Childhood obesity is increasingly becoming a cause of grave concern across the United States. According to the Centers for Disease Control and Prevention (CDC), an estimated 17% of children and teenagers in the 2-19 age groups are obese (Childhood Overweight and Obesity, 2010). A further breakup shows that 10.4% of preschoolers in the 2-5 age groups are obese. The figures stand at 19.6% among6-11 age group and at 18.1% among the 12-19 age groups. These obese children are also at higher health risks for many lifestyle related ailments such as high blood pressure, high cholesterol and Type 2 diabetes. Such high occurrence of obesity among the young children is a cause of great worry since obese children are much more likely to grow up into obese adults.
As mentioned at CDC’s site, approximately of 80% of obese children grow up to be obese adults and children who were overweight before the age of 8, were likely to have a much more severe obesity in adulthood. Besides the health risk posed to obese children, childhood obesity is also extremely expensive and according to the United States Department of Health and Human Services, hospital costs associated with childhood obesity alone were over $127 million in 1997-1999 (Assistant Secretary for Planning and Evaluation) with an estimated cost increase to $225 million in 2009. In view of all these data, it is imperative to find a solution for childhood diabetes so that we can help in the formation of a healthier nation.
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Over the years, government and healthcare workers have taken several steps to control childhood obesity. However, their attempts have so far met with limited success. Living a healthy life style is important to families; however, with the increasing economic and social pressures facing our nation today, many families aren’t able to implement healthy living without some type of assistance. Healthy living is often ignored in favor of other pursuits and in such a scenario, fighting obesity can prove to be an uphill battle. Before we can take any definitive action to reduce childhood obesity, there is a need to understand the various motivations of families, schools and healthcare providers which may prevent them from paying more attention to children’s health. Several organizations have a wide range of studies investigating the incidence of obesity among children.
For example, the Robert Wood Johnson Foundation has suggested that there may be a relationship between poverty and obesity, since families who are food insecure, that is, they have limited or uncertain access to adequate food, are more likely to hoard food when it is available, leading to obesity (Robert Wood Johnson Foundation, 2010). Similarly, a recent controversial study suggests that overeating rather than lack of exercise may be responsible for childhood obesity (Smith, 2010). Yet another study found that children born to overweight parents or in a community where most children were overweight were often not perceived as obese by their family or Child Health Services staff, even when they were clearly obese according to National Standard for Health Statistics (NCHS) standards (Myers and Vergas, 2000). This study pointed out a critical problem in combating childhood obesity since recognizing and accepting obesity among children is the first step towards combating it.
The problem of childhood obesity is well recognized among healthcare workers and researchers and there is no dearth of studies on this subject. Yet few studies have been able to suggest a way to combat the problem successfully. The purpose of the present study is to come with suggestions that would help the government and healthcare workers fight the problem of childhood obesity much more successfully.
There is a huge amount of existing literature on the topic of childhood obesity. Some of the widely accepted causes of childhood obesity include genetic causes, parental influence and other environmental factors. Various researchers have shown that parental activity and food preferences have a direct impact on a child’s activity and food preferences and, therefore, strategies that alter the parental behavior can help reduce instances of childhood obesity (Sothern and Gorden, 2003, Anzman et al, 2010). When obesity is present in infancy and early childhood, the most commonly accepted causes include “excessive maternal weight gain or smoking during gestation, shorter-than-recommended duration of breastfeeding and suboptimal amounts of sleep during infancy (Wojcicki and Heyman, 2010).
While most scientists are in general agreement as far as causes of childhood obesity is concerned, when it comes to it prevention, every researcher has a different suggestion. For example, Torre et al (2010) found that it was not just enough to have healthy food and exercise standards in school but it was also important to make these healthy options attractive and enjoyable for these steps to be effective. However, Birch and Ventura (2009) believe that school based intervention does not work because by the time children are enrolled in school, they are already overweight. They suggest controlling food intake in infancy and childhood will lead to better results.
Recently, the First Lady, Michelle Obama launched a “Let’s Move” campaign to combat childhood obesity. The main features of the campaign is to empower parents and consumers by revamping the nutritional labeling of products, improving nutritional standards of the National School Lunch Program, increasing the opportunity for physical activity and improving access to high quality food (Wojcicki and Heyman, 2010). Although the campaign promises to help reduce instances of childhood obesity by adopting a multifunctional approach, its efficacy in the real world remains to be seen. The success of the campaign depends on the willingness of parents and consumers to adopt some of the lifestyle changes suggested in the campaign. Before we can successfully treat a problem, it is important to understand the real underlying causes of the problem.
