Public Awareness and Human Diseases, Research Paper Example

Abstract

That human awareness is the key to preventing the most serious human diseases cannot be denied. Childhood obesity is fairly regarded as one of the most complex and controversial public health issues. The current state of medical science emphasizes the importance of preventing obesity early in life. The paper discusses the issue of childhood obesity and the groups most affected by it. A discussion of the causes of childhood obesity is provided. The paper links childhood obesity to diabetes and cardiovascular complications. Preventable and non-controllable risk factors are discussed. The paper provides a brief insight into the evolution and current treatment for childhood obesity. The Springfield-Greene County Park and Recreation community program is analyzed. Recommendations are provided to improve the community program.

Public awareness plays the key role in preventing various diseases and their complications. Childhood obesity is one of the most controversial and complex public health issues in present day America. Thousands of children suffer the consequences of excessive body mass and its health complications. The current state of medicine treats prevention as the essential ingredient of successful strategies against childhood obesity. Dozens of community programs and public health strategies were developed to educate children and their parents about the risks of obesity and the value of healthy lifestyles. Springfield-Greene County Park and Recreation community program is a good example of how anti-obesity community programs work in the U.S. Unfortunately, the program lacks multi-ethnic focus and does not target low-literacy groups. Therefore, it is imperative that community programs for childhood obesity have multi-ethnic orientation and maintain long-term commitment to their public health goals.

The past decades were marked with a rapid increase in prevalence and incidence of childhood obesity at a global scale (Han, Lawlor & Kimm, 2010). Australia, Canada, France, Japan, Great Britain and the United States witnessed a rapid increase in prevalence of childhood obesity, which doubled and even trebled during the last ten years (Han, Lawlor & Kimm, 2010). However, certain population subgroups have been affected by childhood obesity more than others: ethnic minorities, children from the low socioeconomic strata, and children from the southern regions of the American continent exhibit higher rates of obesity compared with the rest of the American population (Food and Nutrition Board, 2005). FNB (2005) suggests that Native American, non-Hispanic blacks and Hispanic children are disproportionately affected by childhood obesity risks. Statistically, almost 25 percent of non-Hispanic black children have and exceed the BMI’s 95th percentile (FNB, 2005). According to Centrella-Nigro (2009), high obesity prevalence among Hispanic children is a complex result of multiple influences, which include low socioeconomic status, the lack or absence of health insurance, low physical activity and misbalanced nutrition, as well as well as the degree of acculturation and parents’ perceptions of obesity and overweight (Centrella-Nigro, 2009). Problems with medical insurance and acculturation issues are, probably, the primary reasons why immigrant children are particularly vulnerable to the risks of developing obesity early in life (Kirchengast & Schober, 2006).

Variations in BMI are directly related to socioeconomic disparities, and the low-income groups demonstrate the highest incidence of obesity at the national level (FNB, 2005). BMI is increasingly sensitive to food prices: while the price of fast food steadily decreases, the real cost of healthy foods, fruits and vegetable, constantly grows (Cawley, 2010). Further, low-income families lack physical activity opportunities, whereas ethnically and racially segregated schools do not have enough resources to allocate for recreational and sport activities (Forster-Scott, 2007). Ultimately, geographical considerations heavily impact prevalence and incidence of obesity. Children from rural territories and towns consume more dietary fat and fewer fruits and vegetables, compared with children in cities (Simen-Kapeu, Kuhle & Veugelers, 2010). As a result, the quality of their diets is lower than that of children in large urban territories.

The causes of childhood obesity are numerous and varied. However, misbalanced diet and the lack of physical activity are the main factors of excessive weight in children. Dietary habits and physical inactivity pose a serious challenge to the future of public health in the developed world: children show greater reliance on cheaper foods and are unwilling to participate in sports and recreation activities. Certainly, genetic factors and metabolism disorders contribute to the development of childhood obesity, but they are of secondary importance, compared with dietary and lifestyle habits, which are easy to fix and prevent. The effects of obesity on children are not limited to physical sufferings but cover a wide range of psychological difficulties, from depression, to low self-esteem and social stigmatization. In the meantime, endocrine and cardiovascular systems are primarily affected by childhood obesity. Type 2 Diabetes and coronary heart disease are among the most frequent complications of childhood obesity. The link between obesity, diabetes, and coronary heart disease is not difficult to explain.

