Childhood obesity

Childhood obesity is a condition where excess body fat negatively affects a child's health or well-being. As methods to determine body fat directly are difficult, the diagnosis of obesity is often based on BMI. Due to the rising prevalence of obesity in children and its many adverse health effects it is being recognized as a serious public health concern. The term 'overweight' rather than 'obese' is often used when discussing childhood obesity, as it is less stigmatizing, although the term 'overweight' can also refer to a different BMI category. The prevalence of childhood obesity is known to differ by sex and gender.

Classification

Body mass index (BMI) is acceptable for determining obesity for children two years of age and older. It is determined by the ratio of weight to height.

The normal range for BMI in children vary with age and sex. While a BMI above the 85th percentile is defined as overweight, a BMI greater than or equal to the 95th percentile is defined as obesity by Centers for Disease Control and Prevention. It has published tables for determining this in children.

The US Preventive Service Task Force reported that not all children with a high BMI need to lose weight though. High BMI can identify a possible weight problem, but does not differentiate between fat or lean tissue. Additionally, BMI may mistakenly rule out some children who do have excess adipose tissue. It is therefore beneficial to supplement the reliability of a BMI diagnosis with additional screening tools such as adipose tissue or skin fold measurements.

Effects on health

Psychological

The first problems to occur in obese children are usually emotional or psychological. Obese children often experience bullying by their peers.Obesity.Org
/ref> Some are harassed or discriminated against by their own family. Stereotypes abound and may lead to low self-esteem and depression.

Physical

Childhood obesity however can also lead to life-threatening conditions including diabetes, high blood pressure, heart disease, sleep problems, cancer, and other disorders. Some of the other disorders would include liver disease, early puberty or menarche, eating disorders such as anorexia and bulimia, skin infections, and asthma and other respiratory problems.

The early physical effects of obesity in adolescence include, almost all of the child's organs being affected, gallstones, hepatitis, sleep apnoea and increased intracranial pressure. Overweight children are also more likely to grow up to be overweight adults. Obesity during adolescence has been found to increase mortality rates during adulthood.

A 2008 study has found that children who are obese have carotid arteries.

Long-term effects

Children who are obese are likely to be obese as adults. Thus, they are more at risk for adult health problems such as heart disease, type 2 diabetes, stroke, several types of cancer, and osteoarthritis. One study showed that children who became obese as early as age 2 were more likely to be obese as adults. According to an article in ''The New York Times'' all of these health effects are contributing to a shorter lifespan of five years for these obese children. It is the first time in two centuries that the current generation of children in America may have a shorter lifespan than their parents.

Causes

Childhood obesity can be brought on by a range of factors which often act in combination. "Obesogenic environment" is the medical term set aside for this mixture of elements. The greatest risk factor for child obesity is the obesity of both parents. This may be reflected by the family's environment and genetics. Other reasons may also be due to psychological factors and the child's body type.

A 2010 review stated that childhood obesity likely is the result of the interaction of natural selection favouring those with more parsimonious energy metabolism and today's consumerist society with easy access to energy dense cheap foods and less energy requirements in daily life.

Factors include the increase in use of technology, increase in snacks and portion size of meals, and the decrease in the physical activity of children. A study found kids that use electronic devices 3 or more hours a day had between a 17- 44% increased risk of being overweight, or a 10- 61% increased risk of obese (Cespedes 2011).

Childhood obesity is common among children from, low-income, African American and Hispanic communities. This is mainly because minority children spend less time playing outside the house and staying active. Some contributors to childhood obesity is that parents would rather have their children stay inside the home because they fear that gang, drug violence, and other dangers might harm them.

Genetics

Childhood obesity is often the result of an interplay between many genetic and environmental factors. Polymorphisms in various genes controlling appetite and metabolism predispose individuals to obesity when sufficient calories are present. Over 200 genes affect weight by determining activity level, food preferences, body type, and metabolism. Having two copies of the allele called FTO increases the likelihood of both obesity and diabetes.

