Obesity has reached epidemic proportion globally and childhood obesity is already epidemic in some areas and on the rise in others Research findings suggest that lack of physical activity, sedentary behavior, parental obesity, socioeconomic status, eating habits, and environmental factors, as well as genetic and metabolic conditions, are coincident with the increased incidence of overweight.
With automation and machination, there are large shifts towards less physically demanding work, and increased use of automated transport, technology in the home, and more passive leisure pursuits act as a catalyst to the obesity epidemic. There have been profound economic and social changes in society and transformations in behavioral patterns of communities over recent decades, and these societal changes and worldwide nutrition transitions are speeding up the obesity epidemic. Obesity is a complex public health issue, and our society has a very negative view of overweight and obesity since body esteem or satisfaction with appearance is the domain of self-worth most affected by obesity.
Obese children are more likely to suffer from a psychiatric disorder, depression, behavior problems, social stigmatization, and are often victims of bullying. Though obesity has been stigmatized in the past, the high prevalence of obesity among all socioeconomic groups in the recent decades indicates that societal attitude may be changing with time, and studies suggest that when addressing youth overweight status, mental health problems also need to be addressed, since comorbidity of mental health problems and overweight may hinder any efforts at achieving a healthy weight status.
Prevalence of obesity: Literature review
Childhood obesity is a global epidemic and rising trends in overweight and obesity are apparent in both developed and developing countries. (Flynn, McNeil, Maloff, et al., 2005). World Health Organization (WHO), in 2007, estimated that 22 million children under the age of 5 years were overweight throughout the world. (Childhood overweight and obesity, 2008). According to NIH Obesity Research data “more than 65 percent of U.S adults are overweight or obese, with nearly 31 percent of adults—over 61 million people—meeting criteria for obesity.” (Strategic Plan for NIH Obesity Research, 2004).
Statistical evidence shows that, since 1970, the prevalence of obesity in the U.S. has more than doubled for preschool children (aged 2-5) and adolescents (aged 12-19) and more than tripled for children aged 6-11 years. (Overview of the IOM’s childhood obesity prevention study, 2004). “Many adult diseases have their origin during childhood, and excessive weight gain is a precursor to a wide variety of physiological aberrations that ultimately predispose to morbidity and mortality.” (St-Ong, Keller & Heymsfield, 2003). “Obesity currently results in an estimated 400,000 deaths annually and costs the nation nearly $122.9 billion” and it is the number one health threat facing America. (Ridgway, Jaffe & Braunstein, 2005).
Considering the gravity of the situation in the United States “the goal set by Healthy People 2010 is to reduce the proportion of obese children and adolescents to 5% by 2010.” (Koplan, Liverman & Kraak, 2005). The obesity epidemic is aggravated by societal changes as well as nutrition transition, as economic growth, modernization, urbanization, and globalization of food markets are triggering the obesity epidemic.
The increasing incidence of child obesity is of special concern because health consequences of obesity range from increased risk of premature death to serious chronic conditions that reduce the overall quality of life. However, in North America, which is ranked among middle-income countries, “obesity is still viewed as a sign of high social status, fertility, and prosperity” and obesity level is high among the female population of Morocco and Tunisia (Mokhtar et al, 2001).
Development of obesity in children and adolescents
Obesity is scientifically identified based on an individual’s Body Mass Index, and it refers to bodyweight that is at least 30 percent over the ideal weight for a specified height in accordance with BMI. In a general sense, it can be termed as an excess of body weight compared to the normally accepted standard of accumulated fat. Body composition assessment of young children, particularly during ‘adiposity rebound’ with its unique pattern of body size development, is viewed as the most effective approach in identifying the repercussions of future risk of obesity in children.
Literature on obesity studies reveals that the onset of obesity begins from the womb as undernutrition in the womb affects the fetus’ metabolism. Reduced availability of nutrients may train the fetus’ metabolism to conserve rather than use calories, which prompt the body to add more calories during infancy as well as adult life when more nutrients are available. A scientific review of evidence to confirm the “association between infant size or growth during the first two years of life and subsequent obesity” revealed that infants born with the highest BMI or who grew rapidly during infancy are at greater risk for future rapid growth and becoming obese (Baird et al, 2005).
Though overfeeding is considered as one of the most likely causes, the causes of rapid infant weight gain are unknown. Hence, Dennison et al. (2006) suggest that ‘there is a real need for more research to understand the parent-child mechanism, genetic and ethnic determinants, and environmental factors that present an increased risk for rapid infant weight gain and the development of childhood overweight and adult obesity.’
The prevalence of obesity is linked with consuming more calories than the body needs and an imbalance between calories consumed and calories burned, which may be due to genetic, hormonal, behavioral, environmental, and even cultural factors. However, the recent discovery of the fat cell hormone ‘leptin’ and other appetite-regulating hormones has demonstrated that certain types of obesity are not simply due to overeating, but are the result of “misregulated pathways that control the balance between appetite and energy expenditure.” (Conquering Diabetes: A Strategic Plan for the 21st Century: Report Summary and Recommendations, 2007).
