Course:KIN366/ConceptLibrary/Child Overweight

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Movement Experiences for Children
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KIN 366
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Instructor: Dr. Shannon S.D. Bredin
Email: shannon.bredin@ubc.ca
Office: Rm 212, Unit I Osborne Centre
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Overweight has been defined by the World Health Organization as an “abnormal or excessive fat accumulation that presents a risk to health” (2015). Globally, the prevalence of excess weight in children has risen dramatically with over 42 million “overweight children under the age of five” (WHO, 2015). Excess weight in children has become a serious health problem not only for low-income countries but for high-income countries as well (Kelishadi & Aziz-Soleiman, 2014). If excess weight is not controlled, it can lead to obesity amongst children and subsequently in adulthood. It is estimated that by the year 2020, “more than 60% of global disease burden will be the result of obesity related disorders” (p. 994). According to the Canada Health Measures Survey (CHMS) conducted from 2009 to 2011, 19.7% of the children surveyed, between the ages of 5-11, were overweight based on the WHO BMI cut-offs (Roberts, Shields, de Groh, Aziz, & Gilbert, 2012). Being overweight can have a negative effect on the movement experiences of children. Overweightness in children may lower self-esteem, adversely affect musculoskeletal capabilities, as well as may prevent participation in physical activity in a group setting.

CLASSIFICATION

The Body Mass Index (BMI) is a tool used to classify an individual as either underweight, normal, overweight, and obese. An individual’s BMI can be calculated by “dividing body weight in kilograms by height in meters squared” where a BMI ≥ 30.0 kg•m-2 is an indicator of obesity (American College of Sports Medicine [ACSM], 2014, p. 63). While this method is a better indicator of overweight and obesity in adults, in children “it is difficult to develop one simple index for the measurement of overweight and obesity…because their bodies undergo a number of physiological changes as they grow” (WHO, 2015). Therefore, the World Health Organization has instead prepared a growth standard table/chart for children aged 0-5 years and a growth reference table/chart for individuals aged 5-19 years (WHO, 2015). For children aged 0-5 years, length/height-for-age, weight-for-age, weight-for-length, weight-for-height, BMI-for-age, head circumference-for-age, arm circumference-for-age, subscapular skinfold-for-age, and triceps skinfold-for-age tables can be used to determine where the child falls (WHO, 2015). For children aged 5-19 years, BMI-for-age, and Height-for-age charts can be used and a weight-for-age chart can be used for children aged 5-10 years (WHO, 2015). In general, a child who falls between the 85th and 95th percentile would be considered overweight and a child falling beyond the 95th percentile would be considered obese (Anderson, & Butcher, 2006; Garver, 2011).

TRENDS

The rate of overweight children in Canada has been on the rise since the seventies. ). “In 1978, only 15% of [Canadian] children were overweight or obese” and by 2007, “29% of adolescents had unhealthy weights” (Childhood Obesity Foundation, n.d.). Studies have also shown that overweight trends in children can be seen as early as 6 months old; the early age of overweight characteristics among children is only adding fuel to the increase in the number of children that are obese (Yucel, Kinik, & Aka, 2011). ). “The prenatal period, the adiposity rebound period (around 5 to 7 years of age), and puberty” are certain periods in a child’s life that are more susceptible to the onset of excessive weight gain and leading up to obesity (p. 755). Diseases that were seen in the adult population, such as type 2 diabetes and cardiovascular disease, are now being seen in children (Tremblay, Esliger, Copeland, Barnes, & Bassett, 2008). Since uncontrolled overweight can lead to obesity, we also see an increasing trend in the number of childhood obesity cases. Even though we see a greater number of childhood obesity cases in developing countries (35 million), the prevalence of childhood obesity is instead greater in developed countries, 11.7% in developed countries vs 6.1% in developing countries (de Onis, Blossner, & Borghi, 2010).

CAUSES OF OVERWEIGHT

There are many factors that play a role in the development of overweight amongst children and if not controlled, can lead to the onset of obesity. While we may perceive that genetics plays a greater role at determining one’s susceptibility to being overweight and obese, the obesogenic environment that we live in instead plays a much greater role. Obesogenic environment refers to the ‘sum of influences that the surroundings, opportunities, or conditions of life have on promoting obesity in individuals or populations” (Swinburn, Egger, & Raza, 1999, p. 564). The same environment is also the main root of overweight, which is a precursor to obesity. These environments include, but are not limited to, easy access to calorie dense food items, lack of safe outdoor environment, lack of access to facilities that facilitate physical activity, and heavy reliance on passive transportation.