As such, obesity is a major feature of a number of rare genetic conditions that often present in childhood:

* Prader–Willi syndrome with an incidence between 1 in 12,000 and 1 in 15,000 live births is characterized by hyperphagia and food preoccupations which leads to rapid weight gain in those affected.
* Bardet–Biedl syndrome
* MOMO syndrome
* Leptin receptor mutations
* Congenital leptin deficiency
* Melanocortin receptor mutations

In children with early-onset severe obesity (defined by an onset before ten years of age and body mass index over three standard deviations above normal), 7% harbor a single locus mutation.

One study found that 80% of the offspring of two obese parents were obese in contrast to less than 10% of the offspring of two parents who were of normal weight. The percentage of obesity that can be attributed to genetics varies from 6% to 85% depending on the population examined.

Family practices

In the recent decades, family practices have significantly changed, and several of these practices greatly contribute to childhood obesity:
* With a decreasing number of mothers who breast-feed, more infants become obese children as they grow up and are reared on infant formula instead.
* Less children go outside and engage in active play as technology, such as television and video games, keep children indoors.
* Rather than walking or biking to a bus-stop or directly to school, more school-age children are driven to school by their parents, reducing physical activity.
* As family sizes decrease, the children's pester power, their ability to force adults to do what they want, increases. This ability enables them to have easier access to calorie-packed foods, such as candy and soda drinks.
* The social context around family meal-time plays a role in rates of childhood obesity

Social policies

Different communities and nations have adopted varying social practices and policies that are either beneficial or detrimental to children's physical health. These social factors include:
* the quality of school lunches
* the emphasis of schools on physical activity
* access to vending machines and fast-food restaurants
* prevalence of and access to parks, bike paths, and sidewalks
* government subsidies for corn oil and sugar
* advertising of fast-food restaurants and candy
* prices of healthy and unhealthy foods
* access to fresh, healthy, and affordable food

Advertising

Advertising of unhealthy foods to children increases their consumption of the product and positive attitudes (liking or wanting to buy) about the advertised product. Children's critical reasoning (the ability to understand what an advertisement is and the aim of advertising to buy the product) is not protective against the impact of advertising, and does not appear to be fully developed during adolescence. In some nations, advertising of candy, cereal, and fast-food restaurants is illegal or limited on children's television channels. The media defends itself by blaming the parents for yielding to their children's demands for unhealthy foods.

Socioeconomic status

It is much more common for young people who come from a racial or ethnic minority, or for those who have a lower socioeconomic status, to be overweight and to engage in less healthy behaviors and sedentary activities.

Prevention

Schools play a large role in preventing childhood obesity by providing a safe and supporting environment with policies and practices that support healthy behaviors. At home, parents can help prevent their children from becoming overweight by changing the way the family eats and exercises together. The best way children learn is by example, so parents should lead by example by living a healthy lifestyle. Screening for obesity is recommended in those over the age of six. Both physical activity and diet can help to reduce the risk of obesity in children from 0 to 5 years old; meanwhile, exclusive physical activity can reduce the risk of obesity for children aged from 6 to 12 years old, and adolescents aged from 13 to 18 years old. The implementation of strategies to improve childcare services such as preschools, nurseries, daycare, and kindergarten on healthy eating, physical activity, and obesity prevention shows little effect on a child's diet, physical activity, and weight status.

Maternal Body Mass Index

Maternal body mass index (BMI) is an important predictor of childhood obesity. Mothers with pre-pregnancy obesity, as defined by BMI ≥30 kg/m², are known to have children that have higher growth rates and more likely to have obesity.

Dietary

The effects of eating habits on childhood obesity are difficult to determine. A three-year randomized controlled study of 1,704 3rd grade children which provided two healthy meals a day in combination with an exercise program and dietary counsellings failed to show a significant reduction in percentage body fat when compared to a control group. This was partly due to the fact that even though the children believed they were eating less their actual calorie consumption did not decrease with the intervention. At the same time observed energy expenditure remained similar between the groups. This occurred even though dietary fat intake decreased from 34% to 27%. A second study of 5,106 children showed similar results. Even though the children ate an improved diet there was no effect found on BMI. Why these studies did not bring about the desired effect of curbing childhood obesity has been attributed to the interventions not being sufficient enough. Changes were made primarily in the school environment while it is felt that they must occur in the home, the community, and the school simultaneously to have a significant effect.

