Course:KIN366/ConceptLibrary/Child Obesity

Movement Experiences for Children
KIN 366
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Instructor:	Dr.Shannon S.D. Bredin
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Childhood obesity is a condition where the body has accumulated a high amount of excess body fat, which results in poor health status and well-being (Reilly, 2007). To diagnose obesity in children, the body mass index (BMI) is often used. The prevalence of obesity in children has excessively grown worldwide and has been a major public concern due the serious health complications that come from it (Ebbeling, Pawlak, & Ludwig, 2002). The childhood obesity epidemic has many contributing factors, which make providing a solution difficult. These factors include genetics, nutrition, the amount of exercise we get, and the environment we surround ourselves in.

Classification

Obesity can be defined as having “abnormal or excessive fat accumulation that presents a risk to health” (World Health Organization, 2015). It has been challenging to establish one simple measurement to diagnose overweight and obese children because their bodies undergo many physiological changes as they grow (World Health Organization, 2015). To measure overweight and obesity in infants and young children aged 0-5, the WHO launched the Child Growth Standards. This measures length/height-for-age, weight-for-age, weight-for-length, weight-for-height, and BMI-for-age (World Health Organization, 2015). There are charts for boys and girls for each age, which reveal the standard optimum values for growth measurements. The measurements are necessary in order to determine whether a child is healthy and growing well. For example, children who are underweight or short for their age may have health complications and must undergo some treatment to improve their status (World Health Organization, 2015). This can be used as a tool for detecting children who are not growing properly and to distinguish whether the infant or child is under or over weight compared to the average child. To measure overweight and obesity in children above the age of 5, the BMI is used. The BMI is considered the most useful measure to determine individuals who are overweight or obese because it is the same for both sexes and for all ages, but should only serve as a rough guide as it does not consider body fat percentage (World Health Organization, 2015). BMI is “calculated as weight (kg) divided by the square of height (m) and expressed as a function of age and gender” (Rollan-Cachera, 2011, pg. 325). The BMI is categorized into four ranges, which includes underweight, normal range, overweight, and obese (World Health Organization, 2015). Individuals who fall between the 85th and 95th percentiles, sex and age specific, or have a BMI of 25kg/m2 or higher are classified as overweight. Those above the 95th percentile or have a BMI higher than 30kg/m2 are considered obese.

Statistics

Roberts, Shields, de Groh, Aziz, & Gilbert from Statistics Canada (2012), report that the prevalence of overweight and obese children has risen since the late 1970’s in Canada. In Canada, 1.6 million children between the ages of five and seventeen have been classified as overweight or obese between 2009 and 2011 (Roberts et al., 2012). This shows that close to one third (31.5%) of children are overweight or obese in Canada. Obesity rates between boys and girls differ. Roberts et al., (2012) reveals that boys are about three times more likely to be obese.

Causes

It is shown that obese children are at an elevated risk for being obese as an adult and are more likely than their lean counterparts to experience significant health problems (Ward, 2001). There are many complex factors that are working in combination to increase a child’s risk of become overweight or obese (Mayo Clinic, 2015). Some of the main causes of obesity include genetics, behaviour (nutrition, physical activity, screen time), environment, and socio-economic status (Bellows & Moore, 2014). They will be discussed below:

Genetics: There are many genes involved in determining a child’s susceptibility to obesity (Bellows & Moore, 2014). Children that live in a family of overweight or obese people are more likely to put on additional weight, especially when in an environment that supports unhealthy food and doesn’t encourage physical activity (Mayo Clinic, 2015). This shows that there is a link between genetics and the environment that influences the likelihood of obesity.
Behaviour: Weight gain occurs as a result of energy imbalance. Generally a child has a larger energy intake compared to energy expenditure, which results in this imbalance (Anderson & Butcher, 2006). Behaviours towards nutrition, physical activity, and screen time play a major role in contributing to childhood obesity.

