Term Paper and Annotated Bibliography: Childhood Obesity in Malaysia

Abstract: Childhood obesity has been growing at the critical stage now and is the most common nutritional problem among children in developed as well as in developing countries. This unhealthy trend will progress to adulthood and is expected to lead to huge economic costs in health and social security systems. Among the many factors which contribute to the increasing prevalence of childhood obesity include environment, poor eating habits and food choices, lack of exercise, psychological issues and stress and also genetic factors. This paper then comes up the readers with the way on how to prevent the child becoming obesity and also some treatment that are needed for childhood obesity. Keywords: Childhood obesity, obesity, factors, prevention, Malaysia

INTRODUCTION A balanced diet comprising of diverse and healthy foods is key to promoting good health. Foods contain vital nutrients that aid our bodys metabolic function. However, a lack of consumption of these nutrients or feeding upon the wrong kinds of food leads to an accumulation of toxins within the body, resulting in chronic diseases in the long run. A nutritious diet while ensuring overall well being, helps to maintain a healthy Body Mass Index (BMI), reduces the risk of several debilitating diseases like cancer, cardiovascular ailments, diabetes, osteoporosis and stroke. Thus a nutritious & healthy diet is important in the prevention and cure of various diseases. Obesity is the most common nutritional problem among children in developed countries.1 Overweight and obesity in childhood are known to have significant impact on both physical and psychological health. The mechanism of obesity development is not fully understood and it is believed to be a disorder with multiple causes. Obesity is emerging as a widespread nutritional problem, although being underweight is still a problem. Being overweight during childhood and adolescence increases the risk of developing high cholesterol, hypertension, respiratory ailments, orthopedic problems, depression and others illness.
Jonathan Sorof & Stephen Daniels, Obesity hypertension in children: a problem of epidemic proportions, American Heart Association, 40, 2002, 445.
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Term Paper and Annotated Bibliography: Childhood Obesity in Malaysia

The prevalence of overweight children in Malaysia has increased in recent years. Weight categories is determine by using Body Mass Index (BMI) to measure weight adjusted for height. Age and gender is specific BMI for children, due to childrens changing body compositions over time and the different growth rates of boys and girls. Overweight children increase the risk for certain medical and psychological conditions. Table 1: Pravelence of overweight in children according to age and sex.

18 16 14 12 10 8 6 4 2 0 6 7 8 9 10 11 12 B oy Girl

Source: Segal, David G. and Sanchez, Juan C. Childhood obesity in the year 2001, The Endocrinologist, 11, 2001, p306.

Obesity is the most common nutritional problem among children in developed countries. Obesity is caused by an imbalance in energy input versus output, resulting in a positive energy balance.2 In Malaysia, a survey has also demonstrated increasing prevalence of obesity with increasing age: 6.6% among 7-year-olds, rising to 13.8% among 10-year-olds as presented in Table 1. It show that overweight children have an increased risk of being overweight as adults. This situation is due to the level of awareness amongst Malaysian regarding childhood obesity.3
Gareth Williams & Gema Fruhbeck, Obesity: science to practice, (United State: John Wiley and Sons, 2009) 110.
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Tee ES & Cavalli-Sforza LT., Nutrition in Malaysia: Assessment, Analysis and Action. Malaysian Country Paper for the FAO/WHO International Conference in Nutrition, (Kuala Lumpur, Institute for Medical

Term Paper and Annotated Bibliography: Childhood Obesity in Malaysia

That also determines their attitudes or behavior towards the seriousness of this issue. This issue of childhood obesity can be control by doing a lot of physical activity, early detection and seeking the right treatment if necessary. In Malaysia, rapid and marked socio-economic advancement over the past two decades has brought about significant changes in the lifestyles of communities. These include significant changes in the dietary patterns such as an increase in consumption of fats, oils and refined carbohydrates and a decreased intake of complex carbohydrates. This has resulted in a decline in the proportion of energy from carbohydrates, while an increase in the percentage contribution of fat.

