancing calories intake, etc. Schools also have an important role to play in addressing the obesity problem among school kids. It is no secret that most of the meals that are provided to most school children’s are not balanced and leaves them much to be desired. In addition to the meals provided, kids are exposed to a variety of sugary drinks and candies that are available from vending machines that are strategically located within common areas in the school building. For example, in the cafeteria, auditoriums etc. Companies are beginning to target children in schools. This is done by placing adverts in school publications, placing adverts on school buses, equipment, supplies, etc. (Frisco, 2009). Because of the obesity problem among school kids, the agency that are responsible for supplying all schools meals should be mandated to provide nutritious meals to the kids. They should also embark on policies that all vending machines should supply only nutritious drinks and snacks, especially healthy drinks and snack bars.

Another major contributor to the obesity crisis is the prevalence of the growing number of fast food outlets within most communities. These fast foods outlets provide meals that are not nutritiously balanced and are targeted mostly towards kids and families. Although these foods are not nutritious and balanced, the kids are being drawn to them because of the way they are presented through advertisement. According to Michelle Frisco, corporations are spending billions of dollars on advertising foods to children’s and more than half of these food advertisements on television are marketing sweets, fats, fast foods, etc. (Frisco, 2009). Another reason could be attributed to its pricing policy that makes their products affordable. These foods are so priced, making it easily affordable to kids. Effect of physical education on Obesity Another key factor resulting in childhood obesity is the lack of limited participation in physical activities. Research has shown that in most homes, there seems to be a minimum amount of physical activities among its members. Numerous researches have shown that people who were inactive or participated very little in any type of sporting activities during their school years will manifest itself in their adult years.

These adults (Parents) who for whatever reason may not have engaged in these school physical activities on becoming adults maintain the same inactive statuesque. This problem sadly to say does not stop there but are past on to their children who themselves grow up being physically inactive, contributing to the obesity crisis. It has also been argued that circumstances contribute to the inactivity of some of these household. For example inaccessible playgrounds, parks etc. Because of the inaccessible recreational facilities, kids turn to technology gadgets as their only form of recreation. Thereby, contributing to the obesity crisis. One solution to this problem is by parents incorporating physical activities into their kid’s daily lifestyle at a young age. Children’s tend to learn and imitate the actions of their parents, so parents adding some form of physical activities into their daily routine and encouraging the kids to join would account for some form of physical activity daily.

The obesity crisis also has a direct connection with our school system. Schools are not introducing the activity to kids at a young age. Most of the physical activities in schools that are taken by the gym departments are not geared towards satisfying all the needs of the students. Many students may not like some of the activities and therefore may not be willing to participate. Sometimes too, kids might get laughed at when trying some of these activities and might decide to withdraw. One way to help ease these problems is to ensure that there are enough activities for all the different students. Also, ensuring that gym teachers convey the message and benefits to the kids in such a way that they don’t feel inferior or anyway intimidated. Schools should be mandated to encourage walking to school rather than biking.

Introduction

Obesity is a complicated contemporary disease that can be simply defined as having an excessive amount of body fat to the point it starts to cause health problems. Therefore, obesity is not only a superficial or beauty concern as one may contemplate, but it also encompasses hidden dangerous health problems, such as heart disease, diabetes, high blood pressure and certain types of cancers. In fact, obesity has become a huge problem to the point it is considered a global epidemic (Barness, Opitz, & Gilbert‐Barness, 2007). According to World Health Organization (WHO) obesity is identified when the Body Mass Index (BMI) of a person is 30 or higher; and in order to calculate person’s (BMI) you have to divide the weight in kilograms by the square of height in meters. The BMI accuracy is derived from the charts that take into account the gender and age of a person and compare them to their peers (Barness, Opitz, & Gilbert‐Barness, 2007), more specifically, when we are talking about the obesity problem in children we are talking about one of the most critical and important global health concern of the 21th century that threaten current and future generations. Childhood obesity is a multifaceted health issue. It arises when a child is well above the normal or healthy weight for his or her age and height. Furthermore, childhood obesity can have long lasting adverse health effects as well as short term adverse health effects on the children’s life as they will be in danger of suffering from various health complications and diseases such as nonalcoholic fatty liver disease, sleep apnea, type 2 diabetes, asthma, cardiovascular disease and poor learning skills, The World Health Organization (WHO) experts have estimated that there are 43 million overweight children under the age of five around the world, and by 2025 more than 60% of global disease burden will be the direct result of obesity and obesity related complications. There is an ongoing debate as to what causes obesity exactly. However, according to Ells et al, (2005) obesity is a result from several factors that exist in the same person and contribute to causing obesity, factors like; socioeconomic status, special educational needs, environmental factors, genetics, personal lifestyle and health care services.

