Childhood Obesity

Childhood Obesity: The New Epidemic Page 1

Childhood Obesity: The New Epidemic

PHC 618

Yvonne Ritchie

Everglades University

November 7, 2015


Abstract

The rise of obesity in the United States is alarming. The question is do we start with the adult obesity first to conquer the epidemic? If obesity is in the children who are more likely to become obese adults, should we learn what is causing the epidemic in them first? Childhood obesity affects children during their learning years. If can combat the epidemic during the child’s informative years and teach them how to combat it then we can combat the adulthood obesity and the diseases that it causes. As an industrialized country with the so many natural resources and the newest technology at our disposal, how are we becoming so ill from being overweight? In the United States, there are approximately 12.7 million children and 78.6 million adults that are overweight. The United States ranks ninth globally among non-industrialized and industrialized countries and are ranked number one among the industrialized countries.


Discussion

Obesity has been on the rise for the past thirty years in the United States. This is an epidemic that is causing other diseases to rise in numbers. “In the United States, we have approximately 78.6 million adults and 12.7 million children that are overweight or obese.” (cdc.gov). “The United States is ranked 9th globally among non-industrialized and industrialized countries. The United States is ranked number one among the industrialized countries.” (who.org). “Today, Approximately 1 in 3 adults (34%) and 1 in 6 children and adolescents (16.2%) are obese. Obesity – related conditions include heart disease, stroke, and Type 2 diabetes, which are among the leading causes of death.” (HealthyPeople.gov). Are the prevention programs that the United States implemented enough to stop this epidemic? This study will look at the programs for prevention of obesity that the United States has already implemented.

Obesity is defined as a person having body mass index (BMI) greater than 30 kg/m2. Extreme obesity is defined as a person having a BMI greater than 40 kg/m2. Obesity is “rapidly becoming the leading cause of preventable death in the United States, with obesity- related deaths projected to soon surpass deaths related to tobacco abuse.” (Hurt). “In analysis of the leading causes of global mortality and burden of disease, obesity, and being overweight were among the ten causes for each.” (Hurt). The Expert Committee of the American Medical Association recently concluded that there is strong evidence that eating away from home, specifically consumption of fast foods is a risk for childhood obesity.”(Hurt). The restaurants have increased their portion sizes in the past twenty years. The NIH has defined portion “as the amount of food that you choose to eat for a meal or snack.” (nhibi.nih.gov). the restaurant size portion is enough to feed 2 or 3 servings per plate. The NIH has defined servings “as the measured amount of food or drink.” (nhibi.nih.gov). Here are a few examples that the NIH has charted which shows the increased calorie intake.

Comparison of Portions and Calories 20 Years Ago to Present Day

20 Years Ago Today

Portion Calories Portion Calories

Bagel 3'' diameter 140 6'' diameter 350

Cheeseburger 1 333 1 590

Spaghetti w/meatballs

1 cup sauce3 small meatballs

500 2 cups sauce3 large meatballs

1,020

Soda 6.5 ounces 82 20 ounces 250

Blueberry muffin

1.5 ounces 210 5 ounces 500


The CDC has noted the effects on childhood obesity may lead to the following health problems:

Heart disease caused by high cholesterol or high blood pressure Type 2 Diabetes Asthma Sleep Apnea Social Discrimination Hepatic Steatosis.

“In a population based sample of 5 – to 17 – year olds, almost 60% of overweight children had at least one CVD risk factor while 25% of children had two or more CVD risk factors.”(cdc.gov). “Type 2 Diabetes has begun to emerge as a health – related problem among children and adolescents. The onset of diabetes in children and adolescents can result in advanced complications such as CVD and Kidney failure.” (cdc.gov).

The Healthy People with the help of the CDC has shown the following prevalence of obesity in the states and the United States territories. These numbers are alarming to the health care providers wondering how they can help bring the numbers down and what is causing the numbers to be raising.

No state had a prevalence of obesity less than 20%. 5 states and the District of Columbia had a prevalence of obesity between

20% and <25%. 23 states, Guam and Puerto Rico had a prevalence of obesity between

25% and <30%. 19 states had a prevalence of obesity between 30% and <35%. 3 states (Arkansas, Mississippi and West Virginia) had a prevalence of

obesity of 35% or greater. The Midwest had the highest prevalence of obesity (30.7%), followed by

the South (30.6%), the Northeast (27.3%), and the West (25.7%).