A Cochrane review of a lower fat diet in children (30% or less of total energy) to prevent obesity found the existing evidence of very low to moderate quality, and firm conclusions could not be made.

Calorie-rich drinks and foods are readily available to children. Consumption of sugar-laden soft drinks may contribute to childhood obesity. In a study of 548 children over a 19-month period the likelihood of obesity increased 1.6 times for every additional soft drink consumed per day.

Calorie-dense, prepared snacks are available in many locations frequented by children. As childhood obesity has become more prevalent, snack vending machines in school settings have been reduced by law in a small number of localities. Some research suggests that the increase in availability of junk foods in schools can account for about one-fifth of the increase in average BMI among adolescents over the last decade. Eating at fast food restaurants is very common among young people with 75% of 7th to 12th grade students consuming fast food in a given week. The fast food industry is also at fault for the rise in childhood obesity. This industry spends about $4.2 billion on advertisements aimed at young children. McDonald's alone has thirteen websites that are viewed by 365,000 children and 294,000 teenagers each month. In addition, fast food restaurants give out toys in children's meals, which helps to entice children to buy the fast food. According to a 2010 report, 40% of children aged 2 to 11 asked their parents to take them to McDonald's at least once a week, and 15%of preschoolers asked to go every day. To make matters worse, out of 3000 combinations created from popular items on children's menus at fast food restaurants, only 13 meet the recommended nutritional guidelines for young children. Some literature has found a relationship between fast food consumption and obesity. Including a study which found that fast food restaurants near schools increases the risk of obesity among the student population.

Whole milk consumption verses 2% milk consumption in children of one to two years of age had no effect on weight, height, or body fat percentage. Therefore, whole milk continues to be recommended for this age group. However the trend of substituting sweetened drinks for milk has been found to lead to excess weight gain.

Legal

Some jurisdictions use laws and regulations in an effort to steer children and parents towards making healthier food choices. Two examples are calorie count laws and banning soft drinks from sale at vending machines in schools. In 2017 the Obesity Health Alliance called on the United Kingdom government which would be formed after that year's general election to take measures to reduce childhood obesity, for example by banning advertisements for unhealthy foods before 9:00 pm and banning sports sponsorship by manufacturers of unhealthy foods. The failure of Theresa May's then incumbent government to cut sugar, fat and salt content in foods was criticised by health groups. Health experts, the health select committee and campaigners described Conservative plans over childhood obesity as, "weak" and "watered down".

Physical activity

Physical inactivity of children has also shown to be a serious cause, and children who fail to engage in regular physical activity are at greater risk of obesity. Researchers studied the physical activity of 133 children over a three-week period using an accelerometer to measure each child's level of physical activity. They discovered the obese children were 35% less active on school days and 65% less active on weekends compared to non-obese children.

Physical inactivity as a child could result in physical inactivity as an adult. In a fitness survey of 6,000 adults, researchers discovered that 25% of those who were considered active at ages 14 to 19 were also active adults, compared to 2% of those who were inactive at ages 14 to 19, who were now said to be active adults. Staying physically inactive leaves unused energy in the body, most of which is stored as fat. Researchers studied 16 men over a 14-day period and fed them 50% more of their energy required every day through fats and carbohydrates. They discovered that carbohydrate overfeeding produced 75–85% excess energy being stored as body fat and fat overfeeding produced 90–95% storage of excess energy as body fat.

Many children fail to exercise because they spend long periods of time engaging in sedentary activities such as computer usage, playing video games or watching television. Technology has a large factor on the children's activeness. Researchers provided a technology questionnaire to 4,561 children, ages 14, 16, and 18. They discovered children were 21.5% more likely to be overweight when watching 4+ hours of TV per day, 4.5% more likely to be overweight when using a computer one or more hours per day, and unaffected by potential weight gain from playing video games. A randomized trial showed that reducing TV viewing and computer use can decrease age-adjusted BMI; reduced calorie intake was thought to be the greatest contributor to the BMI decrease.

Technological activities are not the only household influences of childhood obesity. Low-income

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