Causes of obesity

To put it in simple terms; obesity can happen when you consume more calories (unit of energy people get from the food and drink they consume on a daily basis) than it is required to perform your daily activities. However, obesity usually results from a combination of factors like; genetic factors, behavioral factors, metabolic factors, hormonal factors and socioeconomic factors. The genes you inherit from your parents may directly affect the amount of fat your body store, and where that fat is distributed within your body (Hewitt, 1997). Genetics may also determine how effectively your body converts food into energy (metabolic rate), how your body regulates your appetite and how your body burns calories during physical exercise (Faith, Johnson & Allison, 1997). Therefore, obesity tends to run within the same family and that’s not just because of the shared genes but also family member usually share similar lifestyle (eating habits and exercising). On the other hand, there is a saying that “you can’t outwork an unhealthy diet”. A diet that’s high in calories, and based mainly on junk food like; fast food and sugared soft drinks can lead directly to weight gain and ultimately obesity. Moreover, the screen time (numbers of hour spent looking at computer, tablet and phone screens) is highly associated with weight gain as you can easily without paying much attention consume more calories every day than you burn through exercise and daily activities. Furthermore, several social and economic factors are linked directly to obesity, as it’s very challenging to avoid obesity if you don’t have safe areas to walk or exercise in. Similarly, you may not have been even taught how to consume healthy food and exercise regularly, or you don’t even have access to healthier foods or training equopments (Variyam, 2005). In addition to that, the people you spend your time with may influence your weight; therefore, you’re more likely to develop obesity if you have friends or relatives that suffer from obesity themselves (Cutler, Glaeser & Shapiro, 2003).

Obesity in Mexico

Mexico is one of the emerging Latin American countries and is ranked 11th of the most populated countries in the world (UN, 2012). The capital of Mexico, “Mexico City” represents fast evolving economies which lead to population growth from 1.6 million back in 1940 to 14.8 million in 1990, as people move from countryside areas to urban areas in search of better work environment and better life conditions (Arredondo, 2007). However, almost half of the population is classified as poor or directly prone to poverty (Barquera, Campos & Rivera, 2013). Moreover, Mexico is currently the second most obese country in the world and researchers predicted that by the year 2030, 39% of the Mexican population will be obese (OCED, 2017). Furthermore, about 28% of all the yearly fatalities in Mexico are caused by obesity and obesity-related diseases a total of 170,000 people (Gomez, 2015). In addition to that, according to the World Health Organization (2016) reports, Mexico registers the highest global frequency increase of children who are overweight or obese. As between 1999 and 2012, the frequency of obesity among children age five to eleven year-olds has increased from 28.2% to 36.9% (0.7 percentage points/year) in boys, and from 25.5% to 32.0% (0.5 percentage points/year) in girls (Barquera, Campos & Rivera, 2013). Once established, obesity is very challenging to treat, and the excess body weight in childhood increases the risk of presenting obesity during adulthood; as well as increase the risk of obesity related complications and diseases (Ben-Sefer, Ben-Natan & Ehrenfeld, 2009).