Overweight and obese people are at increased risk for developing many health risks, such as cardiovascular disease, stroke, hypertension, Type-2 diabetes, insulin resistance, and glucose intolerance, congestive health failure, osteoarthritis, sleep interruption, and other respiratory problems; infertility, psychological disorders, and stress, urinary incontinence, and kidney stones; cancer of the kidney, endometrium, breast, colon, and rectum, etc. (Ridgway, Jaffe & Braunstein, 2005).
Kids who are unhappy with their weight may be more likely than average-weight kids to develop unhealthy dieting habits and eating disorders, such as anorexia nervosa and bulimia, and they may be more prone to depression, as well as substance abuse. Considering the health risks linked with obesity more attention is needed to prevent this epidemic, by providing maximum facilities and resources to healthcare providers and community participants.
In the view of WHO, fundamental causes behind the rising level of childhood obesity are a shift in diet towards increased intake of energy-dense foods that are high in fat and sugars but low in vitamins, minerals, and other healthy micronutrients, and a trend towards the decreased level of physical activity. (Global strategy on diet, physical activity, and health: Childhood overweight and obesity, 2008).
Eating patterns have been associated with overweight among pre-school children, and the increase in overweight among them has a major concern because obesity tends to track over time. Obesity and excess weight gain in children and young adults can be associated with the consumption of snacks containing fat and sodium, sugar-rich caloric beverages, and large portion-size fast foods. Children’s eating behavior, development of food preferences, and physical activity are developed from family settings, and parental tastes, feeding strategies adopted, and food made available to children play an important role in childhood overweight.
Over the past few decades in conjunction with children’s body weight increase their consumption of fast foods and soft drinks also has increased manifold. It is observed that consumption of food outside the home has considerably increased over the past three decades and there is also a marked increase in household spending on away-from-home foods. IOM Fact Sheet depicts that children and youth aged 11 to 18 years visit fast food outlets an average of twice a week, and those who ate fast food consumed more total calories and fat, sweetened beverages, and fewer fruits, vegetables, and milk than those who did not consume fast food.
“The proportion of foods that children consumed from restaurants and fast food outlets increased by nearly 300% between 1977 and 1996” and children’s soft drink consumption also increased during those years. (St-Ong, Keller & Heymsfield, 2003). It is hypothesized that the greater energy intakes in children who consume large amounts of soft drinks and fast foods are not compensated for by increased physical activity or decreased energy intakes. Since quick and easy seems to be the mindset of the many people in the new millennium, today’s busy families refrain from cooking nutritious meals at home and resort to fast food and prepackaged meals, which are rich in calories and large in portion size, but poor in vital nutrients essential for the healthy development of the human body.
In addition, many kids are spending less time exercising and more time in front of the TV, computer, or video game. Evaluation of a national sample of school-aged children revealed that “children who watched more television, ate fewer family meals, and lived in neighborhoods perceived by parents as less safe for outdoor play were more likely to be overweight.” (Gable, Chang & Krull, 2007).
Studies have shown that soft drink consumption is also associated with lower dietary intake of vitamin A and C, calcium, magnesium, and riboflavin, as well as an increase in calorie intake in children and adolescents. Investigation of data from the National Food Consumption Survey and the National Health and Nutrition Examination Surveys suggest increases in soft drink consumption and decrease in milk consumption among US children and adolescents because consumption of both regular and diet soda has become more of a social norm since 1996. (Blum et al, 2005). (O’Connor, Yang & Nicklas, 2006).
Lifestyle changes over the past few decades made children have reduced physical activity and increased caloric intake. Increased use of automated means of transportation, such as cars, elevators, and escalators, and reduced playtime and outdoor activities are major lifestyle changes that promote obesity. As per 2002 YMCLS (Youth Media Campaign Longitudinal Survey) Trends in Leisure time and Physical Activity of U.S Adults, “an estimated 61.5% of children aged 9 to 13 years do not participate in any organized physical activity during their non-school hours and 22.6% do not engage in any free-time physical activity (Table 1.). (Industry can play a role in preventing childhood obesity, 2004).
Although increased physical activity and healthy eating habits usually help reduce obesity, researchers warn that obesity is not always a behavioral issue. It is hypothesized that ‘under-nutrition in the womb may adversely affect a fetus’ metabolism—essentially training the child’s metabolism to conserve, rather than use, calories’. Based on a recent study, the “United Nations Food and Agricultural Organization suggests that reducing malnutrition in pregnant women could protect their children from developing obesity.” (Ridgway, Jaffe & Braunstein, 2005). Hence, along with reducing malnutrition in pregnant women lifestyle changes of children will go a long way in preventing obesity in children and adolescents.