Genetics

Genetics do indeed play a role in overweight and obesity since 25-40% of BMI is genetically heritable (Anderson & Butcher, 2006). Twin studies (identical and fraternal) have shown genetics as a factor on pre-determined BMI (Stunkard, Harris, Pedersen, & McClearn, 1990). A systematic review and meta-analysis of literature on the fat mass and obesity associated gene (FTO) also show a significant association between the FTO gene and susceptibility to overweight and obesity (Liu, Mou, & Cai, 2013). However, the effects of the FTO gene only begin after 7 years of age; therefore, we should be careful about taking it into consideration for early onset overweight. There is evidence to show the effects of leptin signalling pathways due to a rare single gene defect as well as overweight and obesity caused by genetic syndromes such as the Prader-Willi syndrome, but the overall evidence is weak (Han, Lawlor, & Kimm, 2010). Also genetics cannot explain the rapid rise in overweight and obesity that we’re seeing, considering that gene pools don’t change at that same rate as obesity has (Anderson & Butcher, 2006).

Diet

Diet plays a major role in the total energy intake for an organism. However over the years, the trends in the type and amount of caloric intake has changed drastically, with foods rich in fat, high in sugar, and large portion sizes are replacing diets that were high in vitamins, minerals, and micronutrients (WHO, 2015). With the availability of calorie-dense food options, the total energy intake can go beyond the normal amount of energy a body needs in order to function. Even if a food item claims to be low in calorie, the added sugar and sodium content to offset the overall caloric value can be harmful to the body (Swinburn & Egger, 2002). Easy accessibility to food items that are high in calories, such as fast food items, packaged processed foot items, etc., allows for this change in diet trends to take place quickly. Greater portion sizes also plays a key role in the excessive caloric intake that goes beyond what the body needs to function optimally. Studies show that when a child turns away from internal cues of satiety, usually after the age of 3 years, to a more externally cued environment for food, they tend to over-eat especially when greater food portion sizes are offered (Birch, 1998; Rolls, Engell & Birch, 2000).

Physical Inactivity/Sedentary Lifestyle

“Physical activity is defined as bodily movement (any form) produced by the contraction of skeletal muscles that increases energy expenditure above the basal level, and can be categorized in various ways, including type, intensity or strenuousness and purpose” (Zhang , 2008, p. 594). According to the World Health Organization (2015), “the most fundamental cause of childhood overweight … is an energy imbalance between calories consumed and calories expended.” The decreasing trend in physical activity is largely due to the more sedentary lifestyle and activities that we are engaged in these days, including, recreation time, transportation, as well as increased urbanization (WHO, 2015). The changing trends in toys over the years have also contributed to the more sedentary lifestyle that children are living these days. Instead of playing with toys that engage the whole body physically, children are logging a lot of screen time through TV watching, computer and console games. A cross-sectional study also confirmed the effects of screen time on increasing the risk of overweight and obesity amongst children, it also drew a connection whereby even physical active children who logged in an excess of 3 hours of screen time each day were still susceptible to being overweight and obese (Lane, Harrison, & Murphy, 2014). We see a dramatic decline in physical activity amongst children (both sexes) between the ages of 9-13 years (Miller, Miller, & Guillory, 2008).

Environment

“The recent increases observed in diabetes prevalence have occurred too quickly to be the result of increased gene frequency and altered genetic pool, emphasizing the importance of environmental factors” (American Diabetes Association, 2000, p. 384). “The ‘environment’ incorporates not only the physical environment but also the economic, policy and socio-cultural environments” (Swinburn & Egger, 2002, p. 290)

Physical Environment

Our surrounding environment plays a role in how active or sedentary we are. It also affects our availability of food sources. When everything is within walking distance, we are more likely to walk or bike instead of taking passive transportation. If fresh food sources such as produce are a distance away, many people might not be willing to take a long trek out and would rather substitute with what is close by.