Factors contributing to childhood obesity in Mexico

In 2012 the Mexican government conducted a nationwide health and nutrition Survey which displayed that around 58.6% of children between the ages of 10 to 14 don’t practice any type of physical activity, while in comparison around 67% of children between the ages of 10 to 14 spent more than two hours per day on screen time (in front of a television screen, a computer screen, and/or a gaming console) (ENSANUT, 2012). Furthermore, within the school environment, only one hour per week of physical education is mandatory in Mexican schools; and around of 96% of the teachers in charge of the school physical education programs do not have a clear program to plan their classes accordingly; furthermore, there is a deficiency in open spaces and playgrounds in most schools that allows children to perform any type of physical activity (Ortega, 2014). On the other hand, low income households; often believe that healthy food is more expensive alternative to the other (cheaper) diets (Aggarwal, Monsivais & Drewnowski, 2012). Furthermore, illiteracy in some parts of Mexico contribute to constant mistaken views and misunderstandings about health and nutrition, where many mothers and grandmothers from previous generations still believe that overweight or obese children are reflection of health, thus lead to overfeeding these children by their parents or grandparents with all sorts of unhealthy food at all times (Martínez-Munguía & Navarro-Contreras, 2014). In addition to that, around 42% of TV commercials in Mexico are focused on the consumption of food and food items that directly leads to obesity (Ortega, 2014). These products can be easily purchased by children and are available everywhere (outside schools, cinemas, theatres, and recreational sites). On the other hand, genetic and hormonal factors are also contributors to children obesity in Mexico; however they are less predominant factors than lifestyles and habits (Gupta, Goel, Shah & Misra, 2012). Approximately 73% of Mexican adult females and 69.4% of Mexican adult males are considered overweight or obese (ENSANUT, 2012), and they play a vital role in the quantity and quality of food consumed on a daily basis and the amount of activity of their children. In addition to that, only 14.4% of Mexican mothers breastfeed their children through the first 6 months of life (ENSANUT, 2012). And according to Horta and Victora (2013) children who are breastfed have an approximate 24% less chance of developing obesity later on compared to non-breastfed children. Health care services are essential partner for prevention and management of childhood obesity in Mexico. As regular contacts during childhood for immunizations and checkup visits allow the chance for both early detection of elevated weight in the child as well as offer opportunities for prevention and treatment early on (MOH, 2008). However, in order to achieve effective health interventions for these children, Doctors must ensure to change their families’ behaviors and perspective about obesity, by educating them about the potential dangers of obesity and the role that they can play (Taveras, Mitchell & Gortmaker, 2009).

Mexican government intervention attempts to counter childhood obesity

Interventions that aim to reducing obesity in Mexico are typically focused around individual’s lifestyle choices (food consumption habits and physical exercising habits) (Jiménez-Cruz, 2006). Many of the government intervention programs fail because they ignore the environmental impacts on food consumption and physical activity and neglect to look at social relationships between them (Christakis & Fowler, 2007). Furthermore, many studies suggest that obesity is caused largely by an environment that view excessive food consumption as social norm as well as discourages physical activity (Cohen-Cole & Fletcher, 2008). In addition to that, Anderson and Butcher (2006) study suggests that children’s physical activity can be directly influenced by how active or inactive their parents are and tend to mimic the eating behavior of them as well. Therefore the right intervention approach requires approaching obesity not only as a clinical problem but also as a public health problem (Cohen-Cole & Fletcher, 2008). A recent intervention attempt by the Mexican government introduced taxes on sugar-sweetened soft drinks of about 1 peso (US$0.06) per liter (Aceves-Martins et al., 2016), the intervention was derived by the increased consumption of high calories beverages among pre-school and school children in Mexico which was directly linked to obesity among them (Barquera et al., 2010).

Solutions

In order to find a realistic and working solution to address childhood obesity problem in Mexico, there is a need for real partnerships and cooperation among key sectors within the country, such as public health agencies, communities, government, private and public health organizations, the media as well as the food and health industry (French et al., 2001). In addition to that, the interventions program should be multidisciplinary and should be school-based, family-based, and clinic-based approach in order to achieve success. Students spend a considerable amount of their time in school (Mcmurray et al., 2002). Moreover, the engagement of teachers and peers in these kinds of programs can improve health behaviors in a large target group and can play an important role in educating these children from a very young age about obesity, the danger of obesity and the how to make smart lifestyle choices in terms of food and exercise. Next to schools, children spend most of their times at home, and reaching a healthy weight for these kids can’t be achieved unless they have full support from their parents at home which enable them to make healthy life choices. In addition to that, family-based intervention programs are considered to be one of the most successful methods for obesity treatment or prevention (Gruber & Haldeman, 2006). Engaging parents in childhood obesity prevention programs make weight loss easier for children; as they can provide moral support as well as enable children to make healthy life choices. On the other hand, Clinic-based programs can work as a diagnostic and educational tool, in a sense it will help detect children who are at risk pf developing obesity and work with their parents to implement a nutritional and physical program to help these kids return to normal weight.

