As the world is going through both epidemiological and nutritional changes, it is affecting those who live in it. Children are the most vulnerable individuals and are highly impacted on the changes. Certain parts of the world have high deficiencies in growth stunt, anemia, iron, and zinc. In contrast, the other parts actually have a rise in obesity, diabetes and other chronic diseases that are related to nutrition. Both overweight and obesity in early childhood have an impact on not only physical but also the psychological health of a child. Obesity and a high percentage of children who are overweight has been a public health issue that is affected by many factors, the environment being a major one. It is a large public health concern for the simple reason that adolescent’s present and future health is at risk. Those who are obese and overweight during childhood will most likely remain obese into adulthood and are more susceptible to develop non-communicable diseases at a young age. “Obesity has reached epidemic levels in developed countries. The highest prevalence rates of childhood obesity have been observed in developed countries; however, its prevalence is increasing in developing countries as well” (Kanekar & Karnik, 2012). Therefore, the impact on children in both developed and those developing countries is more than just the food they eat. Childhood obesity is affected by many factors such as; genetic, behavioral and environmental.
What is childhood obesity?
Throughout the years, as the medical world keeps evolving, the definition of obesity and what is considered to be “overweight” has changed. According to Centers for Disease Control and Prevention, obesity and overweight in childhood is determined by body mass index. To be considered overweight, the BMI must be at or above the 85th percentile and below the 95th percentile. This is a measure for children and teens who have the same sex and age. Obesity is measured at a BMI to be at or above the 95th percentile. In order to calculate the body mass index, the weight of the individual must be in kilograms by the square of height in meters. When calculating the BMI, the sex and age must be taken into consideration. Unlike calculating an adult’ BMI with categories, BMI for children is different. This is due to the composition between bodies that vary with girls, boys, and their age. Throughout the world, the BMI categories in which the percentile falls into to determine overweight and obesity varies. The body fat mass index is a convenient way to measure an individuals body fat, but it is not the most accurate way. “In research, techniques include underwater weighing (densitometry), multi-frequency bioelectrical impedance analysis (BIA), and magnetic resonance imaging (MRI). In the clinical environment, techniques such as BMI, waist circumference, and skin-fold thickness have been used extensively” (Sahoo K et al., 2007). There are varies of ways to determine whether a child falls into either category. Using different methods, may not be as accurate or useful in children because their constant change of body shapes as they go through different growth. One of the downfalls in measuring BMI through diving weight and height is that it fails to distinguish between muscles and bone. Ethnicity is another factor in BMI. Just how different environments throughout the world, can effect calculating the BMI. Childhood obesity is an epidemic throughout the world. In America it affects millions of people. “The obesity epidemic in the U.S., which affects about 10.4% of children between 2 years and 5 years of age and more than 23 million children and teens in total, is estimated to cost our nation $117 billion per year in direct medical expenses and indirect costs, like lost productivity, according to the Robert Wood Johnson Foundation. That total is for one nation for one year. Taking into account the lifetime cost for each obese child, the global effect of the obesity epidemic is staggering” (Lorenzetti, 2016). Obesity is not only putting adolescents lives t risk, but costing them thousands of dollars. It is a major concern being a public health issues but also being largely impacted by the environment.
