Childhood Obesity RUNNING HEAD: Childhood Obesity

Childhood Obesity Peter Schuckert Kaplan University HS315-01

Childhood Obesity Childhood Obesity Childhood obesity has ballooned to epidemic proportions. This increase in childhood obesity has not gone unnoticed. Healthcare professionals as well as parents have noticed this trend. Healthcare professionals and public health officials are concerned that todays obese children will turn into tomorrows obese adults. In order to combat childhood obesity we must first examine the potential underlying causes of the increase in obesity. Only after having a thorough understanding the causes of childhood obesity can it be combated. In order to think about the potential causes of the increase in childhood obesity first we must understand how the medical community measures obesity. Typically obesity is defined as having a body mass index also known as BMI above a particular cutoff point. The BMI is a calculation that compares height to weight. According to American College of Sports Medicine an individual is considered obese if their BMI is 30 or more (ACSM, 2001). Obesity must be addressed at an early age. Obese children are much more likely than

normal weight children to be obese adults. A study conducted in the 1990s showed that 52 percent of children who are obese between the ages of 3 and 6 are still obese when they are 25 years old. While only 12 percent of normal and underweight 3 to 6 year olds are obese at when they are 25 years old (Whitaker, Wright, Pepe, Seidel, & Dietz, 1997) . Although obesity rates have increased for children from every demographic they increased disproportionately for children in low income families than for children overall. As demonstrated above childhood obesity rates are clearly rising. The causes of the dramatic increase are not obvious, even though the biology of weight change is well understood. Essentially when someone consumes more calories than they expend weight gain is the result. Not every case of obesity is due to over consumption of calories. Genetics have been found to play an important role in obesity. Recent studies have concluded that roughly 35 percent of BMI is heritable (World Health Organization, 1997). Obviously genetic drift cannot explain the recent

Childhood Obesity increase in childhood obesity because the gene pool is not changing in such a drastic fashion. However it seems that some people have a genetic disposition for weight gain. Rare medical

conditions such as abnormalities of the endocrine system can lead to weight gain. Yet this scenario is unlikely for most as it has been estimated that less than five percent of obesity cases result from said abnormalities (Zakus, 1982). Even though genetics and some medical conditions can influence someones BMI the primary focus must be on changes in energy balance. Energy balance is the balance between calories consumed and calories burnt. It is easy for children to adjust their calorie intake to match their expenditure. In many instances instead of calorie intake being based on energy expenditure it is influenced by external cues (Fisher, Rolls & Birch, 2003). External cues influencing calorie consumption is why many researchers chose to study the role of caloric intake. Children of all ages love fast food. This is why it is a common subject of studies concerning childrens dietary habits. Studies have shown that individuals consuming fast food meals have higher energy intake with lower nutritional value (Paeratakul, Ferdinand, Champagne, Ryan & Bray, 2003). The consumption of food that is high in calories and low in nutritional value is commonly referred to as consuming empty calories. Nevertheless this does not mean that all children who consume fast food are obese. In fact it has been shown that while both obese and lean adolescents consume more calories when eating fast food the lean adolescents typically compensate for the increased caloric intake, while those that are overweight do not (Ebbeling, 2004). Another dietary habit of children is that they prefer to drink sweet beverages instead of water or milk. This is why another frequently studied source of caloric intake is sweet beverages. Primarily the sweet beverages are soft drinks but juices are included as well. As with fast food studies generally establish that drinking these beverages results in higher overall caloric intake. Furthermore numerous studies have found a correlation between obesity and soft drink

Childhood Obesity consumption (Ludwig, 2001). Finally another common source of caloric intake for children that has been the subject of countless studies is snacks. Snack foods have a tendency to contain a disproportionate amount of calories as compared to other foods. The implication is that snacking may increase overall caloric intake. Yet snacking does not seem to be a contributing factor to childhood obesity. In a study comparing obese and non-obese children found that caloric intake from snacks is comparable across the two (Bandini, Vu, Must, Cyr, Goldberg & Dietz, 2000). The researchers arrived at the conclusion that obese children do not consume more junk food than non-obese children. If this