Unfortunately, there are a number of social and cultural barriers to the proper implementation of any such plan. For example, the “Let’s move” campaign depends on the willingness of parents and consumers to make certain lifestyle changes. However, a family used to consuming a particular kind of food, is unlikely to look at the nutritional label and switch over to a healthier alternative unless it has some compelling reason to do so. Also, a family that does see itself as overweight may not be motivated enough to make lifestyle changes. Hence, in order to find a workable solution to the problem, it is important to understand how consumers think. Having nutritional information on food labels may not be helpful if the consumer never looks at it. Hence, it is with aim of understanding consumer behavior that the present study has carried out extensive research among school going children and their parents, so as to come up with workable solutions to the crisis of childhood obesity.
As mentioned above, the perception of childhood weight problems, also differ by culture. For example, Guendelman et al (2010) found that the maternal perception for ideal body weight was lower for Mexican origin women living in California than among those in living in Mexico. It is obvious from this study, that culture plays and important role in how a family perceives it. Clearly, even among Mexican women living in the US, the perception of ideal body weight would higher than the national average because of cultural reasons. Similarly, the rates of childhood obesity are much higher among African American. In general, families belonging to the lower socio-economic strata are more likely to be overweight. Hence, for a program to be successful, it is also important to educate families in what constitutes ideal body weight and target the high risk groups more aggressively.
While it is important to educate parents so as to avoid obesity among preschoolers, it is equally important to implement steps in schools and other institutes to prevent further weight gain among already overweight children. Past experience has shown us that overweight children at school often get bullied and in order to get over the adjustments issues that these children face, they eat even more leading to a vicious cycle. Hence a well though out strategy is needed to prevent further weight gain among already overweight children. Melin and Lenner (2009) found that it is possible to stop and even reverse weight gain among overweight children by providing simple dietary and lifestyle advices to parents after a simple questionnaire along with advice and support from school nurse. Marcus e al (2009) found similar success in their controlled study with 3135 boys and girls in the 6-10 age-groups. In view of the success of these studies, a preliminary suggestion could be to adopt such holistic approaches to counter the problem. However, success in the study was possible because of dedicated school nurses which cannot be always guaranteed. And not all parents may adopt lifestyle changes suggested. Hence, more research needs to be carried out to ascertain the usability of such an approach on a large scale.
Haire-Joshu et al (2008) suggest home visits to increase the intake of fruits and vegetables among parents and their preschool children. This strategy will help reach the preschoolers and tackle the problem of obesity among this age-group. However, such personal visits can be a logistic challenge. Yet, the success of this method means that it cannot be ignored and must be considered while arriving at possible solution to the childhood obesity problem.
Yet another method for controlling childhood obesity, suggested by Dodson et al (2009) involves intervention through state policy. The study interviewed state legislators to understand the factors that enable or impede statewide childhood obesity prevention legislation. The study is good way to understand some of the problems faced by legislators in implementing nationwide measures to combat the problem of childhood obesity.
After going through the available literature on the subject, it became obvious that different researchers have different solutions for battling the problem of childhood obesity. Based on the study of this literature, out preliminary suggestion is that no one method can alone guarantee success and a combination of several methods need to be implemented in order to achieve success. The initiative must come from the highest level and Mrs. Obama’s involvement in the “Let’s Move” project should provide the necessary impetus to fight the problem. Her efforts need to be matched by a number of legislations that would ensure a nationwide adoption of practices for healthier future generations. However, it is also a well known fact that legislations alone are not enough and we need dedicated individuals at the school level to fight the problem.
Educating school nurses and other healthcare providers should be an imperative part of the fight against obesity. Also, programs to improve the nutritional value of the food served in school and to increase the physical activities should be mandated across all the schools. Such school level intervention can go a long way in improving the health of the nation.
Unfortunately, children spend only a small part of their life in schools and in many cases, obesity has already become a problem before the child reaches school. Hence, it is important to educate families to ensure a healthier lifestyle. The intervention must start at the pregnancy stage to ensure that pregnant women do not gain excessive weight. They should also be advised to prolong breast-feeding for as long as possible and to provide a conducive, stress-free environment at home. These could be supplemented by home visits to advice the families in proper intake of fruits and vegetables.
