Journal of Pediatric Nursing
Volume 23, Issue 1 , Pages 1-4, February 2008

Global Childhood Obesity: How to Curb an Epidemic

Article Outline

 

I WOULD LIKE to devote this editorial to global childhood obesity: What do we know about it and, more importantly, what can we do about it. The World Health Organization (WHO) defines overweight as a body mass index (BMI) of ≥25 kg/m2 and obesity as a BMI of 30 kg/m2 (WHO, 2007). The BMI is being used to track the prevalence of obesity throughout the world, as well as the risk factors associated with specific BMIs (James, Leach, Kalamara, & Shayeghi, 2001). The incidence of type 2 diabetes, for example, steeply rises as BMI increases. Type 2 diabetes used to be a disease of older adults, but obese children are developing this disease before puberty. There are some concerns that obese children may be at risk for other adult diseases, such as myocardial infarction (Ebbeling, Pawlak, & Ludwig, 2002).

According to WHO, throughout the world, approximately 22 million children less than 5 years of age are considered overweight. In the United States, the number of overweight children has doubled, and the number of overweight adolescents has tripled over the past 20 years. These trends are global: Increasing childhood overweight and obesity rates are present in most industrialized nations and in many developing countries (WHO, 2007).

Although the statistics are alarming, this may be a particularly opportune time to raise public awareness of the global obesity epidemic. Currently, nations throughout the world are recognizing the importance of acting together to address ecological shifts and serious climate change that threaten our planet's existence. Campaigns are underway throughout the world to adopt environmentally friendly interventions at local, national, and international levels. “Green” words are surfacing in our vocabulary on a daily basis, and people everywhere are making efforts to exchange polluting habits with conservationwise behaviors, such as recycling and the use of energy-efficient appliances and vehicles. People's lifestyle choices are often voluntary, but countries throughout the world are developing and enforcing policies to protect the environment. It is a good time, therefore, to create parallel actions, locally and globally, to address the global obesity epidemic that is plaguing the quality of life for millions of adults and children.

Research suggests that the best way to tackle the obesity epidemic may be via environmental change. Although genetics may predispose some individuals to obesity, the epidemic proportions of obesity indicate that environment plays a significant role (Ebbeling et al., 2002, World Health Organization, 2007). According to the Institute of Medicine (1995), “the root of the problem must lie in the social and cultural forces that promote an energy-rich diet and a sedentary lifestyle” (p. 152). The term toxic environment is being used to describe environments where people have increased access to high-energy foods and decreased physical activity incentives (Wadden, Foster, & Brownell, 2002). The rise of obesity indicates the prevalence of toxic environments. In the United States, many schools are considered toxic environments for children. In some school settings, physical education opportunities are unavailable, whereas the cafeterias offer poor food choices and candy and soft drink vending machines are on site (Wadden et al., 2002). One study conducted with children from Mexico City found that obesity risk decreased by 10% for each hour per day of moderate to vigorous exercise, whereas risk increased by 12% for each hour per day of television (TV) time (Hernandez et al., 1999). TV time is a triple toxic threat: It displaces physical activity; it exposes children to numerous food commercials; and children tend to consume more high-energy foods when they are watching TV (Epstein, Paluch, Consalvi, Riordan, & Scholl, 2002).

Alarming worldwide obesity trends may be due to global spread of Western lifestyles (Deckelbaum & Williams, 2001, World Health Organization, 2007). Throughout the world, children are being increasingly exposed to cheap processed foods that contain large amounts of fats and sugars. Processed foods are readily available, heavily marketed, and packaged or sold as large portions. Westernization is also associated with increased automated transportation and increased, passive leisure time pursuits, including TV and computer gaming (WHO, 2007).

The family environment can make a difference. The risk of obesity is higher for children when at least one parent is overweight. This is especially true for children less than 10 years of age (Whitaker, Wright, Pope, Siedel, & Dietz, 1998). Parental support for physical activity can increase children's involvement (Sallis, Procashka, & Taylor, 2000). Eating meals together as a family may decrease hours of TV viewing and increase nutritious food consumption (Gillman et al., 2000, Wiecha et al., 2001). In the United States, there have been increasing trends of families eating out. Children consume more energy-dense foods in greater amounts when they eat out compared with when they eat at home. In the 1970s, American children ate out 17% of the time, and only 2% of their total diet was composed of fast food. Since the 1990s, the rate of eating out has doubled to 30%, and there has been a fivefold increase in fast-food consumption: 10% of children's total energy intake (Lin, Guthrie, & Frazao, 2001). Given these connections between family factors and the potential toxicity of the child's home environment, it is no surprise that other risk factors for childhood obesity include neglect and associated social–emotional problems (Ebbeling et al., 2002).

