Examining The Global Epidemic Of Obesity Health Essay

Childhood fleshiness is a turning epidemic worldwide. Fleshiness in kids may really good be one of the most serious public wellness challenges of the twenty-first century. The job is world-wide and is increasingly impacting many lower and in-between income states, preponderantly in inner-city milieus. The expectedness has increased at a startling rate. Harmonizing to the World Health Organization there was an approximative 22 million kids under the age of five who were considered corpulent in 2007 throughout the universe ( Obesity in America, 2009 )
Fleshiness, what is it? Is obesity the same as corpulence? Obesity is the term used when mentioning to a individual developing excessively much organic structure fat. Bing fleshy merely means the individual weighs excessively much. In both instances it means the person ‘s weight is larger than what is measured to be in good physical form for his or hers stature. Obesity takes topographic point Oklahoman or subsequently when the individual eats excess Calories than they are able to use. Each individual and kid needs a different balance of Calories in and Calories out this depends on such things as familial composing, eating excessively much, eating nutrients high in fats and non being active.Examining The Global Epidemic Of Obesity Health Essay.  Childs who are fleshy and corpulent are prone to remain corpulent into maturity and more prone to develop non-communicable diseases like bosom disease, arthritis, shot, some malignant neoplastic diseases, and diabetes, cardiovascular diseases at a younger age. Childhood fleshiness is associated with an elevated possibility of premature decease and disablement in maturity. This subject is talkinga bout child fleshiness, its causes such as over feeding, effects such as premature decease and its solutions such ass exerting.
Sometimes it is easier to disregard a kid who is overweight because typically the excess lbs are attributed to what is dearly referred to as babe fat. It is non uncommon to hear people say that the kid will turn out of it, it is merely a stage. There are babes that are born corpulent, preponderantly the consequence of an corpulent, diabetic, or female parents with unneeded weight addition during their gestation. The causes of neonatal fleshiness are for that ground evident ; extreme insulin which is formed by the foetus itself to get down with if the female parent is a diabetic and excessively much supply of trans-placental foods if the female parent has an unneeded sum of weight addition. Neonatal fleshiness is non automatically traveling to turn into childhood fleshiness or adolescent fleshiness, nevertheless there may be more of an amplified likeliness if the corpulent baby is born to an corpulent household or even adopted by an already corpulent household. Surveies have made known that the likeliness of childhood fleshiness additions in conformity to the sum of corpulent relations including grandparents, aunts, uncles, and siblings in the count. Nonetheless, young person and ulterior fleshiness is non basically inherited as documented in surveies of adoptive kids. Children that are of a normal birth weight when adopted into a household that has corpulent members will more likely become corpulent as a consequence ( Obesity in America, 2009 ) .