Obesity is strongly associated with insulin resistance (Hannon, Rao & Arslanian, 2005). Insulin resistance is directly related to the risks of Type 2 Diabetes and cardiovascular diseases in children and adults (Hannon, Rao & Arslanian, 2005). Obesity leads to increased insulin resistance, when insulin-sensitive issues diminish or lose their ability to respond to insulin at cellular levels (Hannon, Rao & Arslanian, 2005). At the earliest stages of obesity, insulin-producing cells increase insulin secretion, to compensate for the lack of insulin-sensitivity in body tissues (Hannon, Rao & Arslanian, 2005). However, pancreatic cells cannot cope with excessive secretion of insulin and fail, leading to inadequate secretion of insulin and, consequentially, clinical diabetes (Hannon, Rao & Arslanian, 2005). In a similar vein, childhood obesity is invariably associated with increased levels of lipoproteins and lipids, and increased blood pressure (Freedman, Khan, Srinivasan & Berenson, 2001). Low levels of insulin or its absence contribute to the development of cardiovascular complications in overweight children (Freedman et al, 2001). Coronary heart disease is a regular, long-term outcome of childhood obesity, which develops later in life. Children at or above the 95^th percentile are particularly vulnerable to cardiovascular risks in adult life.

Most, if not all, risk factors of childhood obesity are easy to prevent. Kuhle, Allen, and Veugelers (2010) explored the obesity epidemic and came to an unexpected conclusion that most risk factors for pediatric obesity exhibited remarkable preventive potential. More than 40% of childhood obesity cases could have been prevented, through healthier eating and active lifestyles (Kuhle, Allen & Veugelers, 2010). Cessation of smoking during pregnancy could significantly reduce the risks of overweight and obesity in children (Kuhle, Allen & Veugelers, 2010). “High maternal pregnancy weight and excess sedentary activity in children emerged as the factors with the greatest potential for prevention” (Kuhle, Allen & Veugelers, 2010, p.367). Low energy intake, increased consumption of fruits and vegetables, and physical activity could help future mothers to reduce excessive weight before and during pregnancy.

Non-preventable factors of childhood obesity are but few: family history, socioeconomic factors, food prices and agricultural policies, as well as genetic influences, do play their part in the development and progression of the disease. Neuroendocrine, hormonal abnormalities and neurobehavioral factors can be potentially responsible for early-onset obesity in children (Mitchell, 2009). However, the effect of genetic mutations on the obesity epidemic is at least insignificant. At least one half of childhood obesity cases could have been prevented, through healthy nutrition and active lifestyles. However, sound food and health insurance policies could alleviate the burden childhood obesity at the state level. Also, community programs could contribute to the development of public obesity awareness and healthy lifestyles.

The current state of medicine provides extensive information about childhood obesity, its risk factors and consequences, as well as available treatment methods. However, for centuries, diets were the key ingredient of anti-obesity strategies for children and adults. Since the 1700s, diets have been used to reduce and control weight (Paxon, 2006). In the 20^th century, 18-Day diets, Scarsdale and South Beach diets enjoyed unprecedented popularity in women and men (Paxon, 2006). The rapid development of dietary solutions to obesity was further accompanied by the creation and implementation of anti-obesity medications, which ranged from simple purgative preparations to complex drugs, like Fen-Phen and Orlistat (Paxon, 2006). Most anti-obesity medications had severe side effects, and bariatric surgery had to become an effective alternative to conventional methods of treating obesity. Also called “an intestinal bypass”, the surgery linked the small intestine to its lower portion, leading to decreased absorption of food by obese patients (Paxon, 2006). Today, laparoscopic surgeries are widely used to treat obesity in children. However, childhood obesity diagnosis remains one of the most complicated and challenging procedures in contemporary clinical practice.

How do diagnose childhood obesity is a difficult question. Clinicians treat Body Mass Index (BMI) as the most appropriate procedure for diagnosing overweight and obesity in children (Magnusson, 2005). BMI is a straightforward measure, which is easy to apply in clinical settings. International standards of childhood and adolescent weight facilitate the diagnosis and the development of global strategies against childhood obesity (Magnusson, 2005). However, the use of BMI in childhood obesity makes it difficult to differentiate between lean and fat mass, and the risks of confusing a person with a large mass of muscles with an obese person are particularly high (Magnusson, 2005). Here, waist circumference and skinfolds could add value to pediatric obesity diagnosis.  Skinfolds measure is used to measure the levels of subcutaneous fat, while waist circumference helps to define and evaluate the distribution of fat (Magnusson, 2005). Possibly, a combination of these measures could create a complete picture of obesity diagnosis in children.