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Childhood obesity is a condition in which children are significantly overweight for their age and height. Obesity at a young age in children may lead to having high blood pressure, high levels of cholesterol, breathing problems, asthma, sleep apnea, anxiety, depression, low self-esteem, and can also lead to children having diabetes. Sometimes individuals do not realize or notice any signs of high cholesterol, high blood pressure, or even know that they have diabetes the only sign they will show is being overweight. One of the leading chronic diseases throughout the world is actually obesity and it is the topmost leading cause here in the United States mortality, morbidity, disability, lastly healthcare cost adds up to billions of dollars in preventable spending each and every year. Obesity is having excess amounts of adipose tissue also known as fatty tissue which is a connective tissue that mainly consists of fat cells, it secretes products such as lipids and metabolites. Excess amounts of lipids and metabolites may lead to insulin resistance which can then lead to type two diabetes. It is said that about 17 percent of children are considered to be obese which puts them at high risk for a range of different health problems. In the United States, the percentage of children who have obesity has astonishingly tripled since the 1970s. 1 out of 5 children from ages 6 to 19 have obesity. The way obesity is identified is by an individual’s BMI (body mass index). BMI is a screening tool used for measuring obesity and overweight, the BMI percentile is usually just measured for young adults and children. Children with a BMI at or above the 85th percentile and less than the 95th percentile are considered to be overweight. Children with a percentile that is higher than 95 are considered obese. Parents need to focus on improving their children’s diet and their exercise habits which is one of the best ways for children to achieve a healthy weight.

In most cases, childhood obesity is because of overeating and not exercising enough. However, there are so many other factors that come into play to increase the risk of having obesity. One of the many reasons is closely related to a child’s diet. Unhealthy food choices and regular consumption of high-calorie foods, like the consumption of fast food and baked goods, can cause weight gaining, which then leads to obesity. Short sleep duration, excessively eating, not exercising enough, the neighborhood they live in, their metabolism, and an individual’s surroundings are all causes of obesity. Obesity has brought a range of problems for children at an early age. It’s an important public health priority that needs to be addressed as many people are taking this very lightly and saying “it’s okay, children don’t know any better”, but parents don’t realize that by saying this, they’re only making it worse and letting their children make a habit of eating fast foods and junk foods that lead to obesity. It’s so much easier now for parents to simply buy their kids ready-made frozen food and warm it for them to eat or simply buy the child food from any fast food restaurant that’s quick and easy for them. It’s so easy for parents to give their children lunch money telling them “you may buy something for yourself at school from the vending machines” thus why kids are buying soda and chips and eating that for lunch. Parents are somewhere running away from their responsibilities or are either too busy to cook for their children which is why they take the easy way out by giving the child money or buying them fast food themselves. Therefore kids are adapting and getting used to eating junk food which is very addicting for them and once they have started it becomes very hard for them to stop. If we were to go around asking children from ages 5-19 what they like to eat and what their favorite food is the majority of these children will say chips, sodas, french fries, candies, ice cream, and other junk food they are so used to eating.

Since there is a fast-food restaurant at almost every corner of any block it has become very accessible for people. Because of this parents often become lazy and decide to buy their children food from fast-food restaurants like McDonald’s, Taco Bell, Burger King, or Wendy’s. Another reason why people buy fast food is that it is a much cheaper alternative. The second of the many reasons is the lack of physical activity, children are rarely seen exercising, going out for a run, going for a walk at the park ever since computers and televisions have come into our lives children tend to stay inside instead of taking part in outdoor activities. Physical activity was seen as a form of entertainment for some people in the past however, now with the world making technological advances each and every day, it’s taking over children’s lives. A computer or television becomes a child’s entertainment instead, children wake up shower, sometimes they even forget to eat and if they do they grab the easiest form of food while they play video games with their friends. They start to indulge in junk food around them and sit for hours on a chair just eating the junk food. The environment that children are around has a major contribution to obesity, if children are constantly around bags of chips, pizzas, and candy bars, the children will most obviously indulge in these foods instead of fruits and vegetables.