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In some instances the baby may basically turn out to be corpulent due to those who take attention of such baby, for illustration: attention workers, grandmas, or extra parent-surrogates. As such some of the baby ‘s attention givers may simply detect the baby ‘s fleshiness as babe fat ” or cunning chubby babe. ” Another ground and usually done unconsciously is that the health professional may hold a inclination to give the baby a helping of milk or nutrient as a agency of hushing the baby, or to expose their personal ability to raise a kid. If by the baby ‘s first birthday the baby is still considered corpulent, the baby may so be physically delayed in normal development. Such things such as, sitting up, creeping and walking, which in bend would so detain the rate at which the baby should achieve the amplified energy expense that usually goes with the toddler-stage actions ( Hume, 2003 ) .
Adolescent fleshiness is more important for the ground that it is widespread with females alternatively of males with less privileged juvenile females more normally.Examining The Global Epidemic Of Obesity Health Essay.  The United States fleshiness amongst the striplings has become excess outstanding with misss of African American, Native American, Pacific Islander, and Mexican American beginnings. The normalcy is that corpulent misss and male childs after turning one-year-old are taller than non-obese kids, in some instances in surplus of 10 centimetres after 10 old ages of life. Both male childs and misss who are corpulent are extremely developed in bone growing, which in bend can do them to halt turning before others of the same age group. Sexual growing is besides extremely developed in corpulent misss along with male childs. For a miss who is corpulent to hold a premature beginning of her catamenial rhythm due to the increased rate of development is non uncommon, in some corpulent misss this has started before the 10th twelvemonth of life.
There have been surveies that show the juvenile beginning of fleshiness, are due to the parental and or other kids ‘s encouragement to gorge and in some instances even intentional over eating of kids ( Garn, 1985 ) . Apprehensions about the nutriment of corpulent childs may convey more to puberty a few physicians perchance would demo hesitating toward proposing, cut downing the consumption of Calories in apprehensiveness that it may detain the growing, even though it is usual an corpulent stripling is far more developed than those of the same age group. It is besides helpful to be able to do a differentiation between the accustomed corpulent and those who are freshly corpulent, for the accustomed obese are at a higher hazard to return to fleshiness. There are summer cantonments that dedicate themselves to assisting with the systematically corpulent childs above all corpulent females, have minuet go oning accomplishment in cut downing the fleshiness degree, an even higher sum have a inclination to get worse for accustomed gluttony and unequal sums of exercising. In some corpulent kids such things as parental separation, divorce, or other emotional subscribers perchance will promote gorging to replace the thing they perceive as losing in antecedently non-obese kid. Furthermore, preteens and adolescents that are may unite stages of overindulge and non eating plenty, finally doing such eating upsets such as binge-eating syndrome and anorexia nervosa.
There are many factors that contribute to the fact that today ‘s young person are corpulent. Society can be blamed. Many kids are set in forepart of a telecasting as a signifier of supervising ; this greatly reduces the aspiration of such kids to make anything else. Most kids do non travel outdoors to play with their friends any longer, as a replacement they have a inclination to hang out at the promenade, film or are playing video games none of these activities make kids exercise any energy. Those kids who have parents who are more active in their auxiliary activities are by and large less likely to go fleshy or corpulent ; these kids are besides more disposed to hold healthier picks of nutrient provided to them. Another indispensable fact that points to society is that households tend to be overly busy, which in bend they make the determination to waive doing a place cooked alimentary repast, often ends up traveling for the immediate attack to make repasts which is fast nutrient. In today ‘s society kids are sent to school without eating breakfast ; the most indispensable repast of the twenty-four hours. In order for a kid to advance the needful sum of metamorphosis for their organic structure to remain healthy it is of import to hold a proper well balanced breakfast. The offense rate in many countries is another lending factor taking to the fleshiness in kids today. There are far more parents afraid to allow their kids travel outdoors and play due to the fact they fear their kid may be abducted by a alien or struck by an out of control rushing vehicle. Examining The Global Epidemic Of Obesity Health Essay. Those kids who would usually be allowed to walk to school as a signifier of exercising are now being dropped off by a parent due to the antecedently mentioned frights.
Some people have said that the issue is fixed in the familial make-up of our organic structure, and the issue is that in the class of the 1000000s of old ages of life on this universe we have been taught to eat every bit much as we could if we got our custodies on a good thing. For illustration a parent stating his or her kid you are non go forthing that table until your home base is clean. ” At the beginning this was in portion to the fact that nutrient was in short supply and so the endurance of the fittest regulation was applied. Alternatively all we have to make now is heat something up from some kind of packaging and name it dinner, so we sit in forepart of one signifier of engineering or another, we have wholly done off with the physical work such as the Hunt that it one time took to fix our repasts, which one time kept people in form. It is really possible that these eating wonts will be passed down to the coevalss yet to come.
Harmonizing to CBS NEWS ‘ Mary Bellizzi an expert with the International Obesity Task Force, there is an approximative 22 million kids under the age of five worldwide are fleshy or corpulent. In some parts of Africa fleshiness affects more kids than malnutrition does every bit much as four times greater. There is an estimated 300 million corpulent people worldwide In the United States ; some 60 % of grownups are fleshy or corpulent, as are about 13 % of kids. The fleshiness undertaking force estimates that in some states, more than 30 % of the kids are corpulent ( Collins, 2007 ) . In Egypt more than 25 % of 4-year-olds are fat and that fleshiness rates are besides more than 25 % T among kids aged between four and 10 in Chile, Peru and Mexico ( Childhood overweight and fleshiness, 2009 ) . The highest rate of childhood fleshiness is in the states where this small to no debris nutrient within the civilizations such as, Egypt, Algeria, and Uzbekistan. The childhood fleshiness rate in Burkina Faso one of the poorest states, is really similar to that of the United States of America considered to be the fast nutrient capital of the universe. Harmonizing to Musaiger in 2004 exercising was the activity done the least sum in Egypt over the class of a typical twenty-four hours. Amongst grownups between the ages of 20 -70 old ages old merely 2 % reported to exerting during a typical weekday, this figure merely increased to 8.5 % on the weekend yearss, and merely a flooring 2.5 % over their annual holidaies ( Musaiger, 2004 ) .