Thus, based on the review of the existing literature, we advice a combination of legislative, school-based, hospital-based and home-visits as a comprehensive way of treating the problem. As a next step, we decided to carry out extensive interviews among schools, healthcare professionals and parents to find out what in their opinion will work best. We felt that such a primary research was necessary because any legislation or rule which does not have the support of the general public is bound to fail. And the only way to gauge public support is through directly contacting the people who will be impacted.
As the next step for our research, we carried out an extensive research in the schools and hospitals in the area. We contacted seven hospitals and 35 schools in the area for permission to interview their staff, patients and parents. After an initial reluctance, four hospitals and 21 schools allowed us to carry out the interviews within their facilities. In all the schools, we contacted the school nurses since they are most aware of the health of the children in their schools. We also talked with some of the teachers who volunteered. Next, after getting permission from the Principals, we randomly approached some of the parents in the Parents Teachers Association.
In hospitals, we approached pediatricians, nurses and patients in the Ob-Gyn and Pediatrician departments for the purpose of the survey. To ensure privacy, none of the patients were asked for their names, thus making patient participation anonymous. Since our aim was to get their opinion, getting their names was not considered necessary. In all, we were able to get positive survey results from 667 volunteers, including all the school nurses and pediatricians in the surveyed schools and hospitals. Of these, 110 were healthcare professional and teacher and 557 were patients and parents of children. The surveys were carried out by two research assistants who were properly trained in the survey taking techniques to present a non-threatening front the respondents.
The surveys were administered through face-to-face interviews. We chose this method over mail-in or phone based surveys because it allowed us gauge the actual reactions of the subjects to a question. We theorized that respondents might give a different answer in a written survey and may not actually believe in it. To ensure that the responses we received were a true measure of the respondent’s opinions, the research associates were trained to notice any hesitations and ask further questions to find out the reason for these hesitations to help the respondents arrive at the right answers. However, care was taken to ensure that the respondents did not give the answers that they though we wanted to hear. Instead, they were gently guided to answers that they truly believed in. The face-to-face method also helped the research associates to gather additional data about the general opinions of the respondents, which could help in the formation of future policies. Finally, face-to-face interviews made sure those respondents who volunteered completed the entire surveys so that we did not have to discard any of the surveys because of incompleteness.
The survey consisted of a different set of questions for the healthcare providers and a different set of questions for patients and parents. The healthcare providers were asked about the general health of their patients, the percentage of their patients they perceived to be overweight, how they defined overweight and other questions regarding the their direct involvement with their patients to help reduce obesity and their success rates in these interventions.
The patients were asked questions regarding their opinion about obesity, how they defined obesity, lifestyle related questions including nutrition and physical activities, their openness to adopting healthier lifestyles and how they felt about intervention in the form of home visits. Both the groups were asked about their opinion on what steps would be most helpful in reducing childhood obesity.
More than 90% of healthcare providers and teachers believed that their patients (or students) were in good general health. 85% of the healthcare providers believed that that less than 10% of their patients were overweight or obese. 100% of the pediatricians reported that they offered lifestyle advice to the parents of overweight children. However, when asked what kind of advice they provided, the answers varied from vague suggestion regarding getting more exercise and eating healthier foods to actually teaching a few exercises and giving a list of foods to avoid.
Among the school nurses, only 22% said that they gave lifestyle advice to their patients. Hospital nurses generally did not give direct advice to their patients and only 15% said that gave any lifestyle related advice, usually when asked. As far as school teachers were concerned, they generally did not offer any opinion on the health of their students and their parents and kept their opinions to themselves.
Among the patients and parents of school going children, 100% agreed that obesity was dangerous disease and must be treated urgently. Almost all the patients and parents believed in the concept of correct weight range for a particular height and said that those above this range were obese. 82% of the patients contacted believed that they or their children were not obese. 30% of the respondents said that they regularly exercised, 55% said they exercised when they got time and remaining said that they did little or no exercise. 77% of the respondents claimed to eat a well balanced diet. However, when asked about their intake of fruits and vegetables, only 55% said that they took five servings of fruits and vegetables daily. 100% of the respondents were aware that they should get five servings of fruits and vegetables but gave reasons ranging for lack of time to children do not like vegetables for not being able to consume the required quantities. When asked about how they would feel about in-home intervention, 33% said they would welcome it, while another 20% said that a visit would help them. The rest, however, viewed it as an invasion of privacy.