Prevalence¶ of Self-Reported Obesity Among U.S. Adults by State and Territory, BRFSS, 2014

¶Prevalence estimates reflect BRFSS methodological changes started in 2011. These estimates should not be compared to prevalence estimates before 2011.

Source: Behavorial Risk Factor Surveillance System, CDC.


*Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥ 30%.

Source: Behavorial Risk Factor Surveillance System, CDC.

*Sample size <50 or the relative standard error (dividing the standard error by the prevalence) ≥

30%.


CDC Tables

2013: Percent of students in grades 9-12 who are obese†

Location Type Location Value 95% CI Sample Size

National National 13.7 (12.6-14.9) 12,580

States

Alabama 17.1 (14.6-19.9) 1,499

Alaska 12.4 (10.5-14.6) 1,167

Arizona 10.7 (8.3-13.6) 1,520


Arkansas 17.8 (15.7-20.1) 1,470

Connecticut 12.3 (10.2-14.7) 2,270

Delaware 14.2 (12.9-15.6) 2,475

Florida 11.6 (10.5-12.8) 5,491

Georgia 12.7 (11.1-14.4) 1,898

Hawaii 13.4 (11.6-15.4) 4,405

Idaho 9.6 (8.2-11.1) 1,841

Illinois 11.5 (9.8-13.4) 3,046

Kansas 12.6 (10.6-14.8) 1,899

Kentucky 18.0 (15.7-20.6) 1,537

Louisiana 13.5 (11.0-16.4) 1,034

Maine 11.6 (10.2-13.3) 8,079

Maryland 11.0 (10.6-11.4) 49,231

Massachusetts 10.2 (8.5-12.1) 2,547

Michigan 13.0 (11.4-14.9) 4,110

Mississippi 15.4 (13.1-17.9) 1,446

Missouri 14.9 (12.3-17.8) 1,539

Montana 9.4 (8.4-10.5) 4,679

Nebraska 12.7 (10.9-14.8) 1,827

Nevada 11.4 (9.6-13.6) 2,047

New Hampshire 11.2 (9.7-13.0) 1,544

New Jersey 8.7 (6.8-11.2) 1,644

New Mexico 12.6 (10.4-15.2) 5,146

New York 10.6 (9.6-11.7) 9,493

North Carolina 12.5 (10.8-14.5) 1,770

North Dakota 13.5 (11.8-15.3) 1,931

Ohio 13.0 (10.8-15.5) 1,404

Oklahoma 11.8 (10.0-14.0) 1,333


Rhode Island 10.7 (9.5-12.0) 2,304

South Carolina 13.9 (11.6-16.5) 1,555

South Dakota 11.9 (9.8-14.4) 1,272

Tennessee 16.9 (15.1-18.8) 1,831

Texas 15.7 (13.9-17.6) 3,039

Utah 6.4 (4.8-8.5) 2,136

Vermont 13.2 (11.3-15.4) 5,853

Virginia 12.0 (10.8-13.4) 6,483

West Virginia 15.6 (13.5-18.0) 1,561

Wisconsin 11.6 (9.7-13.9) 2,771

Wyoming 10.7 (9.4-12.2) 2,910Footnotes†Obese is defined as body mass index (BMI)-for-age and sex ≥ 95th percentile based on the 2000 CDC growth chart; BMI was calculated from self-reported weight and height (weight [kg]/ height [m²]).NotesNational estimates from the national YRBSS survey. State estimates from the state YRBSS survey. State estimates are not available when the state does not participate in the survey, the state does not ask the question, or the state does not achieve a sufficient response rate to weight the data.Data SourceYouth Risk Behavior Surveillance SystemSuggested CitationNutrition, Physical Activity and Obesity Data, Trends and Maps web site. U.S. Department of Health and Human Services, Centers for Disease Control and Prevention (CDC), National Center for Chronic Disease Prevention and Health Promotion, Division of Nutrition, Physical Activity and Obesity, Atlanta, GA, 2015. Available at http://www.cdc.gov/nccdphp/DNPAO/index.html.

There are psychological stress that overweight or obese children and adolescents also have a risk in having. They can develop low self – esteem which may interfere with their education, social development, and social functioning. They are often bullied by their peers. They may carry this low self – esteem into adulthood.