What are some of the best ways to forestall and handle childhood fleshiness? The extra sums of energy consumption in add-on to the diminution in exercising or general activity are the important operators in mention to fleshiness in a kid, comparable with fleshiness in an grownup. With an exercising plan lasting 45 proceedingss in length, a kid who is about 165-kg ( 75-lb ) can fire up to 180 Calories while invariably running, walking, dancing, and biking. While nearing childhood fleshiness, there are three phases of bar to see: aboriginal bar, this phase ‘s primary end is to keep a customary BMI all the manner through babyhood and pubescence. The 2nd phase is known as primary bar, is intended toward halting fleshy kids with a BMI in between the 85th to 95th percentiles from going corpulent. The 3rd phase of bar is referred to as the secondary bar, to take attention of corpulent kids with a BMI above the 95percentile to cut down co-morbidities and turn around fleshy and fleshiness, if possible. Without a uncertainty, the demand to equilibrate the energy consumption with the energy end product is in order to replace the inaction with physical activity. In the disincentive of fleshiness, puting the importance of eating plant-based nutrients, vegetable, and fruit, perchance could be a cardinal measure as to maneuvering clear of nutrients that are considered energy-dense. Body aggregate index is the most normally used method for ciphering whether person weigh excessively much. BMI is calculated by spliting a individual ‘s organic structure weight in kgs by his or her tallness in metres squared ( weight [ kilogram ] /height [ m ] 2 ) . A BMI of 20-24 is considered healthy. Examining The Global Epidemic Of Obesity Health Essay. An grownup is fleshy if his or her BMI is 25 or higher and corpulent at a BMI of 30 ( Grosvenor, 2006 ) .
Other cardinal ways of forestalling fleshiness is proper nutrition during of import developmental phases. During the antenatal phase provide good quality antenatal nutrition and wellness attention, remain off from unneeded maternal weight addition, be in charge of diabetes, aid female parents lose weight after giving birth, and show them with nutritionary instruction. During the first six months of an baby ‘s life promote the female parent to suckle. Try non to present solid nutrients until after six months of age. After the age of six months continue to supply a well balanced diet, doing certain to avoid an surplus of high caloric bites. Make certain to supervise weight addition purely. As the kid reaches the preschool age make available nutrients that facilitate spread outing healthier picks, offer assurance with suited patterns, observe the gait of weight addition in order to avoid fat sedimentations under the tegument, and do available nutritionary instruction to the kid and parents. As young person attacks and becomes the dominant age make certain to detect the gait of weight addition in comparing to the young person ‘s tallness of the kid, in instance the kid starts to derive an inordinate sum make certain to decelerate the weight addition. Be certain proctor and avoid unneeded pre-pubertal fat sedimentations under the tegument. In add-on to supervising the kid offer nutritionary instruction and most of import brand certain the kid is encouraged to acquire out and take part in day-to-day physical activity. The adolescence stage of life may be the hardest to supervise due to the growing jets, nevertheless ; after such growing spurt prevent an inordinate sum of weight addition. Make certain continually to supply and promote nutritionary instruction every bit good as day-to-day physical activity.
Fleshiness is a disease that is traveling to go on to turn quickly over the old ages to come although it can be overcame and cured with merely a small spot of forbearance and difficult work. Obesity serves to hold the potency of a fatal disease, which can be cured with exercising. If we take away a part of the telecasting clip from our kids, which is act uponing them the most with the commercials of fast nutrient or nutrients that are unhealthy for them, this would be a good starting land. With each high fat, high caloric nutrient they ingest, the more likely they are to develop such wellness jobs as high cholesterin, metabolic syndrome. Type 2 diabetes is another serious disease that can develop as a consequence of fleshiness. The grownups hold a cardinal duty in educating the following coevals about the turning epidemics. They need to educate the kids of the utmost earnestness of both fleshiness and diabetes. Smoke is considered to be far worse than fleshiness as of right now nevertheless it is my belief that if the epidemic continues to distribute that fleshiness will take far more lives than those taken by smoking. Examining The Global Epidemic Of Obesity Health Essay.
The effects of fleshiness are non merely felt by those who are enduring from the disease, nevertheless all the people within the society are experiencing the effects. See the lifting monetary values in wellness attention insurance, as there are more people diagnosed as being corpulent and needing extra medical specialties the cost of these services get passed on to all consumers of the needful insurance. Another consequence of fleshiness is those that the auto industries are sing. The auto industries have to redesign the vehicles to suit the of all time turning members of society. All though this seems like a really infinitesimal alteration nevertheless in bend causes the monetary values of vehicles to increase, impacting the consumers. ( The Effects of Obesity on Society as a Whole, 2009 )
What about the ill will and biass that those who are corpulent face on a day-to-day footing? Equally extreme as it may be there was one time a medical physician on a wireless talk show in the United Kingdom that suggested that McDonalds make their doors smaller so that corpulent people could n’t acquire through them ( Shah, 2008 ) . See the fact that some employers will happen a ground to turn down an corpulent occupation applicant due to their ain antipathy for the corpulent. Is it right non by any agencies nevertheless it happens. The employers besides use the logical thinking of the increased wellness attention insurance ; besides if the corpulent individual is hired they are more likely hired on at the lower paid chance. The corpulent individual may be perceived as being lazy even if in the yesteryear and continues into the hereafter doing the efforts to lose the excess weight. There may be one top to being corpulent, the fact that the friends an corpulent individual discoveries will most probably be echt friends because they are judging on personality and non looks or abilities.