NUTRITION AND EATING HABIT It is difficult to correlate nutritional choices and childhood obesity using observational research. However, trend data suggest some changes in eating patterns and consumption that may be correlated with increases in obesity. In general, children and adolescents are eating more food away from home, drinking more sugar-sweetened drinks, and snacking more frequently.4 Convenience has become one of the main criteria for people food choices today, leading more and more people to consume quick service or restaurant meals or to buy ready-toeat, low cost, quickly accessible meals to prepare at home. The nutritional composition of childrens diets as well as the number of calories consumed is of interest to determine the effect of food consumption on childhood obesity. Income and population growth, coupled with changes in lifestyle to one of urbanisation, have increased the demand for food and induced changes in food habits, food purchasing and consumption patterns. Food balance sheet data are useful to indicate trends of food intake patterns rather than consumption per se in the absence of nation-wide food consumption surveys. Table 2 shows the changes in sources of calories in Malaysia from 1961 to 1997, the amount of calories obtained from cereals decreased from 61% to 41%; meanwhile, calories

Research, 1993) 98.

4

Tee ES, Nutrition in Malaysia: where are we heading? Malaysia Journal of Nutrition, 5, 1999, 87.

Term Paper and Annotated Bibliography: Childhood Obesity in Malaysia

from meat, eggs and fish increased from 6.2% to 14.3%, sweeteners from 9.5% to 18%, and oils and fats from 11.4% to 14.8%, respectively.5 Table 2: Changes in sources of calories in Malaysia, 19611997

Year Cereals Starchy roots Vegetables & fruits Pulses Meat, fish, eggs Milk, excluding butter Sweeteners Oils & fats Miscellaneous
1961 63 197072 197981 198890 1997

61 1.9 4.2 1.0 6.2 2.9 9.5 11.4 1.9

57 1.9 3.8 1.0 6.7 2.9 12.4 12.4 1.9

48.6 1.9 3.8 1.0 9.5 3.8 12.4 17.1 1.9

40 2.9 3.8 1.0 12.4 3.8 13.2 21.0 1.9

41.0 1.9 3.8 1.0 14.3 3.8 18.0 14.8 1.4

Sources: Ministry of Health Malaysia and Academy of Medicine Malaysia. Clinical practice guidelines on management obesity 2003. Kuala Lumpur: Ministry of Health, 2003.

CAUSES OF CHILDHOOD OBESITY The causes of childhood obesity are multi-factorial. Overweight in children and adolescents are generally caused by a lack of physical activity, unhealthy eating patterns
Ministry of Health Malaysia & Academy of Medicine Malaysia, Clinical practice guidelines on management obesity 2003, ( Kuala Lumpur: Ministry of Health, 2003) 10.
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Term Paper and Annotated Bibliography: Childhood Obesity in Malaysia

resulting in excess energy intake, or a combination of the two. Genetics and social factors socio economic status, race or ethnicity, media and marketing, and the physical environment also influence energy consumption and expenditure. Most factors of overweight and obesity do not work in isolation and solely targeting one factor may not going to make a significant impact on the growing problem.6 a) Poor eating habits and food choices Bad behavior is also one of the causes. This group of children eats food that is low in nutrition and high in fat. This group of children eats fast food meals, rich desserts and drinks with a lot of sugar. They also usually over eaten, and the food that they consume has many empty calories. In other words, the food that they eat does not provide enough nutrition for a children needs. This same group of children eats lots of sweets food which in general have empty calories.

Figure 1: Food pyramid Sources: How much is a serving? 1992. Retrieved 19 Feb 2011 from < http://search.live.com/results.aspx?q=much-&src= b) Lack of Exercise Lack of regular exercise is a factor that has contributed to this being one of the causes of childhood obesity. Children who spend a lot of time watching television programs will have a greater risk of child obesity than those who go outside playing
Elissa Jelalian, & Ric G. Steela, Handbook of childhood and adolescent: issues in clinical child psychology, (New York: Springer, 2008) 89.
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Term Paper and Annotated Bibliography: Childhood Obesity in Malaysia