Genetics is another main reason, If a child is born into a family of overweight people, they are most likely already predisposed to obesity. In addition, of course, medical conditions have an effect on the child’s weight. Not common but there are genetic diseases and hormonal diseases that can predispose to child obesity, this includes hypothyroidism, which is when the thyroid gland does not release enough hormones to control metabolism. There are also many emotional consequences that occur with obesity, children who are obese are bullied and teased for their body weight each day and come home sad, depressed, lock themselves up in their room which leads to depression and anxiety. A healthier approach can turn things around for a child that is obese, when going grocery shopping a smarter alternative is to choose fruits and vegetables as compared to convenience food. Limiting sweetened beverages and fast food consumption plays a positive role in weight loss. Finding activities of a child’s interest and limiting their computer time emphasizes more physical activity. The more people become aware of the results of obesity, the more precautions they are most likely to take moving forward. As much as technology has positive effects for us today, it also comes with negative effects as well. Computers and televisions can cause children to become inactive, and not aware of their surroundings. Limiting their computer and television time can also help in putting an end to obesity.

Therefore, Getting childhood obesity under control can be beneficial for future generations, and for this generation. If everyone in our community can do their part we can try to prevent childhood obesity. Changing the snacks in vending machines is a huge step forward to decreasing childhood obesity. Although this may seem like such a small thing to do, it is actually a major cause of obesity just like preventing children from smoking in schools, local communities, and in-school youth organizations are important the snacks in the vending machines at schools should also be an important factor to look out at. Schools need to stop selling and filling up their vending machines with only junk food and should have healthy alternatives as well. The amount of physical activity being performed in schools should be increased to at least 30 minutes mandatory each day instead of once a week. Serving sizes at restaurants should also be reduced. Restaurant owners need to stop advertising new deals each day because for them it’s business but for people, it’s their life. People look at these advertisements and end up falling for them. If we can stop obesity in young ages ranging from 6-19 and if we can help children adapt to a healthier lifestyle starting at a young age we can stop obesity overall and decrease the numbers in all ages.

World health organization (WHO) defined obesity as abnormal or excessive fat accumulation that presents a risk to health. Body weight measure by the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres). A person with a BMI of 30 or more is generally considered as obese1.

According to Center of disease and control (CDC), childhood overweight is BMI at or above the 85th percentile and below the95thpercentile for children and teens of the same age and sex while Obesity is BMI at or above the 95th percentile for children and teens of the same age and sex 2.

Prevalence of childhood Obesity in Unites states estimated to be 13.9% among 2- to 5-year-olds, 18.4% among 6- to 11-year-olds, and 20.6% among 12- to 19-year-olds 1.

Southern European countries have the highest prevalence of child obesity. In Cyprus, Greece, Italy, Malta, San Marino and Spain, approximately 1 in 5 boys (ranging from 18% to 21%) are obese while Denmark, France, Ireland, Latvia and Norway are among the countries with the lowest rates, ranging from 5% to 9% in either sex3.

A study in Saudi Arabia including Jeddah, AL Dammam and AL Khobar only, showed obesity prevalence to be 24.1 % in males and 14% in females. High proportion of Saudi adolescents spent more than 2 hours on screen time daily and almost half of the males and three-quarters of the females did not meet daily physical activity guidelines.

Contributing Factors to Childhood Overweight and Obesity in Kuwait were assessed in a cross sectional study that predicted that family history of high cholesterol and diabetes were significantly associated with the children’s BMI categories, Age of the children was found an important predictor of increase of BMI. Hours spent on sedentary activities, such as watching TV, videos or DVDs per day, eating food from takeaway restaurants and lack of physical activity such as walking to or from school in the last 5 days for females are also important predictors to increase in BMI of the children6.

Childhood obesity campaigns are needed to reduce obesity, improve wellbeing of children, and reduce future pressures on the health services and society. An example of such campaigns is which was released by United Kingdom government on 2016. Actions include Introducing a soft drinks industry charge and the revenue from these charges will be used in programmes to reduce obesity and encourage physical activity. Charges will be on producers and importers, not on consumers. Other actions include Taking out 20% of sugar in products, support innovation to help businesses to make healthier product, support with the cost of healthy food for those who need it most, help children to enjoy an hour of physical activity every day, Healthier schools food and Enabling health professionals to support families such as talking to them about their diet , referring them to weight management services, clubs and websites.