In his Annual report of 2002, the UK Chief Medical Officer has described it as a health time bomb.

Overweight and obese children are likely to stay obese into adulthood with increased risk of associated major chronic diseases. Consequently, socioeconomic disparities observed in obesity supplement socioeconomic inequalities in health (Law et al., 2007). Prevention of childhood obesity therefore is critical.

In this paper, the author will examine the complex interaction of social, economic, biological and environmental determinants of health that may explain the recent explosion, shifts in demographic trends of this worldwide problem, and briefly explore lifestyle and behavioural factors that may create particular risks. A discussion about causes, complications and treatment options of childhood obesity will follow.

The author will review and analyse determinants and health policy initiatives, critically appraise various global, national and local strategies, initiatives and interventions, which aim to prevent obesity in childhood and examine their link to conventional health promotion models and theories. Examining The Global Epidemic Of Obesity Health Essay.

By critically examining the range of interactions and existing initiatives, the author seeks to propose appropriate interventions to tackle the growing challenge of childhood obesity.

Key words: childhood obesity, inequalities, policy, strategy, prevention, health promotion

DEFINITION

Obesity/Adiposity is defined as ‘a condition characterised by excessive body fat’. Body fat can either be stored predominantly around the waist or around the hips.

Body Mass Index (BMI) is used to measure obesity and defined as:

Bodyweight (Kg) (Keys et al., 1972)

Height (m) 2

BMI is useful in clinical practice and epidemiologic studies, but has limitations. Freedman et al. (2004) reported that although BMI is a good measure of fat mass in children with high BMIs, it is not a reliable indicator in thinner children. Two international datasets that are widely used to define overweight and obesity in pre-school children are International Obesity Task Force (IOTF) reference and World Health Organisation (WHO) Child Growth Standards (2006). None is superior to the other and both tend to underestimate or overestimate the prevalence when used on the same population (Monasta et al. 2010).

Thresholds for obesity in children in UK (and Scotland) are measured by referring to

UK National BMI classification system that uses reference curves based on data from several British studies between 1978 and 1990 (Cole et al, 2000).

Children are classified as overweight or obese using the 85th and 95th percentiles as cut points.

PREVALENCE, trends and costs

Obesity has become an epidemic in many parts of the world and surveys over the last decade have documented the rapidly increasing prevalence of obesity and overweight among children along with rising socioeconomic inequalities (Wang and Lobstein, 2006; Lobstein, Baur and Uauy, 2004).

The latest WHO report (Mercedes, Monika and Elaine, 2010) based on surveys from 144 countries estimates that globally, 43 million children (including 35 million in developing countries) are overweight and obese and another 92 million are at risk of overweight. This corresponds to a prevalence increase from 4.2% in 1990 to 6.7% in 2010.

In England, 2008 figures showed 16.8% of boys aged 2 to 15, and 15.2% of girls were classed as obese, an increase from 11.1% and 12.2% respectively in 1995 (The Health and Social Care Information Centre, 2010). Amongst Organisation for Economic Cooperation and Development (OECD) countries, only USA and Mexico having higher levels of obesity than Scotland and this is expected to get worse even with current intervention practices. Scottish Govt. report (2010) states that in 2008, 15.1% children were obese and 31.7% were overweight.

Amidst this doom and gloom scenario are recent reports (Stamatakis, Wardle and Cole, 2010) showing trends in overweight and obesity prevalence have stabilized or reversed in pre-teens and early teenage years in France, Switzerland and Sweden. Examining The Global Epidemic Of Obesity Health Essay.In the US too, the obesity epidemic may be stabilising (Ogden et al.,2010) but it is too early to know whether the data do reflect a true plateau (Cali and Caprio, 2008). Similarly, in England, trends in overweight and obesity prevalence have levelled off after 2002 (Stamatakis, Wardle and Cole, 2010); however, socioeconomic inequalities have deepened.

Healthcare (direct) costs of obesity are only a fraction of overall (indirect) costs to society (McCormick, 2007) which are due to loss of employment, production levels and premature pensions and deaths. Obesity is responsible for 2-8% of total health costs in Europe and other developed countries (WHO, 2007).

Direct costs of obesity in Scotland were about £175 million in 2007/8 and expected to double by 2030. The indirect costs were much higher (about £457 million) and expected rise to £0.9 billion-£3 billion by 2030 (Scottish Govt. report, 2010).

In England, recent estimate of direct obesity-related costs to NHS is £4.2 billion and this may double by 2050. Cost to the wider economy is in the region of £16 billion, and will rise to £50 billion per year by 2050 if left unchecked (Department of Health (DH) report, 2010).

INEQUALITIES

Although no clear relationship between socio-economic status (SES) in early life and childhood obesity (but confirmed a strong relationship with increased fatness in adulthood) was reported by Parsons et al.,(1999); a more recent systematic review by Shrewsbury and Wardle (2008) supports the view that overweight and obesity tend to be more prevalent among socio-economically disadvantaged children in developed countries. Similar patterns are shown in data from England (Stamatakis, Wardle and Cole, 2010; Law, 2007) and Scotland (Scottish Govt. report, 2010).

However, trends vary within different ethnic populations as highlighted by Wang and Zhang (2006); a review by Caprio et al. (2008) who studied the influence of race, ethnicity and culture on obesity trends concluded higher prevalence in non-Caucasian populations in US.

Although earlier reports (Wang, 2001) revealed that the burden of this problem was mainly in wealthier sections of the population in developing nations, recent reports (Lobstein, Baur and Uauy, 2004; Wang and Lobstein, 2006) indicate that prevalence is rising among the urban poor in these countries, possibly due to their exposure to Westernized diets overlapping with a history of undernutrition.

The reasons for the differences in prevalence of childhood obesity among population groups are complex, involving race, ethnicity, genetics, physiology, culture, SES including parental education, environment, as well as interactions among these variables (Law et al.,2007; Caprio and Cali, 2008; Townsend and Ridler, 2009).