The difficulties in obesity diagnosis do not prevent medical professionals from developing treatment solutions to childhood obesity. The current state of treatment for pediatric obesity emphasizes the importance of complex management approaches (Nathan, 2009). Pharmacological, non-pharmacological, and surgical treatments are used to reduce the negative symptoms and consequences of pediatric obesity. In the context of non-pharmacological treatment, diets take the central position: dietary strategies aim at reducing energy intake and portion size (Rolls, 2010). Individualization of diets, food journaling, and family support play an essential role in raising the effectiveness of dietary interventions in childhood obesity (Fitch & Bock, 2009). Motivational interviewing adds to the bulk of treatment strategies for pediatric obesity (Schwartz, 2010). When non-pharmacological treatment and behavioral modifications are ineffective, anti-obesity medications like Orlistat and sibutramine can become a relevant means of treating pediatric obesity (Wald & Uli, 2009). Ultimately, surgical approaches to managing childhood obesity lead to promising results (Leslie, Kellogg & Ikramuddin, 2009). Unfortunately, surgeries are associated with numerous risks, including child consent for surgery and difficulties with follow-up compliance in children (Leslie, Kellogg, Ikramuddin, 2009). Bearing in mind the preventive potential of the principal risk factors for childhood obesity, it comes as no surprise that prevention has become the principal ideology of public health policies. Prevention is particularly valuable for pre-school children, who have better chances to develop and follow healthy eating and lifestyle habits, compared with their older peers.

Prevention ideology dominates global, state, and local anti-obesity programs worldwide. Springfield-Green County Park has a long history of obesity-prevention programs and is one of the major participants of the national We Can! Programs in the U.S. Participation in Media-Smart Youth Program and the city’s Fire Fall annual event was one of the most successful attempts to distribute information, materials, and healthy food samples to children (National Heart Lung and Blood Institute, 2011). This community program actively utilizes the media and information potential of various public events and develops effective partnerships with schools and parent groups (NHLBI, 2011). The effectiveness of the program is justified by the facts that

• the information in the program is widely available and easy to understand;
• the information is delivered in a manner, which is equally educating and entertaining;
• the information is supportive and helpful; and
• the program involves children in a broad range of educational activities, which teach healthy eating habits and contribute to healthy lifestyles.

Celebrities and popular figures actively participate in the community programs and add value to its healthy messages. That the community program covers parent partnerships, school and youth curricula, and community events is one of its most significant benefits. Unfortunately, not everything at Springfield-Green County is done well.

First, the community program lacks a multiethnic focus. However, ethnic minorities are a population subgroup, most affected by childhood obesity (FNB, 2005). For example, at one of the recent annual events, a few Hispanic and African-American children failed to engage in the community program: they seemed to misunderstand its purpose and message and lacked language skills needed to participate in the community activities. Notably, two of them had the signs of being overweight.

Second, low-literacy groups and individuals are beyond the boundaries of the community outreach. The messages and activities within the Springfield-Greene County community program imply that children and adolescents have the basic idea of what obesity is and how it works. Also, the language of communication and cooperation within the community program is rather complex. Most activities target educated youth, leaving low-literacy groups and pre-school children beyond healthy lifestyle education and learning. Leslie, Kellogg and Ikramuddin (2009) suggest that pre-school have better chances to cope with their obesity problems and develop healthy eating habits. Therefore, it is imperative that Springfield develops programs and activities that target low-literacy groups.

Ultimately, it is not clear how the community program can maintain long-term commitment to its public health goals. More often than not, a public event is momentous and short-lived, and children may fail to follow healthy diets and change their lifestyle habits in the long run. Leslie, Kellogg and Ikramuddin (2009) support this thesis: children encounter considerable difficulties with follow-up compliance. Therefore, annual events may not suffice to improve public health situation in the state. Regular sport activities and holiday / weekend programs could raise the efficiency of anti-obesity interventions. A cartoon character could become a spokesperson and an excellent means to communicate anti-obesity messages to children. At best, children could propose their ideas of whom they would like to see among their “cartoon guests”. Also, community program supervisors could invite more than one cartoon character, to ensure that the needs of multicultural and multiethnic children are met. These are just some of the ways the community program could improve and reduce the scope of the obesity epidemic in the state.

Conclusion

Childhood obesity is fairly regarded as one of the most controversial global public health issues. The past decades witnessed a rapid rise in prevalence and incidence of pediatric obesity at a global scale. Childhood obesity affects all body systems and leads to numerous health complications; yet, most, if not all, risk factors of childhood obesity display remarkable preventive potential. Prevention ideology dominates present day anti-obesity programs, which aim at developing healthy eating habits and lifestyles in children and adolescents. Unfortunately, children from the groups most affected by obesity often remain beyond the boundaries of the community programs’ outreach. Therefore, it is imperative that community programs for childhood obesity have multi-ethnic orientation and maintain long-term commitment to their public health goals.

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