Socioeconomic Status

According to the World Obesity/Policy & Prevention, “children in lower-income families [of industrially developed countries] are particularly vulnerable because of poor diet and limited opportunities for physical activity” (Lobstein, Baur, & Uauy, 2004, p. 5). It is difficult for low- and middle-income parents to include fruits and vegetables in their budgets, especially considering that fruits and vegetables are fairly expensive (Sealy, 2010). A longitudinal study looking at prevalence of overweightness amongst children from birth to 5/6 years of age saw SES play a role in overweight among white, Hispanic, and Asian children, however no clear relationship among Native Americans or African Americans (Jones-Smith, Dieckman, Gottlieb, Chow, & Fernald, 2014). Since the longitudinal study did not go beyond the 6 years, it is possible that a relationship between SES and African Americans and Native Americans might emerge later in life. As SES increases, the probability of overweight amongst the white, Hispanic, and Asian children goes down – depicting an inverse relationship (Jones-Smith et al., 2014). This relationship has also been confirmed by a cross-sectional report that used data from the NHANES (National Health and Nutrition Examination Survey) program from 1971 to 2002 (Wang & Zhang, 2006). THE NHANES data shows an inverse relationship between SES and African Americans and American Indians as well.

Culture

There are cultural differences amongst childhood overweight and obesity. Hispanic and African-American children between the age groups of 4-12 are more susceptible to being obese compared to Caucasian children (Lobstein, Baur, & Uauy, 2004). The culture also influences greatly on the environment in which a child grows as well as the nutrition available for the child. It is difficult “to change eating habits that are ingrained and inherently woven into the tradition and fabric of the individual’s culture” (Sealy, 2010, p. 2).

EFFECTS OF OVERWEIGHT ON HEALTH

According to the World Health Organization (2015), the “most significant health consequences of childhood overweight and obesity, that often do not become apparent until adulthood include, cardiovascular disease, diabetes, musculoskeletal disorders, especially osteoarthritis, and certain types of cancer.” The biggest problem is that there is an “increased risk for overweight or obese youth to become overweight or obese in adulthood” (Singh, Mulder, Twisk, Mechelen, & Chinapaw, 2008, p. 483), which keeps them susceptible to further health implications later on in life. Although overweight can affect many components of health, here are some of the better-publicized health risks associated with overweightness:

Obesity

Even though most studies talk about overweight and obesity together, we should not forget that uncontrolled overweightness in children can lead to the onset of obesity, which is an epidemic of its own. The risk of acquiring further health problems once a child is considered obese, increases drastically.

Diabetes

More and more children are being diagnosed with type 2 diabetes and up to 85% of children diagnosed with type 2 diabetes are either overweight or obese (American Diabetes Association, 2000). Children diagnosed with type 2 diabetes may experience life-long complications related to diabetes due to the longer disease length in a child’s lifetime (Pinhas-Hamiel & Zeitler, 2005).

Cardiovascular Disease

Overweight is associated with an increased risk for cardiovascular disease in children (Friedman et al., 2012). The correlation between Coronary Artery Disease (CAD) and overweight was also demonstrated by a meta-analysis of 21 studies where over 300,000 participants were assessed over a 16 year long period. The study indicated that those who were overweight had a 32% higher chance of developing CAD, while those who were obese had an 81% higher chance of developing CAD compared to those of normal weight (Bogers et al., 2007). Another cardiovascular disease that is brought about by overweightness is the risk for stroke. Strazzullo et al. (2010), looked at over 2.3 million people and found an association between the amount of excess fat and the increase risk for ischemic stroke.

Pulmonary/Respiratory Complications

Children that are overweight are more susceptible to acquiring asthma (Rodriguez, Winkleby, Ahn, Sundquist, & Kraemer, 2002). They are also more at risk for sleep apnea, obstructive sleep disorders (Daniels, 2006). Long-term effects of sleep apnea include day-time hypertension and diastolic dysfunction.

Musculoskeletal Disorders

The excess weight carried by a body places mechanical and metabolic stress on bones, joints, and muscles, which can lead to degenerative joint diseases. Since the bones of children are still growing and have not matured, excess stress due to excessive weight may lead to skeletal growth abnormalities (Daniels, 2006).

MANAGEMENT

Prevention

As previously stated, the environment is the most critical factor in predicting the risk of developing overweightness in children. This means prevention should be focussed on factors in our environment that can be easily manipulated and changed by the individual, like nutrition or physical activity. In order to prevent excess weight gain and maintain a healthy weight, the WHO (2015) recommends:

  • Children and youth aged 5-17 should participate in a minimum of 60 minutes of moderate-to-vigorous intensity activity daily
    • Moderate intensity activities are those that still allow us to have a conversation with some breathlessness
    • Vigorous intensity activities are those that don’t allow us to hold a conversation because the respiratory system is overloaded
  • Physical activities should be aerobic
  • Include those activities that strengthen muscle and bone at least 4 times a week

By incorporating activities that are enjoyable to the child can help in positive and continuous participation.