ETIOPATHOGENESIS and COMPLICATIONS

Kirk, Penney and McHugh (2010) argue the complexity of the obesogenic environment, which comprises of personal (e.g. diet and physical activity preferences; disability), physiological (e.g. genetics, race and ethnic, psychological, metabolic) and environmental factors (home, school, and community). Other contributory factors are influences in society (e.g., social and peer influences, food advertisements) and availability of and access to optimal health care.

Although genetic factors can have an effect on individual predisposition (Wardle et al., 2008), perinatal and maternal factors explain rapidly rising global prevalence rates. Key perinatal factors for childhood obesity (Wojcik and Mayer-Davis (2010), cited in Freemark, 2010) are maternal overweight before, during and after pregnancy, smoking and bottle-feeding. The mother’s dietary habits and level of physical activity are also significant.

Decreased physical activity levels associated with sedentary recreation (video and computer games), mechanised transportation (less walking), and increasing urbanization (limited opportunity to physical activity) are all associated with increased risk of obesity (Trost et al. 2001; Gordon-Larsen, McMurray and Popkin, 2000). Children with disability are at a greater risk to develop obesity (Reinehr et al.,2010); factors include health concerns and restricted access to physical activity.

Epstein et al. (2008) propose that television viewing encourages weight gain not only by decreasing physical activity, but also by increasing energy intake.Examining The Global Epidemic Of Obesity Health Essay.  In addition, television advertising could adversely affect dietary patterns throughout the day (Lewis and Hill, 1998).

Psychosocial factors can influence dietary and physical activity behaviours that define energy balance. Children who suffer from neglect and depression are at increased risk for obesity during childhood and later in life (Johnson GJ et al.,2002; Pine DS et al.,2001).In contrast, social support from parents and others increases participation in physical activity of children and adolescents (Sallis, Prochaska, Taylor, 2000).

There is evidence that breast milk in infancy may protect against overweight in childhood (Harder et al.,2005) while intake of foods with high glycemic index, sugary soft drinks and “fast foods” are associated with increased risk and prevalence of childhood obesity (Ludwig et al.,2001; French, 2001); however, long term trials are needed to corroborate this association. Also, eating out (Zoumas-Morse et al.,2001) appears to be an important contributory life style factor.

Excessive fat in the diet is believed to cause weight gain (Jequier, 2001); though, this association is not consistently shown in epidemiological studies (Atkin L-M Davies, 2000; Troiano,2000).

Lustig (2006) proposes that the relationship between changes in the environment and neuroendocrinology of human energy balance is complex. The author explains that behaviours of increased caloric intake and decreased energy expenditure are secondary to obligate weight gain that is due to associated hyperinsulinemia, leptin antagonism and interference with normal satiety.

Childhood obesity is a multisystem disease with potentially serious complications.

Several studies suggest that childhood overweight/obesity is associated with increased risk of mortality in adult life (Gunnell,1998; Dietz,1998). Young-Hyman et al. (2001) have documented cardiovascular risk factors along with insulin resistance in children as young as five years old. The rising prevalence of type 2 diabetes in obese children is worrying in view of the vascular complications (heart disease, stroke, limb amputation, kidney failure, blindness) (Ludwig and Ebbeling,2001). These risks appear to be higher in non-Caucasians (Goran, Ball and Cruz,2000). Examining The Global Epidemic Of Obesity Health Essay. According to Strauss, (2000) adverse psychosocial effects are more severe in white girls.

Treatment

Effective intervention is essential because obese children are likely to face substantial health risks as they mature (Cali and Caprio, 2008). Further, as healthcare costs of this problem are rising (Wang and Dietz, 2002); intervention is required to prevent morbidity in adulthood while effective tools for primary prevention are developed.

Spear et al. (2007) reviewed the evidence about the treatment options in primary care, community, and tertiary care settings and proposed a comprehensive 4-step approach for weight management. Uli, Sundarajan and Cuttler (2008) support a similar strategy.

Several reviews of lifestyle (i.e. dietary, physical activity and/or behavioural therapy) interventions for treating childhood obesity (Oude- Luttikhuis et al.,2008; Wilfley et al., 2007) have concluded that family based combined behavioural and lifestyle interventions can produce significant reduction in overweight in children and adolescents. Although Golan and Crow (2004) suggested that targeting exclusively parents for change was superior to targeting only children for change, behavioural approaches involving both parents and children in the framework of a combined lifestyle intervention appear to be more effective (Wilfley et al. 2007; Epstein 1994; Bronwell, Kelman and Stunkard 1983). Moreover, intensive lifestyle intervention (with daily exercise, mandatory caloric restriction, multiple clinic visits and counselling sessions) appears to be more successful (Nemet at al. 2005) than standard lifestyle intervention (Epstein and Wing 1980).

There is no consistent evidence to show that decreasing sedentary behaviour by reducing television viewing is effective in weight reduction (Dennison et al. 2004; Gortmaker et al. 1999). However, limiting TV food advertising to children appears to be a useful cost-effective population-based intervention (Magnus et al. 2009).