Prevention is critical, especially at an early age. After the first 5 years of life, there is an increased probability that obese children will go on to become obese adults. The older the child, the greater the risk of obesity continuing into adulthood (Power, Lake, & Cole, 1997). Preventive environmental measures, particularly in homes and schools, need to be in place—now. Prevention is especially important, because the research is mixed with respect to sustainable outcomes resulting from weight loss and weight maintenance behavior change programs. There are equivocal findings for family-based interventions and school-based behavioral change programs. This may be due to toxic environmental factors that constantly bombard children and their families. In the United States, for instance, a typical American child is exposed to 10,000 TV food advertisements per year, and most of these advertisements promote candy, sugared cereals, soft drinks, and fast food (Horgen, Choate, & Brownell, 2001). Additive and persistent “toxins” may be capable of overpowering modest outcomes achieved through behavioral change programs (Ebbeling et al., 2002 ). It is very important, however, to intervene with behavior change programs as early as possible. There is evidence that early intervention can increase children's preference for healthy foods (Birch, 1999). Motivation is another critical success component. Earlier research conducted by Epstein, Valoski, Wing, and McCurley (1990) indicated that behavior change programs for children were able to maintain significant weight loss after 10 years for both overweight and obese children. These programs were based on selective recruitment of children and their families who were motivated to change. Sustainable results were less successful for obese adolescents, again emphasizing the importance of early intervention.

Barlow and Dietz (1998) cautioned that behavior change programs should not be undertaken unless the child and family are ready for change. Harm may result from interventions that lack commitment. This is also true for health care professionals who care for overweight and obese children, “…overweight children and their families often feel embarrassed and ashamed. Clinicians who care for these families must treat them with sensitivity, compassion, and a conviction that obesity is an important, chronic medical problem that can be treated” (Barlow & Dietz, 1998, p. 2).

Obesity is a chronic disease, and it requires the same care and consideration as do other chronic diseases. This means that it is a lifetime endeavor: achieving and maintaining a healthier weight. Professionals who care for obese children and adults are discovering that ideal weight goals are often unrealistic and discouraging. It is important to take small steps, such as modest changes in food choices and exercise that sustain weight loss and weight maintenance behavior (Barlow & Dietz, 1998). A United States-based expert committee on childhood obesity recommended that the first step in weight control for overweight children older than 2 years should be maintenance of baseline weight. “The experience of the committee members suggests that a child can achieve this goal through modest changes in diet and activity. Initial success can be the foundation for future change” (Barlow & Dietz, 1998, p. 6). The expert committee also concluded that success depends on successful collaborations between health care professionals, families, and children.

As mentioned, external toxins, such as TV ads and lack of physical education opportunities in schools, can erode the best efforts of families and children. A vital prevention strategy is effective policy, such as policy that regulates food advertising directed at children. Wadden et al. (2002) suggest that banning food commercials is one potential strategy, but they also suggest the possibility of equal TV time for pronutrition commercials. Another prevention or intervention strategy is to seek funding through government agencies and nonprofit organizations to increase physical activity opportunities for children. The U.S. Department of Agriculture Forest Service (2007), for instance, recently launched its “Kids in the Woods” program. There are programs around the United States that receive funding through the Forest Service. Many of these programs are diverse collaborations between schools, businesses, nonprofit organizations, and the government. The Nature Field Work Partnership in New York City is designed to expose inner-city children to forests and wetlands in the area. Children participate in restoration projects that get them outside and teach them about care for the environment.

It will take all of us to diminish and hopefully halt the obesity epidemic. Awareness of the problem is the first step. The green environment has been a centerpiece in the news. Now, we need to recognize that toxic environments also include those environments that pollute children with slick advertising, junk food, and games they can play for hours with minimal physical exertion. What can nurses do? Within the United States, the Childhood Obesity Action Network (COAN) has an online implementation guide at www.nichq.org/obesityactionnetwork. The implementation guide is composed of specific action steps based on experts' recommendations. The guide includes network tips and tools for childhood obesity prevention and intervention. This action network represents numerous health care organizations and health professionals. Interested individuals can join COAN through free online registration at the site (above). COAN membership connects professionals who are dedicated to improving the care of overweight and obese children.