What is the cause of childhood obesity? Obesity being a public health concern for both adults and children, it is now widely accepted that those results occur from an imbalance that is between both, energy intake and expenditure. However, evidence shows that an individuals genetic background plays an important role and also can be a determining factor. The ecological model suggests that a child’s risk factor for obesity include three of the following; dietary intake, physical activity, and sedentary behavior. Furthermore, those three listed are not the only ones. Family characteristic parenting style and own lifestyle also play a role in a child being obese or overweight. “Genetics are one of the biggest factors examined as a cause of obesity. Some studies have found that BMI is 25–40% heritable. However, genetic susceptibility often needs to be coupled with contributing environmental and behavioral factors in order to affect weight” (Sahoo, K., Sahoo, B., Choudhury, Sofi, Kumar, R., & Bhadoria, 2015). Often, genes are blamed for many health issues that individual get diagnosed with. However, genetic factor accounts for less than 5% of cases in children being obese. That being said, genetics may play a role in developing obesity but it is not the cause of the increase percentage of childhood obesity. The second possible cause of obesity is basal metabolic rate as studies shown. It is defined as the body’s expenditure of energy for normal resting rate. This rate is accountable for 60% of the individual’s total energy expenditure. Studies shown that those who are obese and overweight have a lower rate than those who fall into the normal category. “Review of the literature investigates factors behind poor diet and offers numerous insights into how parental factors may impact on obesity in children” (Sahoo, K., Sahoo, B., Choudhury, Sofi, Kumar, R., & Bhadoria, 2015). Children being vulnerable and learning individuals they often learn by modeling their parents and peers. If the parents are not in-taking proper nutritional foods, most likely children will mirror their actions. Parents are encouraged to try to consume healthier food and try alternative healthier options will influence children to make those choices as well.
Behavioral factor and Obesity. Being that obesity quickly became a public health concern worldwide, it is also associated with other health risks and comorbid conditions. “During the years between 1980 and 2008, the international prevalence of obesity has increased twofold. In 1980, 5% of men and 8% of women were obese, according to the body mass index (BMI) reference of ≥30 kg/m2. Almost three decades later, 10% of men and 14% of women presented with obesity” (Affenito, Franko, Striegel-Moore, & Thompson. 2012). Unfortunately, years later not much has changed. It is documented that more than half a billion of adults worldwide are obese. In children, obesity is increasing just at a quick rate as well. During the 90s 4.2% of children had fallen into the category of both overweight and obese, this percentage had increased in the year 2010 to almost 7%. By the year 2020, it is estimated that the percentage will increase to 9% equaling to 60 million children being overweight or obese worldwide. Considering that an individual’s adulthood is at risk with health related conditions and psychological effects. “Understanding the determinants of obesity is crucial for informing and developing effective prevention efforts, which should be based on a scientific understanding of the multiple and complex risk factors for obesity” (Affenito, Franko, Striegel-Moore, & Thompson. 2012). There are factors that are determinants of obesity from different contexts and the interactions between multiple factors that lead to obesity are not yet understood.
In the ecological approach of obesity in children on the behavioral factors are associated with both dietary intake and physical activity with consideration of the environments in which can affect the health of an individual. Studies show that successful models that address obesity have examined individual’s behaviors and the environment with the goal that changing or altering the environment through public health strategies will be promoted in healthful eating and physical activity. “The ecological model of obesity has been described as “multilevel (e.g., regions, nations, states, cities, and neighborhoods),” taking into consideration the “multistructural components (e.g., physical environment, socio-economic status, and social capital)” and “multifactorial lifestyle behaviours (e.g., diet, physical activity, and stress)” at “multi-institutional (e.g., school, local government, family, and local agency)” levels” (Affenito, Franko, Striegel-Moore, & Thompson. 2012). The approach being ecological accounts for the interrelationships amongst all of the components that negatively influence weight and are behavioral factors. In research the behavior influences on obesity shown that certain behaviors may contribute to weight gain by overeating or reducing the amount of physical activity. In which, these mechanisms are affected by the environment and can affect the overall health of an individual. There are many behaviors that are obesity-promoting but commonly they include fast food consumption, eating away from home, consuming large portions, beverages that contain high sugar levels and not eating breakfast. “In addition to these behavioural factors, multistructural variables such as the physical environment and socioeconomic status have been shown to have a significant influence on food intake and energy expenditure” (Cutler, Flood, Hannan, Neumark-Sztainer, (2011). The proximity of supermarkets, fast food restaurants availability in a given area are an influence on dietary behaviors and the amount of physical activity an individual, especially an adolescent may be involved in. Behavior patterns are affected if action is taken. An adolescent is only responsible as much as the parent. The importance is in the children’s home environment and the nutrient intake. In the future studies need to be designed to study the interactions among behavioral and environmental risk factors for obesity in order to have larger prevention efforts and intervention programs to reduce the risk of prolonging obesity and overweight adolescents.