In obese adolescents, treatment with orlistat or sibutramine as adjunct to lifestyle intervention is prescribed sometimes. However, these drugs can have significant side effects and this approach needs close monitoring and follow-up (Freemark, 2007). Examining The Global Epidemic Of Obesity Health Essay.

Morbidly obese adolescents can benefit from sizeable weight loss following bariatric surgery but with potential serious complications (Lawson et al., 2006; Uli et al.,2008). This necessitates close follow-up and dedication to a specialized dietary regimen (Shen, Dugay and Rajaram, 2004) for successful results.

Evidence base of school-based interventions:

Systematic reviews of random controlled trials (RCT) by Reilly and McDowell (2003) and Bluford, Sherry and Scanlon (2007) did not find sufficient evidence base for interventions to prevent childhood obesity and recommended further research. In contrast, Thomas et al. (2004) put forward a more positive conclusion in their review. Similarly, Flynn et al. (2006) and Doak et al. (2006) reported favourable outcomes in nearly all trials they reviewed.

Interestingly, in an analysis of school-based programs, authors from National Institute for Health and Clinical Excellence (NICE), UK (2006) indicated that the evidence does not convincingly support the “multidisciplinary whole school” approach promoted by UK National Healthy Schools Program.

Nonetheless, Connelly, Duaso and Butler (2007) in their review of RCTs have supported a decisive role for obligatory provision of aerobic physical activity in schools coupled with nutritional education and skills training. Finally, Kropski, Keckley and Jensen’s review (2008) concludes that although evidence is limited, schools play an important role in prevention strategies and directing different techniques at boys and girls may have more impact.

HEALTH PROMOTION MODELS RELATED TO PREVENTION OF CHILDHOOD OBESITY

Knowledge-Attitude-Behaviour model proposes that as knowledge accumulates, changes in attitude are set off resulting in gradual change in behaviour (Baranowski 1999). The model assumes that a person is logical by instinct. However, evidence shows that generally people in a variety of circumstances do not act logically (Shafir and LeBeouf, 2002). A common application of this model to promote change is providing health and nutritional information within school syllabi.

Gaining knowledge may help to set goals and boost self-confidence but has not been shown to cause change in behaviour (Schnoll and Zimmermann, 2001) or to change in physical activity behaviour (Rimal, 2001) except perhaps in specific “right” people (Wang and Biddle 2001). Besides, there is no evidence that interventions based only on education strategies will change behaviour (Contento et al.,1995).

According to Behaviour Learning Theory (BLT), when a specific stimulus elicits a desired behaviour, there is increased likelihood of that behaviour recurring if that behaviour is reinforced (Skinner,1938 as cited in Baranowski et al.,2003).

A modern version of BLT, the Behavioural Economics model (Epstein and Salaens,1999) suggests behaviour is the result of benefits and costs where benefits are reinforcers.Examining The Global Epidemic Of Obesity Health Essay.  Obese people find food more reinforcing than others do whereas physical activity has greater reinforcing value among non-obese people. In addition, preference for a specific physical activity declines when the distance to that activity increases which reduces the reinforcing value of that activity (Raynor, Coleman and Epstein, 1998). Thus, obese people are more likely to find behaviours that lead to obesity more reinforcing.

Saelens and Epstein (1998) applied the model successfully in obtaining increased physical activity. However, application of reinforcers on controlling behaviour is challenging and can be beyond the ability of many parents.

The Health Belief Model explains the utility of health services. It has been widely applied to health-related behaviours (Janz, Champion and Strecher, 2002). The model describes health actions through the interaction of sets of beliefs: perceived susceptibility, perceived seriousness perceived benefits and disadvantages and cues to action.

A meta-analysis study by Witte and Allan (2000) of fear-based communications revealed that they could induce behavioural change by affecting individual’s perception of threat. However, children and adolescents often tend to perceive themselves as invincible, thus the concept of fear, threat and perceived risk and susceptibility are not useful in this age group. HBM may become more relevant if people perceive obesity as a serious threat waiting to happen to them (Baranowski, 2003).

Social Cognitive Theory (SCT) proposes (Bandura 1999) that behaviour is a function of continuous mutual interaction between the environment and the person. The theory assumes that people generally strive for positive outcomes and evade negative ones by changing their behaviours by using self-control.

Programs based on SCT have resulted in some changes as reported in a review by Sharma (2006) of school-based interventions for preventing childhood obesity where SCT was the most popular intervention tool. However, the theory lacks predictability for understanding children’s behaviour that is related to food and activity–it could be that the concepts are too complex for children (Baranowski, Cullen and Baranowski,1999). Furthermore, children may not be expected to or capable of sufficient self-control over their diet and physical activity. Environmental variables like parenting and availability of food and physical equipment may be more beneficial (Cullen et al.,2003). Examining The Global Epidemic Of Obesity Health Essay.