research is to be believed the source of the energy imbalance for obese children must have another root cause. A recent study arrived to a similar conclusion. Information was collected from prepubescent girls on a yearly basis over a period of ten-years (Phillips, Bandi, Naumova, Cyr, Colclough, Dietz & Must, 2004). No association between the consumption of snack foods and BMI, but as in the studies that focused on beverages previously mentioned, however a correlation between BMI and soda was apparent. The other side of the energy balance equation is calorie expenditure. It is common knowledge that calories are expended through physical activity. There are a couple of less obvious ways that calories are also expended. These less common means of expending calories are through dietary thermogenesis and the basal metabolic rate (Westerterp, 2004). Several studies looked into low basal metabolic rate as a cause of childhood obesity. One study researched both obese and non-obese teenagers. This study found that basal metabolic rate is not reduced in teenagers that are obese, and subsequently lower caloric expenditure through ones basal metabolic rate is not the cause of obesity in teenagers (Bandini, Schoeller & Dietz, 1990). Due to the lack of scientific evidence that basal metabolic rate has an effect on childhood obesity it is essential to focus on physical activity. Studies examining the relationship between physical activity and BMI have had mixed results (Sallis, Prochaska & Taylor, 2000) The

Childhood Obesity difficulty in identifying a link between the lack of physical activity and increased BMI could be due to the fact that BMI is a potentially an inaccurate measurement of fatness in the presence of

lean muscle mass in children because they are still developing. Even though the results from some cross-sectional studies have not had clear results, longitudinal studies on the other hand have found a relationship between increased physical activity and decreases in BMI (Berkey, Rockett, Gillman, & Colditz, 2003). Whereas the relationship between physical activity and BMI is uncertain more definite results have been observed between sedentary activities and obesity. Participating in sedentary activities may reduce the participation in more physically demanding activities, making this type of study seem similar to physical activity studies. Time spent doing sedentary activities are easily measured. This is not necessarily the case for physical activity where duration matters. According to the CDC children should get at least 60 minutes of physical activity daily ("Centers for disease," 2011). A study that investigated the connection between watching television and physical activity had some interesting results. Contrary to common beliefs there was not a direct relationship between the two. Another one of the interesting results from this study is a relationship with computer use, reading, and homework. Surprisingly these specific sedentary activities were associated with higher levels of physical activity (Utter, Neumark-Sztainer, Jeffery & Story, 2003). There are several possible ways for television viewing to affect weight. First of course is the prospect previously mentioned above that physical activity is squeezed out. Secondly television advertising targets children and could possibly increase their desire for calorie dense snack foods. Finally for many watching television and snacking go hand in hand. This could lead to higher caloric intake with children who spend large amounts of time watching television. One of the ways children got physical activity in previous years such as recess and physical education has been squeezed out of schools to make room for more academics. The National Association of Early Childhood Specialists in State Department of Education released a

Childhood Obesity statement in 2001 that emphasized how important recess is for children. They noted that almost forty percent of elementary schools have reduced or eliminated recess since the early 1990s (National Association of Early Childhood Specialists in State Department of Education, 2001).

Children do not play outside as much as in previous years. There was a time when children played outside until their mother called them in for dinner, and afterwards they were right back outside until nightfall. This is the exception, not the rule in nowadays. One of the many reasons for the change is a reported increase in homework between the early 1980s and the late 1990s (MacPherson, 2002). Another factor that contributes to children spending less time outside playing is nowadays it is common for both parents to work outside the home to make ends meet. As a consequence many children are unsupervised when they get home from school. Without having an adult to tell them to go outside and play many children turn to video games to entertain them self until a parent gets home. This is a double edged sword as it is yet another sedentary activity that squeezes out physical activity and it reduces the time that children have to interact with their peers. Knowing what behaviors can lead to obesity can help healthcare professionals and parents make changes to deter childhood obesity. Some changes such as avoiding sweet beverages and snacking during sedentary activities parents have to take the lead role, with community health focusing on nutritional education. Community health organizations can take a more active role in the calorie expenditure side of the energy balance equation. They can increase opportunities for physical activity through changing the environment to support walking, biking and access to community and school recreation facilities to increase physical activity. The schools or local parks department can organize after school activities to increase physical activity for children instead of them going home to play video games after school. All of these changes are small, but if they are used in conjunction with one another can have a significant impact.