Nutrition: There has been a drastic increase in the availability and consumption of high-calorie convenience foods and beverages, fast foods, and greater portion sizes of meals that lead to being overweight and obese (Bellows & Moore, 2014). The changes in the food market to endorse unhealthy foods such as energy-dense and high-calorie foods with high amounts of sugar and sodium have been noted in schools, child-care settings, and in the family home (Anderson & Butcher, 2006). These foods that are high in sugar, fat, and calories but low in vitamin and mineral content include things such as baked goods, vending machine snacks, soft drinks, candy, and deserts, which can cause a child to gain weight (Mayo Clinic, 2015). These foods have been accepted because they are quicker and easier to prepare for the children.
Physical Activity: There has been a decrease in opportunities and participation in physical activity, which can contribute to the weight gain in children (Bellows & Moore, 2014). This is shown through the sedentary nature of recreation, transportation, and an increase in urbanization (World Health Organization, 2015). Children today may get less physical activity due to the built environment, being less likely to walk to school, doing less household chores, spending more time viewing television and using computers, and being less physically active at school as well as at home (Anderson & Butcher, 2006). This decrease in exercise has negative impacts on blood pressure, bone strength, and maintaining a healthy body weight (Bellows & Moore, 2014). It has also been shown that children who are physically active are more inclined to be physically active as adolescents and adults and if these children aren’t active they are more likely to be inactive as adults (Bellows & Moore, 2014).
Screen Time: Since physical activity levels have declined, more sedentary behaviours such as watching television, playing video games, and using the computer have increased drastically (Mayo Clinic, 2015). Studies have revealed that the time spent on screens has averaged to over three hours daily and that there is a positive correlation between time spent on the screen and children being obese (Bellows & Moore, 2014). This time that is being spent on the screen is used as a replacement for physical activity. Screen time has been shown to be a contributing factor to increased calorie consumption because many children will eat snacks and meals while watching television or playing on the computer (Bellows & Moore, 2014). Children also tend to eat unhealthy foods because they are influenced by unhealthy food advertisements on television (Bellows & Moore, 2014).

Environment: Environments such as at home, childcare settings, school, and the community all play a role in contributing to childhood obesity (Mayo Clinic, 2015). Children pick up unhealthy eating habits and poor physical activity habits in many of these environments. Adults and other children can affect this issue so it is important to endorse a healthy lifestyle in all of these settings. The government needs to play a role in pushing for rules and improving the built environment so children can eat healthy and participate in physical activity. They can enhance the environment by only allowing schools to sell healthy food options and by improving parks, sidewalks, and walking and biking paths (Mayo Clinic, 2015).
Socio-economic Status: Certain ethnic minorities and low-income families have higher rates of childhood obesity (Bellows & Moore, 2014). These families have many barriers including food insecurity, a shortage of safe places for physical activity, and reduced access to healthy food choices (Bellows & Moore, 2014). The children in these families often eat foods that don’t spoil quickly, such as frozen, pre-prepared meals, which contain a lot of sodium and fat (Mayo Clinic, 2015). They are given this food because it is less expensive than healthier food and is quicker and easier for parents to prepare.

Effects of Obesity on Health

Children that are overweight or obese are at an elevated risk of being overweight or obese as adults (Bellows & Moore, 2014). Childhood obesity is also correlated with a higher chance of premature death and disability in adulthood (World Health Organization, 2015). The World Health Organization (2015) state that obese children are more likely to suffer from severe health consequences in adulthood such as cardiovascular diseases, diabetes, musculoskeletal disorders, and certain types of cancer. Children that are obese are also more susceptible to psychological and emotional consequences (Bellows & Moore, 2014). Although obesity can affect many components of health, below are some major health risks associated with obesity:

Cardiovascular Diseases (CVD): CVD includes high blood pressure (hypertension), high cholesterol, dyslipidemia (abnormal blood lipid levels), heart disease, and stroke (Bellows & Moore, 2014). These issues can be caused by a poor diet and a low amount of physical activity and can lead to a build up of plaque in the arteries (Mayo Clinic, 2015). The build up of plaque will cause the arteries to narrow and harden which may lead to stroke or heart attack. Strazullo et al., (2010) found an association between a high amount of fat and the increase in risk for ischemic strokes.
Diabetes: Children that are obese and who have a sedentary lifestyle are at an increased risk of obtaining type 2 diabetes (Mayo Clinic, 2015). This chronic condition occurs when the pancreas cannot produce enough insulin or when the body cannot effectively use the insulin it produces (World Health Organization, 2015). Heightened blood sugar caused from diabetes can lead to damage to the body’s systems such as the nerves and blood vessels (World Health Organization, 2015).
Musculoskeletal Disorders: The excess body weight that obese individuals carry around places mechanical and metabolic stress on bones, joints, and muscles, which can lead to degenerative joint diseases (Anandacoomarasamy, Caterson, Sambrook, Fransen, & March, 2008). Anandacoomarasamy et al., (2008) shows the relationship between obesity and osteoarthritis in the knee and hip.
Respiratory Function: McClean, Kee, Young, & Elborn (2008), show that obesity can increase the likelihood of having poor pulmonary function and inflammation and further raise the prevalence and morbidity of lung disease. Excess abdominal fat can obstruct lung expansion, the descent of the diaphragm, and reduce respiratory muscle strength, therefore making breathing difficult (McClean, Kee, Young, & Elborn, 2008). Childhood obesity can also lead to having asthma, chronic lung disease (respiratory airways are narrowed and inflamed), and obstructive sleep apnea (abnormal breathing when sleeping) (Mayo Clinic, 2015).
Mental Health: Luppino et al., (2010) states that obese individuals are more likely to develop depression than their normal weight counterparts. Depression criteria in children is categorized by irritable or depressed mood, fatigue, feelings of guilt or worthlessness, thoughts of death, sleeping problems, and changes in appetite (Reeves, Postolache, & Snitker, 2008). Children that are overweight or obese are more likely to be teased and bullied by their peers, which leads to low self-esteem and poor body image (Bellows & Moore, 2014). These children also suffer from anxiety and poor social skills, which may cause the child to socially withdraw and lose interest in normal activities (Mayo Clinic, 2015).

Prevention and Management

Childhood obesity is a complex disease with many different components affecting its prevalence such as genetics, environment, socioeconomic status, and behavioural factors (Ells, Campbell, & Lidstone, 2005). The World Health Organization (2015) recommends that prevention is the most beneficial option for reducing the childhood obesity epidemic because you can only bring the problem under control as there is no one direct cure. Therefore the goal in fighting against childhood obesity is to attain an energy balance through proper nutrition and exercise and to maintain this balance throughout their entire life. Interventions on management and prevention of obesity should involve the child as well as their family, school, and community (Ells, Campbell, & Lidstone, 2005). Some general recommendations from the World Healh Organization (2015) include:

Eat more fruits and vegetables, legumes, whole grains, and nuts
Limit consumption of saturated and unsaturated fats
Limit the consumption of sugars
Participate in at least 60 minutes of moderate to vigorous intensity activities daily

The World Health Organization (2015) reveals the ways in which parents of overweight and obese children can help prevent and manage this issue. Parents must live and promote a healthy lifestyle because children shape their behaviour by observation. Therefore parents must display healthy behaviours and encourage consumption of, and supply healthy foods and promote regular physical activity (World Health Organization, 2015).

Suggestions for the promotion of healthy nutrition at home for infants and young children include (World Health Organization, 2015):

Breastfeed infants
Avoid adding sugars and starches when feeding formula
Provide the appropriate micronutrient intake needed to promote optimal growth and allow the child to regulate their food intake rather than feeding until the plate is empty

Suggestions for children and adolescents include (World Health Organization, 2015):

Provide a healthy breakfast daily
Provide healthy school snacks and meals
Promote the intake of fruits and vegetables
Decrease the intake of energy-dense, nutrient poor foods (pre-prepared and packaged foods)
Reduce the intake of sugar sweetened soft drinks
Have regular family meals
Reduce exposure to advertising of unhealthy foods (television ads of fast foods)
Teach children to resist temptation of unhealthy foods
Educate and provide skills on how to make healthy choices

Suggestions for the promotion of physical activity by parents include (World Health Organization, 2015):

Decrease non-active time such as watching television or playing on the computer
Encourage safe and active transportation to school and other activities
Include physical activity into the family’s daily routine
Provide safe and age appropriate activities

Schools also play a major role in promoting healthy diets and providing adequate amounts of physical activity in order to prevent and manage the childhood obesity epidemic (World Health Organization, 2015). Schools are an excellent place to educate and provide children with skills to make healthy lifestyle choices because children and adolescents spend a significant amount of time there (World Health Organization, 2015). The World Health Organization (2015) presents suggestions to promote healthy diets in schools, which include:

Provide health education to students in order to help them in acquiring knowledge, attitudes, beliefs, and skills to make and practice healthy choices
Provide healthy food options in schools for a reasonable price
Allow vending machines to sell healthy options rather than unhealthy snacks
Food served must meet nutrition standards
Provide school health services to prevent and manage health problems
Build a school garden to establish awareness about food origins
Promote parental involvement

Suggestions in order to promote physical activity in schools include (World Health Organization, 2015):

Offer daily physical education classes and use a variety of activities so all students’ needs and interests are met
Provide extracurricular activities such as sports
Encourage safe and active transportation to school and other activities
Provide access to physical activity facilities
Encourage students, teachers, parents, and the community to be physically active

References

Anandacoomarasamy, A., Caterson, I., Sambrook, P., Fransen, M., & March, L. (2008). The impact of obesity on the musculoskeletal system. International Journal of Obesity, 32, 211-222.

Anderson, P.M., & Butcher, K.F. (2006). Childhood obesity: trends and potential causes.The Future of Children, 16(1), 19-45.

Bellows, L., & Moore, R. (2014). Childhood overweight. Retrieved from http://www.ext.colostate.edu/pubs/foodnut/09317.html

Ebbeling, C.B., Pawlak, D.B., & Ludwig, D.S. (2002). Childhood obesity: public-health crisis, common sense cure. The Lancet, 360(9331), 473-482.

Ells, L., Campbell, K., & Lidstone, J. (2005). Prevention of childhood obesity. Best Practice & Research Clinical Endocrinology & Metabolism, 19(3), 441-454.

Luppino, F.S., de Wit, L.M., Bouvy, P.F., Stijnen, T., Cuijpers, P., Pennix, B.W., & Zitman, F.G. (2010). Overweight, obesity, and depression: a systematic review and meta-analysis of longitudinal studies. Arch Gen Psychiatry, 67(3), 220-229.

Mayo Clinic. (2015). Childhood obesity. Retrieved from http://www.mayoclinic.org/diseases-conditions/childhood-obesity/basics/definition/con-20027428

McClean, K.M., Kee, F., Young, I.S., & Elborn, J.S. (2008). Obesity and the lung: 1. epidemiology. Thorax, 63(7), 649-54.

Reeves, G.M., Postolache, T.T., & Snitker, S. (2008). Childhood obesity and depression: connection between these growing problems in growing children. International Journal of Child Health and Human Development, 1(2), 103–114.

Reilly, J.J. (2007). Childhood obesity: an overview. Children & Society, 21(5), 390-396.

Roberts, K.C., Shields, M., de Groh, M., Aziz, A., & Gilbert, J. (2012). Overweight and obesity in children and adolescents: results from the 2009 to 2011 Canadian health measures survey. Retrieved from http://www.statcan.gc.ca/pub/82-003-x/2012003/article/11706-eng.htm

Rollan-Cachera, M.F. (2011). Childhood obesity: current definitions and recommendations for their use. International Journal of Pediatric Obesity, 6(5-6), 325-331.

Strazullo, P., D’Elia, L., Cairella, G., Garbagnati, F., Cappuccio, F.P., & Scalfi, L. (2010). Excess body weight and incidence of stroke: meta-analysis of prospective studies with 2 million participants. Stroke, 41(5), 418-426.

Ward, D.S. (2001). Physical activity and determinants of physical activity in obese and non-obese children. International Journal of Obesity, 25(6), 822-829.

World Health Organization. (2015). Child growth standards. Retrieved from http://www.who.int/nutrition/media_page/tr_summary_english.pdf?ua=1.

World Health Organization. (2015). Diabetes program. Retrieved from http://www.who.int/diabetes/en/

World Health Organization. (2015). The role of parents. Retrieved from http://www.who.int/dietphysicalactivity/childhood_parents/en/

World Health Organization. (2015). The role of schools. Retrieved from http://www.who.int/dietphysicalactivity/childhood_schools/en/

World Health Organization. (2015). What are the causes? Retrieved from http://www.who.int/dietphysicalactivity/childhood_why/en/

World Health Organization. (2015). What can be done to fight the childhood obesity epidemic? Retrieved from http://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/

World Health Organization. (2015). What is overweight and obesity? Retrieved from http://www.who.int/dietphysicalactivity/childhood_what/en/

World Health Organization. (2015). Why does childhood overweight and obesity matter? Retrieved from http://www.who.int/dietphysicalactivity/childhood_consequences/en/