Childhood obesity

Question

Select a chronic epidemiologic problem or issue (this might be a disease, health condition or another health-related event; your project may focus on primary, secondary or tertiary prevention). It will be important to select a sufficiently narrow focus so that the assignment topic is not too overwhelming!

Part 1 of the Final Project
Write a 10 to 12-page paper summarizing the recent epidemiological research about your chosen topic.
Your paper should address each of the following points:
a) Overview of the problem b) Why this problem/issue is significant overall, and why it is of interest to you c) Review of recent epidemiological studies related to your problem/issue. At least eight (8) research articles are to be reviewed and summarized including the following elements for each study i. Type of study
ii. Population
iii. Methodology including study design and statistical analysis tools used.
iv. Interventions or treatments investigated if applicable
v. Limitations of study
vi. Results – what did the study find and how significant is the finding?
d) Synthesis
i. Summarize the most significant findings from the group of research articles you studied as a prioritized list of each of the following:
1. Implications for health care at all levels – point of care, institution, local, state, national and global
2. Implications for health policy at the local, state, national and global level
3. Implications for further research and program development
4. How could you incorporate some of the findings you learned about into your practice?

APA Format according to the 6th edition of APA Manual
Sub-Titles are needed / One-page Outline for a PowerPoint Presentation
10 pages in length (double- spaced pages not including title and reference pages)
No abstract is needed.
Remember to include a strong introduction and conclusion to your paper.

Answer

Instructor’s Name:

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Contents

Introduction. 3

A review of recent researches on childhood obesity. 3

Synthesis. 10

Conclusion. 12

References. 13

Outline

Introduction

A review of recent researches on childhood obesity

Synthesis

Conclusion

Introduction

Obesity is a condition whereby weight gain reaches a level of posing a serious health threat. Weight gain is measured using a person’s body mass index (BMI), which can be determined easily both by height and weight. Although BMI cut-off points have already been agreed upon for overweight and obese adults, for children, the situation remains a difficult one. This is because the BMI of a child keeps changing with age. Therefore, different cut-off points have to be used depending on the child’s height and age.

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Obesity occurs as a result of the intake of more energy than the one that is expended although some individuals are genetically more susceptible to the condition than others. Today, the rise in obesity is too rapid to be blamed on genetic factors, and thus, must be a reflection of changing levels of physical activity and eating patterns. A recent joint WHO/FAO expert group attributed the drastic increase in childhood obesity to changes in lifestyles, a factor that embodies both eating habits and level of physical exercise. This paper reviews some recent researches in order to assess the latest developments that have been made in the area of childhood obesity.

A review of recent researches on childhood obesity

Arenz&Rückerl (2004) investigated the relationship that exists between breastfeeding and childhood obesity. The research was carried out using meta-analysis and systematic review of published epidemiological studies. These epidemiological studies had been done using case-control, cross-sectional and cohort approaches, and they were comparing early feeding modes as well as adjustments of various compounding factors. First, electronic databases were searched, and then reference lists of various related articles were checked. Then, calculations of pool estimates were done using random- and fixed-effects models. Using the Q-test, heterogeneity was tested. An assessment of publication bias was done using funnel plots and the linear regression method.

In terms of outcome measures, the odds ratio (OR) for obesity during childhood was defined in the form of BMI percentiles. Nine studies in which more than 69,000 participants took place met the inclusion criteria. According to meta-analysis, breastfeeding significantly reduced the risk of becoming obese during childhood. The assumption of homogeneity of results in all the studies that were included was not refuted. Stratified analyses indicated that there were no differences regarding individual study categories, the definition of breastfeeding or obesity, age groups, and the confounding factors for which adjustments were made.

In four studies, a dose-dependent effect of breastfeeding period on the prevalence of obesity was reported. No indication of publication bias was given by a funnel plot regression. This led Arenz&Rückerl (2004) to conclude that breastfeeding appears to have a small but highly consistent, protective effect against childhood obesity.

Veugelers& Fitzgerald (2005) used a multilevel comparison to study the effectiveness of school programs in preventing excessive body weight. The study was motivated by a lack of any evidence on the evidence of these programs amid a sharp increase in childhood obesity cases. In 2003, the researchers surveyed 5200 grade, 5 students, together with their school principals and parents. Their height, weight, and dietary intakes were measured. Then, information on their sedentary and physical activities was recorded. A comparison was made on excess body weight, physical activity and diet across schools with and without any nutrition programs through the use of multilevel regression methods. While doing this, an adjustment was made for socioeconomic characteristics and gender of the parents as well as residential neighborhoods.