The Society of Pediatric Nurses (SPN), our official organization, has also taken a stand against the childhood obesity epidemic. SPN's president recently issued a message describing how pediatric nurses can assist children and their families with curbing obesity risk factors through lifestyle education and counseling. Her message also emphasizes the importance of using online resources, such as COAN and its parent organization, the National Initiative for Children's Health Care Quality (Mott, 2007). The SPN Web site is home to a variety of valuable resources, such as its Position Statement on Overweight Children and Adolescents (SPN, 2007). This position statement affirms that as pediatric nurses, our professional accountability includes the screening and identification of overweight children and adolescents.

I would like to end with a quotation from an article by James et al. (2001): “As the epidemic of childhood obesity emerges throughout the globe, we can confidently predict that the health impact of excess weight gain will be amplified in the years to come” (p. 232S). The time is now to prevent another type of environmental crisis, an obesity crisis, by detoxifying children's daily lives with the tools and resources we have at our disposal, including the knowledge and skills we possess as professional pediatric nurses.

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References 

  1. Barlow S, Dietz W. Obesity evaluation and treatment: Expert committee recommendations. Pediatrics. 1998;102:1–11
  2. Birch L. Development of food preferences. Annual Review of Nutrition. 1999;19:42–62
  3. Deckelbaum R, Williams C. Childhood obesity: The health issue. Obesity Research. 2001;9(Suppl 4):239S–243S
  4. Ebbeling C, Pawlak D, Ludwig D. Childhood obesity: Public-health crisis, common sense cure. The Lancet. 2002;360:473–482
  5. Epstein L, Paluch R, Consalvi A, Riordan K, Scholl T. Effects of manipulating sedentary behavior on physical activity with food intake. Journal of Pediatrics. 2002;140:334–339
  6. Epstein L, Valoski A, Wing R, McCurley J. Ten-year follow-up of behavioral, family-based treatment for obese children. Journal of the American Medical Association. 1990;264:2519–2523
  7. Gillman M, Rifas-Shiman S, Frazier A, Rockett H, Camargo C, Field A, et al. Family dinner and diet quality among older children and adolescents. Archives in Family Medicine. 2000;9:235–240
  8. Hernandez B, Gortmaker S, Colditz G, Peterson K, Laird N, Parra-Cabrera S. Association of obesity with physical activity, television programs and other forms of video viewing among children in Mexico City. International Journal of Obesity. 1999;23:845–854
  9. Horgen K, Choate M, Brownell K. Television and children's nutrition. In:  Singer D,  Spinger J editor. Handbook of children and the media. San Francisco: Sage; 2001;p. 447–461
  10. Institute of Medicine . Weighing the options: Criteria for evaluating weight management programs. Washington, DC: National Academy Press; 1995;
  11. James P, Leach R, Kalamara E, Shayeghi M. The worldwide obesity epidemic. Obesity Research. 2001;9(Suppl 4):228S–233S
  12. Lin B, Guthrie J, Frazao E. American children's diets not making the grade. Food Review. 2001;24:8–17
  13. Mott S. President's message. Retrieved November 6, 2007, from https://www.pedsnurses.org2007;
  14. Power C, Lake J, Cole T. Measurement and long-term health risks of child and adolescent fatness. International Journal of Obesity and Related Metabolic Disorders. 1997;21:507–526
  15. Sallis J, Prochaska J, Taylor W. A review of correlates of physical activity of children and adolescents. Medicine& Science in Sports & Exercise. 2000;32:963–975
  16. Society of Pediatric Nurses . Position statement on overweight children and adolescents. Retrieved on November 6, 2007, from http://www.pedsnurses.org2007;
  17. U.S. Department of Agriculture Forest Service . Kids in the Woods program. Retrieved on November 6, 2007, from http://www.fs.fed.us/recreation/programs/woods/index.shtml2007;
  18. Wadden T, Foster G, Brownell K. Obesity: Responding to the global epidemic. Journal of Consulting and Clinical Psychology. 2002;70:510–525
  19. World Health Organization . Global strategy on diet, physical activity and health. Retrieved on November 6, 2007, from http://www.who.int/dietphysicalactivity/publications/facts/obesity/en/2007;
  20. Whitaker R, Pepe M, Wright J, Seidel K, Dietz W. Early adiposity rebound and the risk of adult obesity. Pediatrics. 1998;101:e5
  21. Wiecha J, Sobol A, Peterson K, Gortmaker S. Household television access: Associations with screen time, reading, and home work among youth. Ambulatory Pediatrics. 2001;1:244–251

PII: S0882-5963(07)00417-4

doi:10.1016/j.pedn.2007.11.004

Journal of Pediatric Nursing
Volume 23, Issue 1 , Pages 1-4, February 2008

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