Childhood Obesity: Causes and Prevention, Literature Review Example

Abstract

Childhood obesity is a major concern for parents, teachers, and the medical community with differing philosophies and theories on causes and prevention. Inactivity, genetics, technology and parenting attitudes and beliefs are factors which contribute to childhood obesity. Peer pressure and social circles also create an epidemic of children overweight or obese. Intervention by parents, physicians and the educational system with support and nutrition with physical activity instruction can help create a culture of informed children.

Introduction

Childhood obesity is a major concern for parents, teachers and health care providers. Children will gain weight as they grow and develop. The problem presents when a child has extra pounds not needed for normal growth and development. Extra weight leads to obesity and particularly for a young child or adolescent can create serious medical conditions continuing into adulthood. Researching and determining particular and specific causes for childhood obesity can help in educating and motivating children and parents towards behavior changes to correct and prevent childhood obesity.

Criteria for determining obesity in children rely on body mass index (BMI) in relation to overall weight, age, height and body structure. A BMI in children ages 6 to 19 years of age between the 85^th and 94^th percentiles is considered in the normal range, while anything over the 95^th percentile is considered obese (Hampl and Summar, 2009). While there are many factors believed to be directly related to childhood obesity, the parents’ perception of weight and healthy lifestyles directly impact children. Not all unhealthy conscious parents will produce unhealthy children; the effect still remains on a child’s upbringing.

Beyond a child’s upbringing, there are genetic factors which play a role in childhood obesity. Excess weight is typically caused by overeating and exercising too little. However, there are some hormonal and genetic causes contributing to childhood obesity. Cushing’s syndrome is one example of a medically predisposed reason for weight problems in children. This condition occurs when the body experiences high levels of the hormone cortisol for an extended period of time. Along with increased weight it can cause high blood pressure, bone loss and diabetes (Mayo Clinic, 2008).

Physical activity and social interaction are also factors in childhood obesity. Luisa Franzini, et.al. (2009) through a research study found that neighborhood social factors as well as the physical environment affect childhood obesity and the importance of health policies and interventions to reduce the likelihood of childhood obesity. With the documented evidence of health related problems associated with obesity, it is important to enlist parents, educators and health care providers to address the problem of overweight children and the dynamics of how diet, activity and social interaction affect an individual. Sarah Barlow, et.al. (2002) conducted a study on the rise in childhood obesity and recognizes the vital component clinicians’ plays in the role of identifying the problem and assess the risk factors for that individual.

Methods

A thorough search of online databases was used to identify relevant and significant peer-reviewed journal articles related to childhood obesity and the causes and preventions for this condition. ProQuest Medical Library was the primary search engine used; access provided by Florida Gulf Coast University with a search limited to a period of 10 years. Search phases used to retrieve appropriate articles included ‘childhood obesity’ and ‘childhood obesity in youth’ and childhood obesity and activity.’ Secondary sources were consulted including medical universities such as the Mayo Clinic was included for supplemental information. Themes discovered included the concepts of parental and social influence, diet and activity.

Eleven papers were reviewed and are included in the findings supporting this literature review on childhood obesity. Several focused on medical evaluation of childhood obesity and the identification of problems early in life (Barlow, Dietz, Klish, and Trowbridge, 2002), (Hampl and Summar, 2009), and (Harker and Saguil, 2009) conducted studies to show the relevance of early detection. The benefits of physical activity and fitness as a preventive and corrective measure were recorded also in a few articles (Morrow and Ede, 2009), (Dwyer, Magnussen, Schmidt and Ukoumunne, 2009). A study of the nutritional significance was researched (Moore, Pawloski, Goldberg and Mi Oh, 2009), as well as infant feeding and childhood obesity (Butte, 2009). Communication (Daniel, 2009) and neighborhood social circles were also a theme in the articles (Cecil-Karb and Grogan-Kaylor, 2009) and (Franzini, Elliott, Cuccaro, and Schuster, 2009). Familial factors were also included in the articles researched (Nsiah-Kumi, Ariza, Mikhail, Feinglass, and Binns, 2009).