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Veugelers& Fitzgerald (2005) found out that students from schools that participated in programs that incorporated recommendations for various school-based healthy eating programs showed significantly low rated of obesity and overweight cases. They had healthier diets and reported much more physical activities compared to students from schools that had not nutrition programs. These findings were an indication that there is a need for a broader implementation of various successful. These programs can go a long way in reducing childhood obesity. In the longer term, they can contribute significantly to the reduction of comorbid conditions and healthcare costs.

Wang (2004) did an analysis that was motivated by the difficulty that arises in defining obesity among children. Recently, several researchers have questioned the rationale for using the sex- and age-specific MBI cut-offs that were proposed by Cole et al (2000) for international use. Wang intended to use the research as an overview of various issues relating to childhood obesity assessment. Additionally, the study was an examination of international secular trends involving childhood obesity, based on the most recent findings.

Wang (2004) found out that currently, BMI is most likely the best choice among several available choices. BMI is easy to determine at a low cost. Additionally, it has a strong relationship with health risks and body fatness. However, BMI poses a number of limitations as an indirect measure of a person’s adipose tissue. This is the main reason why some researchers express concerns over the use of BMI for international reference. The argument raised is that population-specific standards need to be developed due to biological differences among populations. Wang (2004) concluded that although BMI is a feasible tool for measuring body fatness indirectly, it suffered from a number of limitations. Therefore, there is a need for efforts to be made in order to generate valid, more accurate classifications of childhood obesity.

According to Toschke&Kuchenhoff (2005), previous studies have shown that an inverse relationship exists between the frequency of meals and the prevalence of adulthood obesity. In their study, Toschke&Kuchenhoff (2005) sought to find the relationship between the frequency of means and childhood obesity. In this study, the height and weight of 4370 German children aged between 5 and 6 were determined when an obligatory school-entry health examination was being carried out in 2001/2002. The children’s parents answered an extensive questionnaire that addressed various risk factors for obesity. In this regard, the definition of obesity was based on sex- and age-specific BMI points as proposed by the International Obesity Task Force. Daily meal frequency was the main exposure in the investigations.

In this study, obesity prevalence was noted to decrease by the number of meals taken each day. These outcomes could not be explained by confounding factors. This is because of the wide range of socio-demographic, constitutional and lifestyle factors that would have to be put into consideration. Upon additional analysis, the researchers noted that the level of energy intake was higher among nibblers than among gorgers.

Toschke&Kuchenhoff (2005) concluded that an increase in daily meal frequency had a protective effect on obesity in children. This protective effect appeared to be entirely independent of all other risk factors for obesity in children. Meanwhile, modulation of the way hormones such as insulin respond to changes in meal frequency might be useful.

Nader, O’Brien &Houts (2006) used a longitudinal sample comprising of 1042 healthy children from the U.S in a study whose outcomes would assist clinicians in determining BMI levels. The focus was on children who are in their middle childhood and early years of adolescence. Information from both the Human Development Study of Early Child Care and Youth Development National Institute of Child Health were used. The height and weight of the children, who had been born in 1991, were determined at 7 different points. The odds ratios for overweight and obesity were determined at the age of 12. A comparison was made between the children who reached a predetermined BMI percentile in both preschools- and elementary-age periods and who did not.

The logistic regression was used to determine whether and when earlier BMI would be predictive of a child’s weight status at the age of 12. The predicted probabilities of obese or overweight (BMI 85%) were obtained on the basis of the children’s earlier BMI. The researchers found out that obesity persisted for both the children in both the preschool and elementary school-age bracket. Additionally, children who at one time were overweight during the preschool age were 5 times more likely to become overweight at age 12 compared to those who had not been overweight during this same period.

During the elementary school age, specifically ages 7, 9 and 11, the more a child had become overweight, the greater his chances of being overweight while aged 12 relatives to a child who had never been overweight. Sixty percent of all children who had been overweight at any time in the course of their preschool-age had become overweight at the age of 12. The same case applies to 80% of all the children who had been overweight at any time during the elementary period.