Theory of Reasoned Action (TRA) and Theory of Planned Behaviour (TPB):

To explain the relation between attitudes and behaviour (Ajzen and Fishbein,1975 in Baranowski et al.,2003) proposed TRA and said that people are more prone to perform a specific behaviour when they have the intention to perform it. The theory has many limitations – one is that presence or absence of choice can influence behaviour – e.g. unable to perform the intention to buy healthy food due to its unavailability in the local store. Ajzen and Madden (1986) modified TRA to TPB, which emphasises that perceived behavioural control influences intention. Goding and Kok’s review (1996) argued that the efficiency of the theory varies between health-related behaviour categories. TPB model has been applied to childhood obesity prevention programs with results showing both good (Andrews, Silk and Eneli, 2010) and mixed (Fila and Smith, 2006) predictability.

The Transtheoretical model (T) proposes that health behaviour change progresses through six stages of change: “pre-contemplation, contemplation, preparation, action, maintenance, and termination” and describes 10 processes that enable this change (Prochaska et al.,1992). The model has been successfully applied in addictive disorders but has limitations when applied in the treatment of eating and weight disorders (Wilson and Schlam, 2004). T has been applied to obesity with studies reporting both good (Sarkin et al., 2001) and poor predictability (Macqueen, Brynes and Frost, 2002 in Wilson and Schlam, 2004).

The complex etio-pathogenesis of childhood obesity suggests that Social Ecological (SE) Models may generate creative and lasting solutions (Huang and Glass, 2008). The SE model initiated by Bronfenbrenner (1977) and subsequently developed for understanding obesity by Davison and Birch (2001) and Story et al., (2008) proposes that individuals contribute their cognitions, skills and behaviours, lifestyle, biology and demographics, while surrounded in other circles representing the social, physical and macro-level environments to which they are exposed.

Swinburn, Egger and Raza (1999) have described the ANGELO (analysis grid for environments linked to obesity) framework which is an ecological model for understanding environments that are obesogenic. Examining The Global Epidemic Of Obesity Health Essay.

Figure 1. The IOTF model is a SE model and describes societal policies and processes with direct and indirect influences on body weight (Kumanyika et al.,2002) as shown here in Figure 1(above).

An ecological approach is also the basis of the Canadian model, Child Health Ecological Surveillance System (CHESS). As illustrated in Appendix 4, it demonstrates a local approach to tackle childhood obesity and has possible global implications (Plotnikoff, 2010).

Global, regional and national prevention strategies

As part of the response to fight the childhood obesity epidemic, WHO (2004) developed the Global Strategy for Diet, Physical Activity and Health (DPAS) and produced a range of tools to assist Member States and stakeholders to implement DPAS. It emphasised that National plans should have achievable short-term and intermediate goals.

A schematic model developed for WHO by Sacks, Swinburn and Lawrence (2009) for implementation and monitoring of DPAS provides the basis for a framework for action and explains how supportive environments, policies and programmes can influence behaviour change in a population and have lasting environmental, social, health and economic benefits. The monitoring and evaluation component provides the foundation for promotion, policy development and action.

Figure 2: Implementation framework for the Global Strategy on Diet, Physical Activity and Health.

The model emphasises the need of right mix of upstream (socio-ecological) approaches to shape the economic, social and physical (built and natural) environments, midstream ( lifestyle) approaches to directly influence behaviour (reducing energy intake and increasing physical activity), and downstream (health services) approaches to support health services and clinical interventions (Sacks, Swinburn and Lawrence, 2008 in WHO report, 2009).

According to WHO (2009), population-based prevention strategies developed in the context of a ‘social determinants-of-health’ approach and implemented both at the national level and locally in school and community-based programmes will help to change the social norm by encouraging healthy behaviours. Furthermore, transferring the responsibility of tackling health risks from the individual to decision-makers will help to combat associated socio-economic inequalities.Examining The Global Epidemic Of Obesity Health Essay.  In addition, strategies will need coordinated action by multiple stakeholders and effective leadership for success.

Surveillance tools for growth assessment recommended by WHO are Child Growth Standards (WHO Reference, 2007) and the Global School-based Student Health Survey (GSHS) (WHO, 2009).

Key challenges of population based strategies identified by WHO are increasing globalization of food systems that have created economic and social drivers of obesity through changes in food supply and people’s diets, worsening socioeconomic inequalities and tackling obesity in children with physical and/ or mental disabilities. Other important hurdles are poorly designed urbanisation and achieving cost-effectiveness. In this regard, combined approaches that address multiple determinants can improve efficiency of intervention programmes according to a model-based analysis by OECD and WHO (Sassi 2009 in WHO report 2009).

The Ottawa Charter for Health Promotion (WHO 1986) recommends that global prevention strategies should work at multiple settings (e.g. schools, after-school programmes, homes and communities and clinical settings) and use the correct mix of approaches for a given situation along with concern for country- and community-specific factors, such as availability of resources and/or socioeconomic disparities.

It emphasises that such strategies must identify and include at-risk groups, set priorities and realistic targets and engage with all stakeholders in a transparent manner. The public should have access to information on partnerships including potential conflicts of interest. Successful implementation and sustenance of such strategies depends on long-term planning, budgeting and identifying cost-effective interventions such as the ACE-Obesity project (Carter et al., 2009). It is also important to dissociate private sector funding from projects that set direction and techniques of such programs by adopting novel funding strategies.