Obesity affects body esteem
Overweight and obesity are major public health issues not only in the United States but also in all the developed and developing nations worldwide. A history of childhood overweight continuing into adulthood is linked to more severe complications in later life. Studies have shown that the early development of overweight leads to obesity in childhood, which has adverse effects on risk factors for cardiovascular and other chronic diseases.
In addition, it is reported that obese children demonstrate more negative self-perceptions, decreased self-worth, increased behavioral problems, lower self-esteem, and lower body esteem and perceived cognitive ability (French, et al, 1995; Braet, et al, 1997; Strandmeijer, et al, 2000; Davidson & Birch, 2001) Obese children with decreasing levels of self-esteem showed significantly elevated levels of loneliness, sadness, and nervousness. They are also more likely to engage in high-risk behaviors, such as smoking and alcohol consumption and studies establish that ‘early adolescence is a critical period for the development of self-esteem among obese boys and girls.’ (Strauss, 2000).
Obesity can have devastating psychosocial consequences, as recent studies have established that children and young adults who struggle with overweight and obesity tend to have a higher rate of depression and carry very severe psychological consequences and can be linked to numerous psychiatric disorders. Concerns about body dissatisfaction and low self-esteem in obese children and adolescents that center on their distance from societal body shape ideas and experiences of social marginalization, give an insight into the broader stigmatizing view of obesity.
Our society has a very negative view of overweight and obesity, and the public values and attitudes, commonly expressed by the media, often tell us that being obese is an extremely unattractive and undesirable state for an adolescent. Satisfaction of a person with his/her appearance is the domain of self-worth most affected by obesity, which is principally true for obese adolescents and young women. For them, the sense of identity is greatly dependent on appearance and is strongly associated with perceived overweight and depression.
The hostility towards fatness has been compared with other common social prejudices, because the obese body shape frequently gets teased and is labeled lazy, dirty, stupid, ugly, and least intelligent, and the fat is often socially isolated. The principal feature of being overweight is the stigmatization of bodily appearance and character as it is held that the obese are personally responsible for their own state and are blamed for their fatness Overweight act as an important determinant of social experience during adolescence as overweight adolescents receive less friendship nomination than lean peers, and are likely to be nominated as a friend.
The magnitude of association between weight and self-esteem has been shown to be stronger for girls than for boys, and the children’s perceived size was a better predictor of self-esteem than was actual body weight/
The high levels of body shape dissatisfaction and dieting in pre-adolescent and teenage girls is an indication and acceptance of their being overweight as unattractive, unhealthy, and least acceptable among peers. This may lead to depression and related self-esteem issues. A recent study has established that children and young adults who struggle with overweight and obesity tend to have a higher rate of depression and carry very severe psychological consequences and “chronic obesity was associated with psychopathology.”(Mustillo et al, 2003).
Several community surveys in the US and Canada have found an association between obesity and depressive symptoms, history of depression, and measures of psychological distress. Studies have also found that depression predicts the “subsequent onset of obesity “and vice-versa, and “successful weight loss is associated with decreased depression.” (Simon et al, 2006). Based on a nationally representative epidemiological sample, Simon et al (2006) conclude that obesity is positively associated with an increase in mood and anxiety disorders, and ‘variations across demographic groups suggested that social or cultural factors may moderate or mediate the association between obesity and mood disorder.’ (Simon et al, 2007).
Negative social and psychological ramifications of childhood obesity include: ‘being liked to a lesser extent by peers’, ‘being rejected by peers’, and ‘being the victims of various forms of peer aggression’ such as bullying. It is viewed that bullying and victimization by peers may hinder the social development of overweight and obese youth because adolescents are extremely reliant on peers for social support, identity, and self-esteem.
Examination of relationships between bullying behavior with overweight and obesity status in a large sample of 11- to 16-year old Canadian youths by Janssen et al (2004) indicates that overweight and obese boys and girls are more likely to be victims and perpetrators of verbal, physical, and relational bullying than their normal-weight peers. (Janssen. et al, 2004). It implies that overweight children are exposed to psychological stress and strain and concerted effort is needed for preventing the obesity epidemic for the healthy transition of adolescents into adulthood.
Teaching children self-regulation and impulse control, decision-making skills, social competence, and encouraging the reduction of sedentary behaviors will have positive results in their lifestyle. The readiness of the family to make lifestyle changes, including decreasing portion sizes, increasing the frequency of home cooking, decreasing the frequency of eating out, and promoting physical activity are important components in achieving the goal.
Obesity should be approached not as a clinical problem but as a public health problem, and harnessing and exploiting social network phenomenon to spread positive health behaviors will slow the swell of obesity because people’s perception of their own risk of illness depends on the people around them. Pediatric health care providers also have an important role in preventing obesity, since obesity is difficult to treat and early intervention is critical, by monitoring a child’s growth and development pediatricians could predict vulnerability and prevent further maladies.
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