or sporting. This is typically true when the children are eating fast food while watching television or playing video games. c) Genetics In the general population, genetic factors play a role in the risk of obesity development. Unfortunately, some children are naturally predisposed to obesity. These children are born with genes that cause them to put on weight more quickly than other children. The DNA cannot be changed but some small changes such as walking to school, playing outdoor games rather than letting children stay at home and avoid exercise. 7 d) Psychological issues and Stress Some people are mildly obese was cause by psychological or stress problems. Some children have a difficult time dealing with stress so they use food as a comfort when they feel, and many children are prone to eating in response to negative emotions like being bored, feeling anxious or being angry. e) Environments The environment too plays a role in the causes of obesity. The family home is an important place to learn about proper nutrition and enough physical activity. Attitudes, habits, and beliefs about food selection and how to spend family leisure time are critical factors to forming a healthy relationship with food. Modern lifestyles have improved the quality of life but also contribute greatly to physical inactivity. PREVENTION TO CHILDHOOD OBESITY Although trying to help overweight children lose weight is important, even more important may be trying to prevent them from becoming overweight in the first place. This too is not easy, but something that needs to be started in early childhood, especially if the child is at risk for becoming obese, like if they have overweight parents.
David Crawford & Robert W. Jeffery, Obesity prevention and public health, (New York: Oxford University Press, 2005) 126.
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Term Paper and Annotated Bibliography: Childhood Obesity in Malaysia

Almost all researchers agree that prevention could be the key strategy for controlling the current epidemic of obesity. Prevention may include primary prevention of overweight or obesity, secondary prevention or prevention of weight regains following weight loss, and avoidance of more weight increase in obese persons unable to lose weight. Given the insidious consequences of childhood obesity, understanding how best to prevent it remains the principal research priority.8 Indeed, a recent review of obesity in children and young people concluded that obesity prevention is the only feasible solution childhood obesity alike. There are three main ways to prevent the child becoming overweight or obese:

Figure 2: Three main ways to prevent the child obesity

TREATMENT FOR CHILDHOOD OBESITY Obesity treatment programs for children and adolescents rarely have weight loss as a goal. Rather, the aim is to slow or reduce weight so the child will grow into his or her body weight over a period of months to years. Early and appropriate intervention is particularly valuable. There is considerable evidence that childhood eating and exercise habits are more easily modified than adult habits.9 Three forms of intervention include:

Luis A. Meredona Aznar, Epidemiology of obesity in children and adolescents: prevalence and etiology, (New York: Springer, 2010) 102.

Term Paper and Annotated Bibliography: Childhood Obesity in Malaysia

a) Physical Activity Adopting a formal exercise program, or simply becoming more active, is valuable to burn fat, increase energy expenditure, and maintain lost weight. Most studies of children have not shown exercise to be a successful strategy for weight loss unless coupled with another intervention, such as nutrition education or behavior modification10. However, exercise has additional health benefits. b) Diet Management Fasting or extreme exercise is not advisable for children. Not only is this approach psychologically stressful, but it may adversely affect growth and the child's perception of normal eating. Balanced diets with moderate caloric restriction, especially reduced dietary fat, have been used successfully in treating obesity. 11 Nutrition education may be necessary. c) Behavior Modification Many behavioral strategies used with adults have been successfully applied to children and adolescents, self-monitoring and recording food intake and physical activity, slowing the rate of eating, limiting the time and place of eating, and using rewards and incentives for desirable behaviors. Particularly effective are behaviorally based treatments that include parents. CONCLUSION Obesity is a chronic disorder that has multiple causes. Overweight and obesity in childhood have significant impact on both physical and psychological health. In addition, psychological disorders such as depression occur with increased frequency in obese children. Overweight children are more likely to have cardiovascular and digestive diseases in adulthood as compared with those who are lean. It is believed that both over-consumption of calories and reduced physical activity are mainly involved in childhood obesity.
Larry C. James & John C. Linton, Handbook of obesity intervention for the lifespan, (New York: Springer, 2008) 9. Gareth Stratton, Promoting childrens physical activity in primary school: an intervention study using playground markings, Ergonomics, 43, 10, 2000, 1538.
11 10 9

Kathleen Keller, Encyclopedia of obesity, (New York: Sage, 2008) 67.

Term Paper and Annotated Bibliography: Childhood Obesity in Malaysia

Apparently, primary or secondary prevention could be the key plan for controlling the current epidemic of obesity and these strategies seem to be more effective in children than in adults. A number of potential effective plans can be implemented to target built environment, physical activity, and diet. These strategies can be initiated at home and in preschool institutions, schools or after-school care services as natural setting for influencing the diet and physical activity and at home and work for adults. Both groups can benefit from an appropriate built environment. However, further research needs to examine the most effective strategies of intervention, prevention, and treatment of obesity. These strategies should be culture specific, ethnical, and consider the socio-economical aspects of the targeting population.