There are contributing factors that children are facing today. The healthier generation campaign has listed 5 factors:

“Television and media: screen time is a major factor; marketing of unhealthy foods: high in calories, sugars, salt, and fat and low nutrients

Limited access to healthy affordable foods: some people have less access to stores and supermarkets especially in rural, low income neighborhoods, and communities of color

Lack of daily physical activity Increased portion sizes


Higher consumption of sugary beverages.” (healthiergeneration.org).Considering that children have more access to video games and computers nowadays, they have more stationary play time compare to the children of the 1970s and 1980s. The food corporations played into this television time with creating the advertisements directed at the children and adolescents. The children see the ads and persuade the parents into buying the product. The food companies add the low – fat, low sugar, and no high fructose corn syrup onto the labels fooling the consumers especially if the consumers do not understand how to read the labels. The sugary beverages include many fruit juices and flavored water.

The people are afraid of diets or just basically the word “diet.” “Diet reflects the variety of foods and beverages consumed over time and in settings such as worksites, schools, restaurants, and the home.” (healthypeople.gov). The individuals need to have the knowledge and the skills to make healthier choices in their diet. There are social factors that play into influencing the individual’s diet:

Knowledge and attitude Skill Social support Societal and cultural norms Food assistance programs Economic pricing systems

Individuals need to change the belief that dieting is bad. The individual needs to understand that it is a lifestyle choice of being healthier. The individual needs to be educated that any food that is bought prepackaged and prepared can be made at home with fresh ingredients and less fat, chemicals, and sugar. Society needs to brace that it is okay for children and adolescents to eat more vegetables and fruits than a snack cake. The parents need to be educated how to cook a meal instead of popping a prepared meal into the microwave or stopping by that fast food restaurant. Individuals need to get support from their families and friends. The parents need to be changing the whole family lifestyle instead of that child facing it alone.

The economic price systems need to adjust the pricing to be more affordable. When an individual is trying to afford food on a tight budget, it is hard to get all the recommended nutrients. It is easier on the wallet when they can clip coupons and get special buys on the low nutrient junk foods. Many individuals are living in what are considered food deserts. These are low income areas that do not have grocery stores where the residents can go to shop for fresh foods. The grocery stores closed up because they could not afford to stay open in these areas. “The Congress in the Food, Conservation, and Energy Act of 2008 directed the USDA to conduct a 1 year study to assess the extent of the problem of limited access, identifying characteristics and causes, consider the effects of limited access on local populations, and outline recommendations to address the problem. The USDA findings on the access to a supermarket or grocery store is a problem for a small percentage of households. They found 3 pieces of evidence to corroborate this conclusions:

2.3 million (2.2%) of all households live more than a mile from a supermarket and do not have access to a vehicle. Additional 3.4 million (3.2%) of all households live between half a mile to 1 mile and do not have access to a vehicle.

Area based measures of access show that 23.5 million people live in low income areas (areas where more than 40% of the population has income at or below 200 percent of Federal poverty thresholds)


that are more than 1 mile from a supermarket or large grocery store. However, not all of these 23.5 million people have low income. If estimates are restricted to consider only low – income people in low – income areas, then 11.5 million people or 4.1 % of the total population, live in low income areas more than 1 mile from supermarket.

Data on time use and travel show that people living in low – income areas with limited access spend significantly more time (19.5 minutes) traveling to a grocery store than the national average ( 15 minutes). However, 93% of those people who live in low income areas with limited access traveled to the grocery store in a vehicle they or another household member drove.

There is a key concern for people who live in these areas with limited access is that they rely on small grocery stores or convenience stores. If they do carry healthy foods, then it is at higher prices. People in low income households’ shop where food prices are lower when they can. The data on SNAP benefit redemptions from 2008 show that 86 percent of SNAP benefits were redeemed at supermarkets or large grocery stores. The same data show participants who did not shop at supermarkets purchased less non-canned fruit, non-canned vegetables, and milk than SNAP participants who shopped frequently at a supermarket.” (USDA.gov).These areas only have convenience stores that only carry packaged foods, high sugary foods and beverages, and few fresh items. The following table provided by HealthyPeople.com shows us what state has a problem with obesity and low income children.

