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Childhood Obesity Prevention

Nutrition 415 Miniature Literature Review
Denielle Saitta 11/20/2013

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Denielle Saitta Nutrition 415 November 20, 2013 Childhood Obesity Prevention: Miniature Literature Review Abstract: Childhood obesity is associated with factors such as having an inadequate diet due to poor food preferences, scarcity of physical activity, increasing sedentary behaviors, poor parent or sibling modeling, lack of community endeavors and an absence of educational efforts available for children and parents. All of these lifestyle behaviors have led to one in three children being diagnosed as overweight or obese. Childhood obesity has direct and lasting effects on both a child’s physical and mental state of mind. Healthy lifestyle habits, like healthy eating and increased physical activity, can lower the risk of a child becoming obese and developing related health concerns. The dietary and physical activity behaviors of children and teens correlate to the many sectors of society, including families, communities, schools, and resources available to them. Introduction: Childhood obesity is a serious medical disorder that effects children and adolescents, and are more likely to be obese as adults. To asses a child’s weight status, an age and sex-specific percentile for body mass index (BMI) is calculated and often referred to as BMI-for-age. Once the BMI is calculated, the BMI number is plotted on the Centers for Disease Control (CDC) BMI-for-age growth charts, these charts are gender specific, to attain a percentile ranking. The indicated percentile is the relative point of a child's BMI number among those of the same age and sex, these percentiles are of the most frequently used markers to assess the size and growth patterns of individual children. The growth chart shows the weight status classes used for

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children: underweight- <5th percentile, healthy weight- 5th percentile - <85th percentile, overweight- 85th percentile - <95th percentile, obese- >95th percentile (4). Childhood obesity is becoming more and more prevalent in developed countries and is linked to a reduced quality of life, deficiency of educational programs, absence of exercise or play time, and limited prevention efforts. Overweight and obese children have elevated rates of physical and socio-emotional problems, and are at a risk of continued overweight and chronic illnesses later in life (1). These health risks include high blood pressure, type 2 diabetes, elevated blood cholesterol levels, sleep apnea, and metabolic syndrome. There are also many psychological consequences associated with obesity such as low self-esteem, negative body image, and depression. Excess weight at young ages has been linked to higher and earlier death rates in adulthood (1). Many children and parents are unaware of the correct amount of dietary intake and physical activity a child should attain during the day. This lack of knowledge can lead to a misguided conception of what a healthy child should look like. Since children spend much of their day at child-care centers and other school based learning centers, a multi-component school-based intervention on healthy lifestyle choices can affect physical activity and increase consumption of healthier food options (2). Along with efforts being made to education parents and family, there are also a number of measures involving the community to help fight obesity. Aims at the promotion of healthy habits in the population through lessons in schools, wellness systems, health services, and community and working environments are receiving a large amount of attention from the general public (2). Schools have long been deemed a useful context for health programs. By incorporating health lessons, physical education chances, and providing healthier food options for children, school systems are implementing many great changes to help battle the obesity epidemic (3). Though these school-based programs are effective they can be improved by including a maternal

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element. Having parents’ model healthy eating habits and participate in regular physical activity helps to reinforce themes that children learn at school. Furthermore, having friends and family members and playing outdoors has proven useful towards decreasing the physical inactivity and obesity of youth. Physical activity is a critical health behavior for obesity patients. The purpose of this paper is too examine links within a child’s lifestyle behaviors such as physical and mental health effects, educational efforts made within the community and child-care centers, family impacts, and a child’s level of physical activity with interventions designed to prevent childhood obesity. Effects on Physical and Mental Health: Many health issues can stem from childhood obesity. Minimal levels of physical activity and increased levels of sedentary behavior mixed with low levels of fresh healthy fruits and vegetables consumed have been associated with poor health risks among children in today’s society. Many of the cardiovascular concerns that adult-onset obesity are preceded by began in one’s childhood. Hyperlipidemia, hypertension, and abnormal glucose tolerance are just some of the health dangers that occur in obese children and teens (4). Obesity has become the most common modern pediatric chronic disease (5). Along with physical health concerns there are mental health problems, such as negative body-image, depression, increase stressed levels, low self-esteem, and poor socialization ability that have also been found as a result of childhood obesity. Of the nine clinical trials Lawlor et al. (6) evaluated on healthy lifestyle habits, there were beneficial effects on cardio-respiratory fitness and blood cholesterol that were achieved. Also seen from these studies, were positive improvements in a child’s energy, social interactions, and emotional development (6). The key to an improved overall health status is to balance the foods you intake with the energy you burn throughout the day. Swap out foods high in sugar and