Childhood Obesity

Childhood Obesity References

ACSM (2001). ACSM's Resource Manual for Guidelines for Exercise Testing and Prescription, 4th ed., pg 7. Bandini, L. G., Schoeller, D. A., & Dietz, W. H. (1990). Energy expenditure in obese and nonobese adolescents. Pediatric research, 27(2), 198-203. doi: 10.1203/00006450199002000-00022 Retrieved from http://www.nature.com/pr/journal/v27/n2/pdf/pr199047a.pdf Bandini, L. G., Vu, D., Must, A., Cyr, H., Goldberg, A., & Dietz, W. H. (2000). Comparison of high-calorie, low-nutrient-dense food consumption among obese and non-obese adolescents. Obesity Research,7(5), 438-443. Berkey, C. S., Rockett, H. H., Gillman, M. W., & Colditz, G. A. (2003). One-Year Changes in Activity and in Inactivity Among 10- to 15-Year-Old Boys and Girls: Relationship to Change in Body Mass Index. Pediatrics, 111(4), 836. Retrieved from Health Source Consumer Edition Centers for disease control and prevention. (2011, November 09). Retrieved from http://www.cdc.gov/physicalactivity/everyone/guidelines/children.html Ebbeling, C. S. (2004). Compensation for Energy Intake From Fast Food Among Overweight and Lean Adolescents. JAMA: Journal Of The American Medical Association, 291(23), 2828. Retrived from MasterFILE Premier Fisher, J. O., Rolls, B. J., & Birch, L. L. (2003). Childrens bite size and intake of an entre are greater with large portions than with age-appropriate or self-selected portions. American

Childhood Obesity Journal of Clinical Nutrition, 77(5), 1164-1170. Retrieved from http://www.ajcn.org/content/77/5/1164.full.pdf Ludwig, D. (2001). Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. Lancet, 357(9255), 505. Retrieved from Vocational and Career Collection. MacPherson, K. (2002, October 1). Development experts say children suffer due to lack of unstructured fun . . Retrieved May 4, 2012 from http://old.postgazette.com/lifestyle/20021001childsplay1001fnp3.asp National Association of Early Childhood Specialists in State Departments of Education. (2001). Educational resources information center. Retrieved from http://www.eric.ed.gov/PDFS/ED463047.pdf Paeratakul, S., Ferdinand, D., Champagne, C., Ryan, D., & Bray, G. (2003). Fast-food consumption among us adults and children: Dietary and nutrient intake profile. Retrieved from http://www.csrees.usda.gov/nea/food/pdfs/roundtable_references_fast_food.pdf Phillips, S. M., Bandi, L. G., Naumova, E. N., Cyr, H., Colclough, S., Dietz, W. H., & Must, A. (2004). Energy-dense snack food intake in adolescence: Longitudinal relationship to weight and fatness. Obesity Research, 12, 461 472. doi: 10.1038/oby.2004.52 Retrieved from http://www.nature.com/oby/journal/v12/n3/pdf/oby200452a.pdf

Sallis, J. F., Prochaska, J. J., & Taylor, W. C. (2000). A review of correlates of physical activity of children and adolescents. Medicine and science in sports and exercise, 32(5), 963-975. Retrieved from http://www.edf.ufpr.br/mestrado/Referencias2006/AFS Sallis et al 2000.pdf Utter, J., Neumark-Sztainer, D., Jeffery, R., & Story, M. (2003). Couch potatoes or french fries: are sedentary behaviors associated with body mass index, physical activity, and dietary

Childhood Obesity behaviors among adolescents?. Journal of the American Dietetic Association, 103(10), 1298-1305. Westerterp, K. R. (2004). Diet induced thermogenesis. Nutrition & metabolism, 1(1), 5. doi: 10.1186/1743-7075-1-5 Retrieved from http://www.nutritionandmetabolism.com/content/1/1/5 Whitaker, R. C., Wright, J. A., Pepe, M. S., Seidel, K. D., & Dietz, W. H. (1997). Predicting

10

Obesity in Young Adulthood from Childhood and Parental Obesity. New England Journal Of Medicine, 337(13), 869-873. doi:10.1056/NEJM199709253371301 Retrieved from Health Source: Nursing/Academic Edition World Health Organization. (1997) Obesity: Preventing and Managing the Global Epidemic: Report of the WHO Consultation of Obesity. Geneva: World Health Organization Zakus, G. E. (1982). Obesity in children and adolescents: Understanding and treating the problem. Social Work in Health Care, 8(2), 11-29. doi:10.1300/J010v08n02_02