2011: Percent of low-income children aged 2 to less than 5 years who are obese†

Location Type Location Value Sample Size

National National 14.4 3,480,880

States

Alabama 14.2 67,403

Arizona 14.5 86,763

Arkansas 14.2 42,626

California 16.8 262,637

Colorado 10.0 27,529

Connecticut 15.9 27,793

District of Columbia 13.2 6,978

Florida 13.2 241,168

Georgia 13.2 138,941

Hawaii 9.2 17,879


Idaho 11.5 22,272

Illinois 14.8 133,471

Indiana 14.3 73,424

Iowa 14.5 34,420

Kansas 12.8 37,523

Kentucky 15.5 33,224

Louisiana 12.7 53,803

Maryland 15.4 65,020

Massachusetts 16.4 61,551

Michigan 13.3 116,006

Minnesota 12.7 70,589

Mississippi 14.0 47,872

Missouri 12.9 67,853

Montana 11.7 10,720

Nebraska 14.3 22,201

Nevada 12.8 33,582

New Hampshire 14.6 8,249

New Jersey 16.5 78,420

New Mexico 11.4 30,345

New York 14.4 230,903

North Carolina 15.4 103,874

North Dakota 13.2 6,693

Ohio 12.4 121,932

Oregon 14.9 54,316

Pennsylvania 12.3 120,182

Rhode Island 16.6 12,697

South Dakota 15.3 10,351

Tennessee 14.3 69,662


Texas 14.9 447,015

Utah 9.0 23,235

Vermont 12.9 6,179

Virginia 15.6 58,833

Washington 14.1 106,647

West Virginia 14.0 22,653

Wisconsin 14.0 58,885

TerritoriesPuerto Rico 18.0 89,879

Virgin Islands 11.1 2,578

Tribes

Cheyenne River Sioux Tribe-SD 20.7 406

Choctaw-MS 21.2 471

Inter Tribal Council of Arizona 24.0 6,146

Navajo Nation 18.4 5,749

Rosebud Sioux Tribe–SD 22.5 710

Standing Rock Sioux Tribe–ND 23.0 465

Three Affiliated Tribes–ND 31.8 157Footnotes†Obese is defined as body mass index (BMI)-for-age and sex ≥ 95th percentile based on the 2000 CDC growth chart; BMI was calculated from measured weight and height (weight [kg]/ height [m²]). Subjects with unknown or errors in their record were excluded.^Data not available because sample size is insufficient or data not reported.NotesLow-income is defined as U.S. children who attend federally-funded maternal and child health and nutrition programs, including the Special Supplemental Nutrition Program for Women, Infants, and Children (WIC), Early and Periodic Screening, Diagnosis, and Title V Maternal and Child Health (MCH) Program.National includes all contributors in a given year. Contributors can change from year to year. Estimates for states, tribes, or territories are not available in a given year if the group did not participate in the system, did not ask the relevant question, or the sample size is not sufficient in that year.2004-2011 trends by race/ethnicity are affected by the juncture at which contributors implemented the 1997 Office of Management and Budget standards for race/ethnicity data collection and reporting. These standards permitted the reporting of multiple races for the first time and affected how ethnicity data (Hispanic/non-Hispanic) were reported.

Besides changing the individual’s idea about diets and foods, we need to change the idea of exercise. Exercise plays an important role in changing the lifestyle of people in general. We need the parents to go and be active with their child/children with no television or computer screen involved. We need to let the parents know that job, housework, friends, or checking social media or email can wait until after 30 minutes of physical activity and dinner time with the


family. “Probably the most important role for exercise and increased physical activity in individuals with obesity is the recidivism after weight loss from dieting and the maintenance of lean body mass is reduced.” (Hurt). Individuals need to learn and understand that obesity can be changed by lifestyle choices. The lifestyle choices are choices that stay with a person, but often diets only last until the individual hits the desired weight and starts feeling better, or when the person gives up due to no social support, hits a level spot, and/or gets tired of it.

Individuals need to learn “what constitutes good nutrition as opposed to harmful food choices is often not clearly understood by the general public.” (Hurt). “The current food rich environment, in which unhealthy choices are readily available, makes achieving and maintaining the goal of eating healthily difficult.” (Allom). In the cities and towns, there are fast food or diners next to the schools. The adolescents have to fall into peer pressure of buying that value meal of cheeseburger and fries instead of buying that salad. It is cheaper for the person to get a value meal compared to that salad. “The accessibility of food and the presence of cues in the environment, such as the sight, smell and palatability of food has been found powerfully influence eating behavior.” (Allom). The easy access to all food rather than the lack of access to specific healthy foods, may be more important factor in explaining the increase in obesity. The key factor here is the environment. “In the last 20 years, the percentage of calories attributable to fast food consumption has increased from 3% to 12% of total calories consumed in the United States.” (Block). The amount of spending in the United States on fast foods has risen from $6 billion to $110 billion over the last 30 years. Even though there has been a decrease in the fat content (as a percentage of total calories) of the average American’s diet, Americans are consuming more calories. “The USDA reported an increase in the average daily food energy intake from 1,854 calories to 2,002 calories between 1977 – 1978 and 1994 – 1996. In 1995, “away – from – home” foods provided 34 % of total caloric intake and 38 % of total fat intake compared to 18 % comparison for both categories in 1977 – 1978. Fast food is a major component of the “away – from – home” category, accounting for 12 % of total caloric intake for Americans in 1995 compared to only 3 % in 1977 – 1978.” (Block).The smell of cooked meat and French fries over power the smell of fresh fruits and vegetables. We eat with our eyes and noise before our mouth. The healthier foods need to be more pleasing to our senses over the bad foods.