Nutrition

The role of nutrition in childhood obesity was a theme among several of the papers. The importance of environmental factors on obesity is related to nutrition and the permissive attitude in the United States associated with the acceptance of overeating. Nancy Butte (2009) in the Journal of Nutrition studied the impact on infant feeding and the incidence of obesity in children. Factors studied in this research included breast-feeding and formula feeding with socioeconomic status, parental obesity and maternal smoking and birth weight. Family characteristics and genetics were also observed in the study. Breast feeding appears to have a protective effect against childhood obesity while the other factors such as socioeconomic status and parental obesity were found to have significant influence as a cause for childhood obesity (Butte, 2009).

Dausen Harker, et.al. (2009) support this theory and finding in a research performed by Harker and colleges on several earlier studies performed. They found that breastfeeding has a small effect on prevention as recommended by the American Academy of Pediatrics. Nutrition was shown to play a major role in the study along with inactivity and the number of televisions available to the children; particularly if they were allowed a television in their rooms. Harker, et.al. (2009) iterate the importance of interventions aimed at limiting television time and also promoting breastfeeding and appropriate dietary habits to be taught early in life.

Nutritional intervention among children with obesity through education and self-care practices are the focus of an article by Moore, et. al. (2009). A pilot study for a program called ‘Color My Pyramid’ was conducted on 126 fourth and fifth grade students from experimental as well as control schools were compared. Activity levels with nutritional education were undertaken in this study and findings demonstrated the success of the program and the chances for successful employment in school settings (Moore, et.al., 2009). Teaching children to be responsible and accountable for food choices is the theoretical structure of the program. The classes were organized to increase motivation and encourage peer support between the children. A computer program was designed to make the work of dietary education fun and enjoyable; prompting continued use by the children. The program also taught the advantages of physical activity.

Physical Activity

Physical activity and the decline of activity as a child ages and weight increases is the focus of Dwyer, et.al. (2009) and a study on physical fitness in relation to obesity and health problems such as insulin resistance. Dwyer examined a previous Australia study in 2004-2006 which demonstrated a decline in the fitness level between childhood and adulthood is directly associated with obesity. The study specifically looked at children age 9, 12, or 15 undergoing specific cardiovascular fitness testing in 1985. The 2004-2006 follow-up study demonstrated a decline in fitness as a strong predictor of obesity and insulin resistance. Encouraging physical activity in children and fostering a sense of educational wisdom for children to be enabled to live a healthy lifestyle is preventive for health problems in children leading into adulthood.

However, a research done by James Morrow and Alison Ede (2009) questions fitness testing as a state-wide mandate. Given the problems of childhood obesity and the relationship between physical fitness and health style behaviors, physical fitness testing seems appropriate. The problem observed is the methods and structure of the physical fitness testing. The study recommends structure and careful planning when considering fitness testing, particular if this is to be a state-wide mandate. The authors recommend careful planning not in a haphazard way but done to enhance the learning experience and obtain quality data in order for health decisions to be properly made (Morrow, et.al., 2009).

Family and Physicians          

How a family lives and teaches a child about health, weight and lifestyles depend on the parent’s history and beliefs. This provides a direct influence on the educational component for children as well as predicted behavior. Nsiah-Kumi, et.al. (2009) studied factors regarding parents beliefs, history and practices to determine the effect on childhood obesity. The consequences of obesity and the relevance parents have regarding this as well as their own self-efficacy for influencing children have an impact on how a child behaves and handles their nutritional and activity level choices.

This study involved 386 parents of children age 2 to 17 years. Behavior and family genetic histories were included in the study. Race and gender were documented. Diabetes and cardiovascular disease histories were also included in the initial subjects interviews. The results revealed that race, ethnicity, parental education, child gender, and a positive family history of diabetes and cardiovascular disase have a strong influence on parental perceived risk for diabetes in overweight children and the parent’s perceived self-efficacy influences the child’s health behaviors (Nsiah-Kumi, et.al, 2009).

This study is supported by another study conducted by Barlow, et.al. (2002) which studied pediatricians and nurse practitioners regarding their experience and evaluation of overweight children. The sample admitted to being concerned about family history and parental education. The results found that there is a need for educational efforts to increase knowledge and identification of obesity and address preventive measures and ways to help children loose weight and adopt healthier lifestyles. The report found that a number of practitioners were not routinely screening obese children and the need to begin educational endeavors for parents and children is evident.