This study indicates that children whose BMI is higher than the 85th percentile have a higher likelihood to continue gaining weight and to stick to the overweight status by the age of 15 compared to those whose BMI is on the 50th percentile. The implication of the study is that pediatricians need to be confident about counseling parents to start addressing the eating and activity patterns of at-risk children instead of delaying the efforts in the hope that the overweight problems will resolve themselves. Identification of children at risk of adolescent obesity is an excellent way of providing physicians with a good opportunity for earlier interventions. The ultimate goal, in this regard, should be limiting abnormal weight gain from progressing, resulting in the development of obesity and obesity-related morbidity (Nader, O’Brien &Houts, 2006).

Epidemiological studies indicate that there is a relationship between being overweight and cardiovascular disease (Flodmark& Nilsson-Ehle, 2008). In an effort to identify the anthropometric variables that reflect the risk of cardiovascular disease, Flodmark& Nilsson-Ehle, (2008) embarked on a study of unfavorable changes in lipid and apolipoprotein concentrations of 29 obese children aged 14 and 32 obese 12-year old children. All of these children were recruited from a school-based screening program. Anthropometric data that reflected fat and overweight distribution were taken through covariance analysis, with the dependent variables being apolipoprotein, blood pressure, and lipid concentrations.

An adjustment was made to the two groups on the basis of gender, puberty and screening group such that it was possible for data to be pooled. After the adjustment, a significant correlation of waist circumference was correlated to HDL (high-density lipoprotein) cholesterol and triglycerides. The waist-hip ratio was correlated to HDL-cholesterol and triglycerides in a significant manner. The BMI was correlated significantly to triglycerides and diastolic blood pressure. The partial regression coefficients for the circumference of the waist versus apolipoprotein appeared to be as strong as those for the waist-hip ratio.

These results demonstrate that there is a close association between abdominal obesity and an unfavorable lipid profile in children aged between 12 and 14. This may be closely related to an increased risk of cardiovascular disease later on in life. The waist measurement seems to be a highly informative and convenient indicator of metabolic alterations of such kind.

In a different study, James & Kerr (2005) found out that there is an association between the consumption of soft drinks and obesity. Their aim of carrying out the study was determined if consumption of these drinks could be an environmental risk factor for childhood obesity, a growing global problem.

Three separate American studies have already found out an association between childhood obesity and the consumption of sugar-sweetened drinks. It has been found that the energy intake of children who often consume these drinks is high. Therefore, they are more likely to become overweight than those who do not consume these soft drinks (James & Kerr, 2005). In the United Kingdom, a further increase in obesity has been prevented through a school-based program that focuses on the reduction of the number of soft drinks consumed (James & Kerr, 2005).

According to a study done by Dorsey & Wells (2005), few children are receiving a formal diagnosis or treatment despite a high burden of obesity and overweight. Additionally, there are few documented cases of BMI screening despite the fact that this test is cheap and effective. Dorsey and Wells arrived at these findings after carrying out a study to determine the rate of diagnosis and treatment among overweight children. In this study of clinical practice activity with regard to obesity and overweight, a review of 600 randomly selected records was made at two community-based clinics in New Haven.

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Children aged between 3 and 17 who had visited the clinics between January 1, 1999, and December 31, 2000, participated. They were classified according to their BMI. Those on the lower side of the 85th percentile were considered non-overweight; 85th to 94th percentile – at risk of overweight; and 95th percentile or greater – overweight. The main outcome measures consisted of an examination whatever was written on the encounter note for purposes of documenting the BMI. Other measures included treatment for overweight, the examination of comorbid disease and the corresponding diagnosis regarding weight (Dorsey & Wells, 2005).

Synthesis

The reviews of various studies reveal various insights and challenged that have characterized recent childhood obesity research. The most significant finding is that school programs are remarkably effective means of solving the obesity problem among children. These programs should be modeled on the curtailment of consumption of certain diets such as soft drinks. Emphasis should be put on changes involving physical activities and dieting practices.

The main challenge in childhood obesity diagnosis is the fact that the children of different ages, unlike adults, have different BMI standards. This is because they are undergoing continual growth and development. Some researchers have suggested the need for an internationally recognized standard for assessing obesity in children. They point out that some populations have unique characteristics that may make it unfair to generalize the BMI test results to everyone. Therefore, future research efforts may need to be directed towards the ascertainment of population-specific BMI test cut-off points.