The learning behavior of choosing the healthier choices are taught at young ages. The young children who help the parents in the kitchen are often the adolescents who chooses the healthier foods. Children are easier to adapt to learning new ideas than adolescents and adults. Children like to play in the dirt and food, so it is easier to teach them about planting the herbs, vegetables, and fruit trees while teaching them how to make a fresh salad or entrée of vegetables that appeal to their eyes. If the children learn where the types of foods come from and how to prepare it to be healthy, we teaching them a lifetime skill and a healthy lifestyle at the same time that will last their lifespan.

Obesity affects all races, genders, and economic levels but in different ways. The United States Department of Health and Human Services did a National Health and Nutrition Examination Survey between 2005 – 2008. The survey showed:

“Among men, obesity, prevalence is generally similar at all income levels, however non – Hispanic black and Mexican-American men those with higher income are more likely to be obese than those with low income


Higher income women are less likely to be obese than low income women, but most obese are not low income

There is no significant trend between obesity and education among men. Among women, however, there is a trend, those with college degrees are less likely to be obese compared with less educated women

Between 1998-1994 and 2007-2008 the prevalence of obesity increased in adults at all income and education levels.” (DHHS.gov)

There are barriers that we need to change, so we can have a decrease in this epidemic. We need to change how powerful lobbyist representing the unhealthy foods and beverages manufacturers can influence the government officials. “The misinformed constituents – the pervasive fears and misconceptions in many schools and altering school vending practices.” (Dodson). These barriers are stopping the progress of the healthy lifestyle. Many organic food companies are small in operation and cannot afford what the large food corporations can when it comes to lobbying. The schools need to adapt the ideas of where children and adolescents can grow fruits and vegetables depending where their schools are located on the school property or rooftop. The schools then could implicate a program where the students could plant and work with the plants for them to eat at lunch or have a home economics class to prepare the food. This would cut the school the budget in some areas but increase it in others. The children can take this learning tool home and teach their parents how to do it. The schools could also work with the co-op farms in the area to bring in more fresh meats, fruits, and vegetables to serve the students at lunchtime. The small farmers in the community could help implement the new program.

These are some areas that need to be addressed as the epidemic keeps increasing. The changes in the healthcare system are discussed, plans should be offered that directly affect these changes. This epidemic has cost an estimated $ 147 billion dollars. We need to figure out how to improve the current prevention programs. We need to figure out how to get the individuals more informed about the epidemic. The knowledge needs to be taught to all individuals about the healthy lifestyle.

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References

http://nccd.cdc.gov/NPAO_DTM/LocationSummary.aspx?statecode=70.

http://www.cdc.gov/healthyweight/prevention/index.html.

http://www.cdc.gov/nutrition/data-statistics/index.html.

http://www.in.gov/isdh/20060.htm.

http://www.who.int/topics/obesity/en/.

http://www.who.int/topics/obesity/en/

http://www.in.gov/isdh/20060.htm

http://www.cdc.gov/nutrition/data-statistics/index.html

http://www.cdc.gov/healthyweight/prevention/index.html

http://nccd.cdc.gov/NPAO_DTM/LocationSummary.aspx?statecode=70


http://obesity.procon.org/view.resource.php?resourceID=004371.

https://www.healthiergeneration.org.

www.ncbi.nlm.nih.gov/pubmed/17498510.

www.ncbi.nlm.nih.gov/pmc/articles/PMC3033553/.

www.nhlbi.nih.gov/about/org/oei/ .

www.USDA.gov

Block, J., Scribner, R., DeSalvo, K. (2004). Fast Food, Race/Ethnicity, and Income A Geographic Analysis. American Journal of Preventive Medicine.

.

http://www.USDA.gov/

http://www.nhlbi.nih.gov/about/org/oei/

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3033553/

http://www.ncbi.nlm.nih.gov/pubmed/17498510

https://www.healthiergeneration.org/

http://obesity.procon.org/view.resource.php?resourceID=004371

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Childhood Obesity