When asked about their suggestions on how to combat the growing obesity epidemic, 45% suggested passing legislation to improve the nutritional value foods available at fast food joints. Clearly, fast foods were considered the main culprit for the growing rate of obesity. However, when asked if they themselves or their children consumed fast foods, 45% said often, while 53% said occasionally. 60% of the respondents said that they had pre-packaged frozen meals at least three times a week and another 33% said that they had frozen entrees at least once a week.
Besides, fast food, other major culprits cited for increasing obesity were lack of physical exercise or an increasing tendency to spend time in front of television or computers (30%) and lack of availability of healthier food options (20%). Suggestions to combat obesity included mandatory physical activities in school and removing unhealthy food options from school menu. Interestingly, parents had a tendency to blame the schools for increasing obesity and refused to take any responsibility for their children’s growing weight.
The survey made clear that many of suggested preventive measures of research scientists are not likely to be successful in the real world. Intervention in school and making healthier options available in school will not be of much help if parents continue to make unhealthy decisions. The biggest obstacle to the success of any governmental policies is that people for whom these policies are meant may prove to be uncooperative. As is evident from our survey, many of the respondents living unhealthy lifestyles were in denial regarding it. These people can only be helped if they are willing to accept help. And for that they must first accept that they have a problem. Unfortunately, most respondents tended to blame everyone from schools to fast food companies and refused to take any responsibilities themselves. Under the circumstance, it can prove to be an uphill task trying to get these people to cooperate in any governmental intervention.
On the other hand, there seems to be huge support for improving the nutritional value of food served in schools. This can prove to be a great starting point and once sweetened drinks and sodas are eliminated from schools and healthier options are introduced, it may be easier to convince parents to make lifestyle changes.
As far as preschool children are concerned, intervention in hospitals both in the Ob-gyn department and the pediatric department could go a long way. Many first time parents are open to any and all suggestions from doctors and they can prove to be a vital link in combating the obesity epidemic. Also, doctors must advice parents to avoid formula since breast milk has been shown to encourage leaner constitutions. Even the Ob-Gyn department must keep an eye on weight gain during pregnancy since excessive weight gain during pregnancy has been directly linked to obesity among infants.
Intervention through state policy can be helpful but it has its limitations. For example, a good way to improve the nutritional intake of citizens is to pass laws regarding pre-packaged foods and fast foods. Unfortunately, legislators often find themselves battling powerful lobbyists making it extremely difficult to pass many of the laws. Despite these handicaps, state and national legislations can go a long way in battling the problem and legislators should continue to push for tighter and tighter standards.
Finally, there is a need to educate parents about healthier lifestyles. Unfortunately, as seen above, this can prove to be an uphill task given the state of denial among most families. Hence, before the state can intervene there is a need to make families aware of their responsibilities. There could be many ways to do so, however, finding ways to get through to the high risk families was beyond the scope of this study. Future researches could delve into how to make families realize that they are equally to blame for the obesity epidemic and how to convince them to take a more active part in combating the problem.
Conclusion and Recommendations:
We have carried out an extensive two fold research to understand the problem of childhood obesity and ways to combat it. Since previous researches provide a wealth of information and data, these were studied in details to come up with a list of suggested remedies for fighting the problem. Once, the major suggestions had been identified, the next step was to see which one of these would be successful in a practical setting. For this, we carried out extensive primary research. The results showed that while some of the suggestions made by researchers could be easily implemented, suggestions relating direct at-home intervention would most likely face stiff opposition. Another obstacle to fighting childhood obesity was the fact many families were in a state of denial and did not realize that they were making unhealthy lifestyle choices. Hence, before many of the suggestions can be implemented, there is a need to take steps to make families more responsible.
On the hand, many of the suggestions, including intervention in schools, improving nutritional quality of food served in school and legislative interventions can be easily implemented since they have a wide-based support from the general public. Our study has identified some of the ways to combat the problem of childhood obesity, as well as the major obstacles. Future researches could study ways to overcome these obstacles so as to be able to implement a holistic solution to the problem of childhood obesity.
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