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fats for fruits, vegetables, and whole grains. Getting regular medical checkups with a physician can also aid in preventing any possible diseases. Educational Efforts: Educational intervention on healthy eating habits and physical activity in the school could contribute to lessen the current increase in child obesity. Many families do not know the recommended portion sizes for a meal, amount of activity needed each day, or the essential vitamins and minerals a child needs for healthy growth and development. It has been shown that in adulthood treatment of obesity is extremely difficult, so for that reason education towards increased physical activity and nutritious food during childhood is be a crucial strategy in the prevention of obesity (2). The study designed by Llargues et al. (2) evaluated the efficacy of educational intervention on food habits and physical activity in young children. Results showed a reduction in the progression of BMI by 0.89 kg/m2, meaning the prevalence of overweight decreased by 62% at the end of the study (2). By providing educational materials, lessons, and advice in a learning environment, children are able to understand the importance of a healthy and physically active lifestyle. Community Resources: The rate of childhood obesity has been attributed to the lifestyle choices caused from ready access to processed foods that contain high amounts of sugars and fats, in junction with technological and society changes that have changed levels of physical activity. Underprivileged neighborhoods may present higher complications for children’s weight, due to less availability of healthy food choices and unhealthier fast-food selections. These neighborhoods also often lack safe places for children to play outside. Obesity prevention involves the development of intervention components to incorporate out-of-school settings to complement school-based

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interventions already in place (7). Communities are now launching such programs to help clean up playgrounds and parks for children to utilize since outdoor play has been shown to have increased benefits (8). Group play and organized sports have also been associated with higher physical activity levels in children (8). The findings from the qualitative study done by Beets et al. (7) indicated that children recognize the home as a primary setting where they participate in various types of physical activity. This study used self-taken pictures and focus groups to aide in intervention (7). Children were instructed to take pictures when they were being physically active which included any play, game, or sport (7). We must focus efforts for the prevention of childhood obesity on diet and exercise in the communities where children live and go to school since the environment is a central contributor to the obesity hazard. School Involvement: Schools have the ability to make important impacts on both the prevention and treatment of childhood obesity. School nutrition programs can be delivered at very minimal costs to families and can even reach low income children who otherwise may not get the opportunity. Many obesity prevention efforts that modify food habits and promote physical activity have been carried out in the school setting (3). The “Healthy school start” study designed by Nyberg et al. (3) is a cluster-randomized controlled trial. These findings showed that if obesity prevention programs are combined with interventions focused at schools, then the program may lead to improved health and positive health effects in the short and long term (3). Establishing policies to require daily physical education and increasing moderate and vigorous activities during class time greatly increases the energy expenditure of young people (10). Nutritional standards for schools have become stricter at lunch and snack time which is important in the fight against childhood obesity, especially those who receive free or reduced lunches (6). Kids deserve to be

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given healthy and nutritious options for lunch to help their bodies fully develop and grow. Children spend a large portion of their day at school, and by providing health lunch and snack items, nutritional education, and physical education opportunities school systems have the potential to change behaviors to be more health promoting. Family Impact: One of the best strategies to reduce childhood obesity is to improve the diet and exercise habits of the entire family. Social support from parents and other family member correlates to an increase with participation in physical activity and dietary modification (4). Parental involvement in obesity prevention and treatment programs is necessary to the development of a psychosocial environment that promotes healthy eating and physical activity among young people (4). Research suggests that given the essential role that families play in shaping lifestyle behaviors in children, the prevention of obesity in youth populations requires a focus on families (9). The Family-centered Action Model of Intervention Layout and Implementation, or FAMILI, was developed by theories of family development (9). FAMILI uses a mixed-methods approach to conduct research, and positions family members as active participants in the development, implementation, and evaluation of family-centered obesity prevention programs (9). Over 30 different family types, ethnicities, and races were involved in the study (9). When parents take an active role and engage with children in nutritional lessons and help promote adequate amounts of physical activity obesity prevention interventions seem to be more successful (9). Another study noted, that children indicated during focus groups that they were more engaged in some form of game or activity when they were with a friend, family, or relative on a daily basis (7). An adult is a child’s role model, so leading by example and teaching them positive and healthy lifestyle can greatly influence a child’s nutritional behaviors.