Many ethical considerations arise from application of such campaigns. From Utilitarian’s point of view the benefits of this public health action must outweigh the burdens and risks however libertarians main concerns are respect of parents’ choices, liberty and child privacy.

Benefits VS harms and risks: In order to conclude benefits of such action we must know first the negative consequences of childhood obesity. Childhood obesity found to be largely responsible for diseases like fatty liver, sleep apnea, glucose intolerance and insulin resistance and diabetes, asthma, cardiovascular disease, high cholesterol and cholelithiasis (gallstones). It is not only causes diseases, but it also has socio-emotional consequences. Overweight and obese children are often bullied for their weight. It puts the child on a negative stereotype, makes him or her gets discriminated such as exclusion from physical activities or social marginalization. All of these consequences will contribute to low self-esteem, low self-confidence, and a negative body image. Childhood obesity also has academic consequences; a study done in US found that overweight and obese children were missing their school frequently which affects their academic performance.

Main harms and risks of childhood obesity campaigns are Stigmatization and parents’ involvement. Targeting obesity would target the obese person, not the behaviors leading to obesity which my lead to child stigma, so it would be better to use measures that aim at promoting a healthy lifestyle in general, without focusing on overweight or obesity. Another is parents’ involvement in term of parents’ autonomy and their obesogenic environment.

Consent, Privacy and confidentiality: childhood obesity control campaigns will include taking body measurements of the children and hence their personal information. where three essential ethical considerations will arise: consent, privacy and confidentiality. CDC has set specific safeguards for each of them to ensure children safety and protection of their rights.

Clear description of the program should be sent/explained to the parents to eliminate confusion. Communications with parents should focus on the health effects of obesity. Parents must have the choice of the option of refusal. Some programs use passive parental consent.

Privacy is defined as “A state or condition of limited or no accesses to Person”. According to CDC safeguards recommendations, height and weight measurements must not be taken within sight or hearing distance of other people. The trained staff taking the measurement should be the only person to see the results and the results should not be announced out loud.10

Childhood obesity is a well-known health problem internationally. A major spike in cases of child obesity have been observed from the 1980s to the present day, and the World Health Organization has even declared that around 1 in 3 eleven-year-olds are overweight or obese. Behavioral, genetic, and environmental factors have been said to be causes of obesity in children.

Lisa Chamberlain, assistant professor of pediatrics, has mentioned that we’re in a situation in which one-third of all children born in this decade will develop type-2 diabetes because they are overweight. She also said that factors such as food prices, family life, the public school system, and television are all aspects that lead to a child’s obesity.

Not only can this issue cause major risks to a child’s health and lifestyle, but it has also been associated with physical and physiological problems. Important organizations such as the United Nations and World Health Organization have already started taking action and promoting some behaviors and campaigns to better the situation. Some workshops, like, for example, the Alliance for Obesity Prevention: Finding Common Ground, held on October 20, 2011, in Washington, DC, have also arisen in hopes to keep supporting obesity prevention.

All the solutions that have been thought of in order to resolve this issue can be broken down easily into three sections.

The first section includes using the government to prevent obesity in children by implementing policies, such as a ‘health-in-all’ policy, and interventions. Governments can also fund health promotion, monitor non-communicable diseases, and use partnerships and networks that can enhance the effectiveness of initiatives in communities.

The second section includes policies and initiatives nationwide. This focuses on making environments that support healthy diets and physical activity. Marketing campaigns that can affect the whole population are also a characteristic. These campaigns can help with nutritional labeling, food taxes, and restrictions on unhealthy foods and non-alcoholic beverages for children.

The third and last section is community-based. These are usually minor changes only focused on a specific group in a certain place in multiple settings, most commonly in childcare, schools, and community centers.

For example, Thomas Robinson, a professor that has worked on alliances between organizations to prevent childhood obesity, targets behaviors that are motivating in themselves. He uses ethnic dance to encourage pre-adolescent girls to do physical activity while also learning about traditional dances from their country. Another example is that since overweight children tend to not join sports teams, they are more likely to join a team that is only for overweight kids. A study on this found that the BMI decreased in these intervention groups.

In conclusion, this issue has a rather simple solution that includes encouraging certain behaviors that all of society can take part in doing. It’s only a matter of educating, preventing, and sustaining some interventions that promote healthy eating and physical activity practices and promotions.