Treatment

Much like prevention, treatment for overweightness in children should be structured around factors that the individuals can manipulate themselves, making the likelihood of their success higher because they are in control. The Harvard School of Public Health (2015), stresses the importance that a weight loss as little as 5-10% of the body weight leads to increases in meaningful health benefits. The most important part of treatment is being able to correct the energy imbalance. Focus should be on expending more calories than the intake of calories. A treatment program that uses a combination of physical activity and nutrition would provide a greater reduction in BMI than either a physical activity program or nutrition program on their own (Friedrich, Schuch, & Wagner, 2012).

PRACTICAL APPLICATION

We can make a positive difference in our children’s lives by having them engage in physically active activities rather than sedentary activities. Excess screen-time seems to be the leading problem in sedentary living, where our children spend more than 2 hours on a computer, TV, gadgets, or gaming console per day. As parents, it is our responsibility to ensure that our child receives a minimum of 60 minutes of moderate-to-vigorous physical activity every day. We cannot assume that other institutions, such as schools or extra-curricular sports, will fulfill the physical activity requirements that our children need. The following steps can be taken to promote activity in our children and amongst ourselves:

  • Get involved in the physical activity with your children
    • If your child sees you getting involved in the activity, they are more likely to be motivated to participate. Not only is it beneficial for your child, this will allow you to also get some physical activity in your day. Consider it a bonding experience with your child as well!
  • Get the child involved in picking activities
    • This method not only gives the child the sense of autonomy, but will also keep them engaged in the activity because they enjoy it
  • Utilize active transportation, such as walking, biking, rollerblading

Since physical activity isn’t the only portion of the equation that will either prevent or reduce the obesity, we also should take a look at nutrition:

  • Prepare meals
    • Meals prepared at home usually have lower caloric value than meals purchased outside. We are more likely to use fresh fruits and vegetables when cooking at home
  • Read the nutritional guides on store bought products
    • Not only should we be looking at the total caloric value of the product, but also at the various portions of sodium, sugar, fat, and carbohydrates that form the product. Just because an item is low in calories, it doesn’t mean it’s healthy! Companies usually offset the caloric value by adding copious amounts of salts and sugar. Large quantities of salt and sugar in diet can result in various health problems later in life.
  • Use healthy alternatives for snacks
    • Substitute snacks like granola bars, chips, cookies, etc. with fresh fruits and vegetables
  • Make it colourful!
    • A visually appealing meal is more likely to grab the attention of your child
  • Get the child involved
    • Having the child pick at least one item, will keep them interested in the meal
    • By allowing the child to pick and eat from a selection of items on their own volition can help regulate their internal cues of energy intake (Johnson & Birch, 1994). This will prevent over-eating since the child will not be dependent on external cues.

All in all, make physical activity and healthy nutrition a habit.

REFERENCES

  1. American College of Sports Medicine (ACSM). (2014). ACSM’s guidelines for exercise testing and prescription (9th ed.). Baltimore, MD: O’Rourke.
  2. American Diabetes Association. (2000). Type 2 diabetes in children and adolescents. Diabetes Care, 23(3), 381-389. doi:10.2337/diacare.23.3.381
  3. Anderson, P. M., & Butcher, K. F. (2006). Childhood obesity: Trends and potential causes. The Future of Children, 16(1), 19-45. Retrieved from http://futureofchildren.org/futureofchildren/publications/journals/
  4. Birch, L. L. (1998). Development of food acceptance patterns in the first years of life. Proceedings of the Nutrition Society, 57(4), 617-624. doi:10.1079/PNS19980090
  5. Bogers, R. P., Bemelmans, W. J. E., Hoogenveen, R. T., Boshuizen, H. C., Woodward, M., Knekt, P.,…Shipley, M. J. (2007). Association of overweight with increased risk of coronary heart disease partly independent of blood pressure and cholesterol levels: A meta-analysis of 21 cohort studies including more than 300,000 persons. Arch Intern Med, 167(16), 1720-1728. doi:10.1001/archinte.167.16.1720
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