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Physical Activity: Children who engaged in the least amount of vigorous physical activity or watch the most television tended to be the most overweight individuals (1). To increase physical activity in children, activities should not just be exercise based but should include activities similar to hiking, swimming, gardening or dancing (8). Muscle and bone strengthening activities, such as push-ups or jumping rope, are also important in building stronger bodies for children and young teens. (8) Infants, toddlers, and preschool children who are provided the opportunity to participate in daily movement and exercise have a higher prospect of having a healthy development in later life (4). The research study by Howie et al. (8) separated about 230 preschoolers into groups of moderate to vigorous physical activity and each child wore an accelerometer while the children’s movement was observed and recorded. The study identified that high-active and low-active children were equally active while outdoors, and that providing children with more outdoor play may help all children increase physical activity levels (8). Physical activity is critical in battling childhood obesity and if adequately performed can help in prevention. Conclusion: By involving the family and setting good examples by eating healthy foods and exercising regularly helps children identify correct practices. Though these studies all measure different aspects of a child’s life each help provide critical information on childhood obesity and possible prevention methods. Some studies are more similar and obtain research by the same methods, but each study helps to prove the need and positive effects of intervention for children. There is a need to have multiple recommendations and standards for children since all children are different. Encourage children to join sports teams and involvement in other organized group

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activities. Partner with local and state efforts to maintain parks and other play areas for children. Obesity is a major, but preventable epidemic in the United States. Creating alliances among families, child care programs, the community and schools can help adults and children to live longer and healthier lives. The goal in battling the childhood obesity epidemic is to maintain an energy balance which can be sustained throughout the individual's life-span.

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References: 1. Brown JE, Nicholson J M, Broom DH, Bittman M. Television Viewing by School-Age Children: Associations with Physical Activity, Snack Food Consumption and Unhealthy Weight. Social Indicators Research. 2011; 101(2): 221-225. 2. Llargues E, Franco R, Recasens A, Nadal A, Vila M, Pérez MJ, Manresa JM, Recasens I, Salvador G, Serra J, Roure E, Castells C. Assessment of a school-based intervention in eating habits and physical activity in school children: the AVall study. Journal of Epidemiol Community Health. 2011; 65(10): 896-901. 3. Nyberg G, Sundblom E, Norman A, Elinder LS. A healthy school start - parental support to promote healthy dietary habits and physical activity in children: design and evaluation of a cluster-randomised intervention. BMC Public Health. 2011; 11:185. 4. Simpson CG, Gray JP, Waldrep S, Gaus MD. Healthier Lifestyles for Young Children: Partnering with Families. Dimensions of Early Childhood. 2009; 37(1): 15-22. 5. Nemet D, Ben-Haim I, Pantanowits M, Eliakim A. Effects of a combined intervention for treating severely obese prepubertal children. J Pediatric Endocrinology & Metabolism. 2013; 26(1-2): 91-96. 6. Lawlor DA, Jago R, Noble SM, Chittleborough CR, Campbell R, Mytton J, Howe LD, Peters TJ, Kipping RR. The Active for Life Year 5 (AFLY5) school based cluster randomised controlled trial: study protocol for a randomized controlled trial. Trials. 2011; 12: 181. 7. Beets MW, Banda JA, Erwin HE, Beighle A. A Pictorial View of the Physical Activity Socialization of Young Adolescents outside of School. Research Quarterly for Exercise and Sport. 2011; 82(4): 769-778. 8. Howie EK, Brown WH, Dowda M, McIver KL, Pate RR. Physical activity behaviours of highly active preschoolers. Pediatric Obesity. 2013; 8(2): 142-149. 9. Davison KK, Lawson HA, Coatsworth JD. The Family-centered Action Model of Intervention Layout and Implementation (FAMILI): the example of childhood obesity. Health Promotion Practice. 2012; 13(4): 454-461. 10. Grydeland M, Bergh IH, Bjelland M, Lien N, Andersen LF, Ommundsen Y, Klepp KI, Anderssen SA. Intervention effects on physical activity: the HEIA study - a cluster randomized controlled trial. International Journal of Behavioral Nutrition and Physical Activity. 2013; 10:17.

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