Katherine Daniel (2009) also addresses the need for communication to children regarding health and the consequences of an unhealthy lifestyle and emphasizes the need to make prevention as fun as indulgence. The need for government and private organizations to provide education to parents in layman’s terms is important in getting parents to understand first and then teaching children the specifics of health education for childhood obesity prevention. Parents directly influence children through their actions and attitudes. Although children have to learn to be responsible for their choices, they need to be taught how to recognize good and poor choices for better decision making.

Social

The previous articles mentioned have reviewed the need for identifying and correcting the problem of obesity in children. The issue of society and neighborhood environments are factors researched to understand childhood obesity. The authors of “Influences of Physical and Social Neighborhood Environments on Children’s Physical Activity and Obesity” studied 650 children along with their primary caregivers. This study is a community-based, cross-sectional study of health risk behaviors and health outcomes in children (Franzini, et.al., 2009). The home environment and psychological factors were reviewed as well as activity level and socioeconomic status. Deterrents to physical activity in the environment included such things as traffic and graffiti and litter; indicating dangerous environments (Franzini, et.al, 2009). This demonstrates the need for parenting intervention and help in providing choices for activity.

The study also demonstrates the social component being important to physical activity in the particular environment. Safety is an issue for children going outside to play and is a component factored into the research studies. Friendships among children are a direct link to childhood activity and the benefits of social support for both safety and getting outside to play. Similar to the study conducted by Nsiah-Kumi, et.al., parental influence is also a part of potential cause of prevention to childhood obesity. The parents of a neighborhood can group together to watch children for safety and encourage and enforce healthful lifestyles. Franzini, et.al. (2009) believes in neighborhood collective efficacy with the willingness of neighbors to come together for the common good and improving availability and access to recreational resources for children.

Rebecca Cecil-Karb and Andrew Gorgan-Kaylor (2009) also conducted a study on parenting choices, neighborhood safety and activities and the relationship on the health of children. Their conclusions were similar to Franzini, et.all, and included the impact of television on a child’s weight. This study also demonstrated the importance of neighborhood safety and individuals working together to assist in maintaining a safe environment for children and a place for them to play and learn the benefits of healthy lifestyles. Life the other studies reviewed the authors recognize the impact of obesity with health problems leading into adulthood.  Overweight and obesity in children and adolescents are associated with physical problems including hypertension, insulin resistance, diabetes and sleep apnea (Cecil-Karb, et.al. 2009).

Conclusion

The literature review of the journal articles selected demonstrates the need to consider the causes and preventions of childhood obesity. Although many factors may contribute to a child being overweight, the need for parents, society and physicians to address the issue and find ways to help children lead healthier lifestyles is fundamental in dealing with childhood obesity. Children and sweets can go together in moderation, but the need for a balanced diet and physical activity to burn off excess weight is the key to self-control. Overeating anything will cause weight gain if not counteracted with physical activity.

Children have to learn the consequences of overeating and inactivity. The long-term effects may not mean much to children if the concepts are not taught in the language a youngster can understand and appreciate. Talking to a child about diabetes or cardiovascular risk factors must be on a level that a child can understand at the age they are currently. Having parents, teachers and physicians work together in identifying and assisting in childhood obesity causes and prevention is the main key to this problem.

References

Barlow, S.E., Dietz, W.H., Klish, W.J., & Trorwbridge, F.L. (2002). Medical evaluation of overweight children and adolescents: reorts from pediatricians, pediatric nurse practitioners and registered dietitians. Pediatarics, 110(1), Retrieved from http://pediatrics.aappublications.org/cgi/content/full/110/1/S1/222 doi: Google

Butte, N.F. (2009). Impact of infant feeding practices on childhood obesity. The Journal of Nutrition, 139(2), Retrieved from http://proquest.umi.com.ezproxy.fgcu.edu/pqdweb?index=11&srchmode=1&sid=1&vinst=PROD&fmt=3&startpage=-1&vname=PQD&did=1663896141&scaling=FULL&pmid=23412&vtype=PQD&fileinfoindex=%2Fshare3%2Fpqimage%2Fpqirs103%2F20100216161538146%2F11949%2Fout.pdf&source=%24source&rqt=309&TS=1266354939&clientId=8631 doi: ProQuest

Cecil-Karb, R., & Grogan-Kaylor, A. (2009). Childhood body mass index in community context: neighborhood safety, television viewing and growth trajectories of bmi. Health & Social Work, 34(3), Retrieved from http://proquest.umi.com.ezproxy.fgcu.edu/pqdweb?index=2&did=1809207511&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1266346874&clientId=8631 doi: ProQuest