Parents and health practitioners need to start a campaign of counseling their children about the best eating and exercising habits instead of delaying these efforts. Research has shown that when measures to resolve overweight problems among children are delayed, they become difficult to solve by the time the child is 14 years. At this age, they may result in the development of obesity-related morbidity (Nader, O’Brien &Houts, 2006).

Other findings relate to breastfeeding, consumption of soft drinks, daily meal frequency, and abdominal obesity and its risk of later-life cardiovascular disease. Breastfeeding was found to have a small but highly consistent, protective role in preventing obesity. Health practitioners, policymakers and parents should ensure that such a measure is accorded the importance that it deserves in order for the childhood obesity problem to be controlled.  The same case applies to the issue of daily meal frequency.  Toschke&Kuchenhoff (2005) found out that increasing the frequency of daily intake of meals has a protective effect on childhood obesity.

However, some of the findings indicated here were generated against the backdrop of certain research limitations. In most cases, these limitations form a ground for further research. For instance, in the case of frequency of meals, more research on the ways in which hormones such as insulin respond to changes in the frequency of meals is needed. Additionally, it is necessary for state and federal agencies to fund research on the various diets that are purported to be most significant in contributing to childhood obesity such as soft drinks.

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In order for the childhood obesity problem to be solved, there is a need for both practitioners and parents to be at the forefront in bringing about lifestyle change. This will help children develop a culture of healthy eating, regular exercising, and healthy living. In the meantime, the most immediate measure should be the introduction of programs that will lead to the reduction of various obesity risk factors.

Incorporating the findings that I have derived in this paper would be a highly challenging thing to do. However, it is one that can be done. Most of the tasks would involve explaining to parents of obese children about how they should bring up their children in order to help them get out of their problem. Additionally, I would encourage lactating mothers to ensure that they prolong their breastfeeding durations as much as they can in order to reduce the likelihood of their children becoming obese.

Conclusion

In conclusion, childhood obesity a problem that should be addressed at the local, state, federal and global levels in order for a lasting solution to be found. At the state and federal levels, health and education institutions need to be strengthened through the funding of research and healthy living programs. While researchers toil to come up with new findings in child obesity research, health practitioners should be counseling to make the best use of the existing findings.

The problem of BMI cut-off point should be addressed with renewed care in order to ensure that childhood obesity is addressed in the best manner even in populations that are characterized by unique physical characteristics. Meanwhile, all remedial and preventative measures for childhood obesity need to be done within clearly defined health policies and programs at all levels.

References

Arenz, S. &Rückerl, R. (2004) Breastfeeding and childhood obesity—a systematic review, International Journal of Obesity, 28, 1247–1256

Cole TJ, Bellizzi MC, Flegal KM, Dietz WH. (2000) Establishing a standard definition for child overweight and obesity worldwide: international survey, BMJ,320: 1240–1243.

Dorsey, K. & Wells, C. (2005)Diagnosis, Evaluation, and Treatment of Childhood Obesity in Pediatric PracticeArchives of Pediatric and Adolescence Medicine 159:632-638

Flodmark, C. & Nilsson-Ehle, T. (2008) Waist measurement correlates to a potentially atherogenic lipoprotein profile in obese 12–14–year-old children, ActaPædiatrica, 83(9), 941 – 945

James, J. & Kerr, D (2005) Prevention of childhood obesity by reducing soft drinks, International Journal of Obesity 29, 54–57

Nader, P.  O’Brien, M. &Houts, R. (2006) Identifying Risk for Obesity in Early Childhood, Pediatrics, 118(3), 594-601

Toschke, A. &Kuchenhoff, H. (2005) Meal Frequency, and Childhood Obesity, Obesity Research, 13(11), 1932-1938.

Veugelers,  P. &  Fitzgerald,  A. (2005), Effectiveness of School Programs in Preventing Childhood Obesity: A Multilevel Comparison, American Journal of Public Health, 95(3), 432-435

Wang, Y. (2004) Epidemiology of childhood obesity—methodological aspects and guidelines: what is new? International Journal of Obesity 28, 21–28

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