The IOTF (2007) have developed in consultation with WHO a set of (Sydney) principles that define the commercial promotions of foods and beverages to children and guide action on changing marketing practices them. The principles aim to ensure a degree of protection for children against obesogenic foods and beverages.

The European Union (EU) Member States have adopted the European Charter on Counteracting Obesity (2006), which defines WHO policies and action areas at the local, regional, national and international levels for all interested parties in government and private sectors (e.g. food manufacturers, advertisers and traders) and also organizations of professionals (providers) and consumers (users). Examining The Global Epidemic Of Obesity Health Essay.

Policy strategies emphasise the need to identify and focus on at-risk population groups, set realistic goals, and use efficiently coordinated multiple settings and approaches. They also stress the need for research into all aspects of treatment and prevention methods and develop creative sustainable funding (WHO Europe, 2007).

In UK (England), to encourage individual behavioural change, the strategy “Healthy Weight, Healthy Lives: A Cross-Government Strategy” (DH, 2008) has been developed with emphasis on healthy growth and development of children, promotion of healthier food choices and bringing physical activity into people’s lives by building healthy towns on the “EPODE model” ( Borys 2006). It also aims to provide personalised advice and support and create incentives to be healthy.

Policy drivers include national policy changes (e.g. increased support for monitoring of growth, promotion of breast feeding, bans on unhealthy food advertisements, social marketing campaigns) and changes to the food supply (e.g. development of a healthy food code, front-of-pack labelling, limits on fast-food restaurants near schools and parks, increased supply of fresh fruit and vegetables to stores in deprived areas). Change4Life is the marketing arm of the Government’s strategy to stress on prevention through healthier habits from early life (DH, 2009).

Other strategies are development of a national physical activity plan in part tied to the 2012 Olympics with the purpose of improving built environments and support more weight management services. The national Government leads the project and provides resources for local authorities, National Health Service (NHS), and community care partnerships. Government agencies and their partners coordinate to raise funds and integrate projects into existing strategies and programmes for cost-effectiveness.

Long-term goals include developing a national dialogue on society’s response to the epidemic of obesity, provide more support and guidance for PCTs and local authorities and build up skills and capabilities of staff, set aside extra resources and while demonstrating good governance and clear accountability.

In Scotland, the Government and Convention of Scottish Local Authorities (COSLA) have developed a Route Map for decision-makers in government to work with their partners, NHS and businesses to develop and deliver lasting solutions to prevent overweight and obesity (Scottish 2010).Examining The Global Epidemic Of Obesity Health Essay.  The Government has targets to “reduce the rate of increase in the proportion of children with unhealthy BMI by 2018 but none yet for obesity or weight management”.

The aim is to reduce energy consumption, increase physical activity, minimise sedentary behaviour, and create positive health behaviour through early life interventions and building healthier work place environments.

Policy drivers to manage obesity include “HEAT” (health, efficiency, access and access target) which measures achievement rates for intervention programmes, “Counterweight” which is a second-level program to support people who need management of their weight, and “Scottish Enhanced Services” that provides childhood obesity services in primary and community care settings.

To prevent obesity, the Government has developed several initiatives in a framework “Let’s Make Scotland More Active” which is for promoting increased physical activity. Policies to help build healthier lifestyle are the National Food and Drink Policy “Recipe for Success”, eight “Healthy Weight Communities” programmes nation-wide, and “Seven Smarter Choices Smarter Places” to study travel behaviours of communities and their potential to adopt healthier choices.

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“Take Life On” is a national social marketing drive that aims to improve diet and fitness of communities and “Beyond the School Gate” and Scotland’s “Healthy Weight Outcomes Framework” will provide guidance to help create health-promoting communities.

In addition, there are several national programs directed to a “Greener, Healthier, Smarter, Safer and Stronger Scotland” which are likely to have indirect contribution to tackle overweight and obesity. Examining The Global Epidemic Of Obesity Health Essay.

CONCLUSION:

The essay emphasises the rapidly increasing burden of childhood obesity with associated population profile changes and increasing social inequalities. It explains the complex multifaceted and interlinked causal pathways that form the obesogenic environment.

The author has described community and school-based obesity intervention and prevention programmes and explored the role of research protocols in gathering evidence for such interventions and their usefulness. Various prevention strategies and interventions (singly and in combination) that are in practice and the settings and conditions in which they may be effective are reviewed and compared. Existing global, regional and national prevention and implementation strategies and their need to tackle upstream influences to fight childhood obesity are explained.

The present evidence for effective treatment and prevention of childhood obesity is not consistent. It is very difficult to attain significant weight on a long term basis in spite of strenuous efforts – it could be that present prescriptions for diet and exercise are not as effective as they need to be; in addition, the adversities in the environment can overwhelm the beneficial effects of techniques used in current intervention techniques.

Further research is required to identify realistic options for treatment and best practice procedures for public health policies that are cost-effective, culturally sensitive, deal with upstream influences and address population inequalities. Although numerous school and community based programs are having an impact, there is a need for evidence to evaluate effective social interventions so that social policies direct healthy lifestyle approaches.

From the review of available evidence, the author has learnt that policymakers and professional. Examining The Global Epidemic Of Obesity Health Essay.