Daniel, K.L. (2009). The Power of mom in communicating health. American Journal of Public Health, 99(12), Retrieved from http://proquest.umi.com.ezproxy.fgcu.edu/pqdweb?index=0&sid=1&srchmode=1&vinst=PROD&fmt=3&startpage=-1&clientid=8631&vname=PQD&RQT=309&did=1923251171&scaling=FULL&ts=1266346628&vtype=PQD&rqt=309&TS=1266346643&clientId=8631&cc=1&TS=1266346643 doi: ProQuest

Dwyer, T., Magnussen, C.G., Schmidt, M.D., & Ukoumunne, O.C. (2009). Decline in physical fitness from childhood to adulthood associated wtih increased obesity and insulin resistance in adults. Diabetes Care, 32(4), Retrieved from http://proquest.umi.com.ezproxy.fgcu.edu/pqdweb?index=6&sid=1&srchmode=1&vinst=PROD&fmt=3&startpage=-1&vname=PQD&did=1703991851&scaling=FULL&pmid=17598&vtype=PQD&fileinfoindex=%2Fshare3%2Fpqimage%2Fpqirs102%2F20100216140357163%2F6180%2Fout.pdf&rqt=309&source=%24source&TS=1266347038&clientId=8631 doi: ProQuest

Franzini, L., Elliott, M.N., Cuccaro, P., & Schuster, M. (2009). Influences of physical and social neighborhood environments on children’s phyiscal activity and obesity. American Journal of Public Health, 99(2), Retrieved from http://proquest.umi.com.ezproxy.fgcu.edu/pqdweb?index=9&did=1630875561&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1266347138&clientId=8631 doi: ProQuest

Hampl, S.E., & Summar, M.J. (2009). Weighing in on childhood obesity. Pediatric Annals, 38(3), Retrieved from http://proquest.umi.com.ezproxy.fgcu.edu/pqdweb?index=8&did=1659709871&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1266347092&clientId=8631 doi: ProQuest

Harker, D., & Saguil, A. (2009). Early interventions may prevent adolescent, adult obesity. American Family Physician, 80(1), Retrieved from http://proquest.umi.com.ezproxy.fgcu.edu/pqdweb?index=3&did=1803223951&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1266346914&clientId=8631 doi: ProQuest

May Clinic. (2008). Cushing’s Syndrome. Retrieved February 16, 2010 from http://www.mayoclinic.com/health/cushings-syndrome/DS00470

Moore, J.B., Pawloski, L.R., Goldberg, P., & MiOh, Kyeung. (2009). Childhood obesity sudy: a pilot study of the effect of the nutrition education program color my pyramid. The Journal of School Nursing, 25(3), Retrieved from http://proquest.umi.com.ezproxy.fgcu.edu/pqdweb?index=5&did=1922426251&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1266346976&clientId=8631 doi: ProQuest

Morrow, J.R., & Ede, A. (2009). Reserach quarterly for exercise and sport lecture statewide physical fitness testing: a big waist or a big waste?. Research Quarterly for Exercise and Sport, 80(4), Retrieved from http://proquest.umi.com.ezproxy.fgcu.edu/pqdweb?index=1&did=1909377541&SrchMode=1&sid=1&Fmt=3&VInst=PROD&VType=PQD&RQT=309&VName=PQD&TS=1266346814&clientId=8631 doi: ProQuest

Nsiah-Kumi, P.A., Ariza, A.J., Mikhail, L.M., Feinglass, J., & Binns, H.J. (2009). Family history and parents beliefs about consequences of childhood overweight and their influence on children’s health behaviors. Academic Pediatrics, 9(1), Retrieved from http://proquest.umi.com.ezproxy.fgcu.edu/pqdweb?index=13&srchmode=1&sid=1&vinst=PROD&fmt=3&startpage=-1&vname=PQD&did=1723042911&scaling=FULL&pmid=68215&vtype=PQD&fileinfoindex=%2Fshare4%2Fpqimage%2Fpqirs101%2F20100216140844835%2F28574%2Fout.pdf&source=%24source&rqt=309&TS=1266347325&clientId=8631 doi: ProQuest