Nutrition Journal Review – Childhood Obesity, Prevalence and Prevention

This study was conducted in June 2005. In this research the authors have tried addressing different reasons that cause obesity apart from the well aware reasons. As a general rule, when the intake of calories is more than what we spend, obesity occurs. This imbalance might be due to multiple etiologies.

The researchers also mention the environmental factors (both cultural and ecological), lifestyle preferences, behavioral/social aspects and genetic factors as the primary reasons for the prevalence of the obesity among the children (Hill JO et all, Science 1998, 280:1371-1374; Goodrick GK et all, Nutrition 1996, 12:672-676; Eckel RH et all, Circulation 1998, 97:2099-2100; Grundy SM et all, Am J Clin Nutr 1998, 67:563S-572S). The authors agree that the obesity is a chronic disorder and needs to be treated in a professional manner such as strategizing a long-term action plan incorporating different preventative methods.

They suggest the implementation of such ideas at home and in preschool institutions, schools or after-school care services as natural setting for influencing the diet and physical activity (Dehghan et al, Nutrition Journal 2005, 4:24; 1-8). Another important point to be noted in this study is the researcher’s inclination towards the built-in environments as the catalytic forces for the prevention of childhood obesity. They opine that the challenge ahead is to identify ‘Obesogenic Environments’ [=neighbourhood that sustain obesity] and influence them so that healthier choices are made available.

They also emphasised on the need for easier access to these manipulated dietary and environmental choices. Last but not the least, wide promotion of these activities and their benefits to a large proportion of the community is also very important. In addition to these, 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. 4. 8: Preventing Childhood Obesity – A Solution-Oriented Research Paradigm (Thomas N. Robinson, MD, MPH, John R. Sirard, PhD)

In this study the researchers devise a ‘Solution Oriented’ approach towards the obesity prevalence and they brand most of the previous research programs as ‘Problem Oriented’. They contend that these efforts have been inhibited by the predominant biomedical and social science problem-oriented research paradigm, emphasizing reductionist approaches to understanding etiologic mechanisms of diseases and risk factors. Most important applied research questions have been left unanswered, as per the authors, due to the implications of this problem-oriented approach.

They also criticise that ‘problem oriented’ research pattern has slowed the efforts to prevent obesity and improve individual and population health. As an alternative the researchers here propose ‘Solution Oriented’ research paradigm. In this process the authors argue that the experimental research must identify the causes for good health. They intend to make a conceptual shift as far as the research dynamics goes. We can notice changes in phrasing research questions, generating hypotheses, designing research studies, and making research results more relevant to policy and practice.

They also intend to reduce the ‘Laboratory to Patient’ cycle thereby making the process more swiftly accessible to the patient (TN Robinson et all, Am J Prev Med 2005; 28(2S2); 194). 4. 9: Interventions for Preventing Obesity in Childhood – A Systematic Review (K. Campbell, E. Waters, S. O’Meara and C. Summerbell) Most of the features of this research study have already been reviewed in the earlier papers. However, to put it briefly, the overall findings of this review argue that currently there is a scarcity of quality data on the effectiveness of obesity prevention programmes and as such no ubiquitous conclusions can be drawn.

The researchers opine that there is an ever increasing need for well-designed studies that examine a range of interventions for obesity prevention. 4. 10: Prevalence of overweight among children in Europe (T. Lobstein and M. -L. Frelut) This research paper reports the childhood obesity prevalence data from 21 surveys in Europe. The authors here have used a single, internationally accepted definition of overweight in childhood. This, they opine, will allow direct comparisons to be made. The researchers show a tendency for a higher prevalence of overweight among children in western and especially southern Europe.

They discuss some possible reasons for this but they are in abridged state with respect to the interpretation that they tend to make. 4. 11: Role of Television in Childhood Obesity Prevention (M Caroli1, L Argentieri, M Cardone, and A Masi) In this research paper the authors reiterate the negative consequences on food habits and patterns by the usual depiction of food and obesity in television. They urge that different national regulations and norms on TV programs and advertisements which target children must be strengthened so as to sensor such programs and advertisements before allowing them to be broadcasted.

They argue that the television could be an effective tool to educate the children on good nutrition and obesity prevention. 4. 12: Evaluation of Implementation and Effect of Primary School Based Intervention to Reduce Risk Factors for Obesity (Pinki Sahota, Mary C J Rudolf, Rachael Dixey, Andrew J Hill, Julian H Barth, Janet Cade) This study was conducted on 10 primary schools in Leeds on 634 children (350 boys and 284 girls) aged 7­11 years. Here the researchers follow ‘The Active Programme Promoting Lifestyle Education in School’ (APPLES) which is a multidisciplinary programme.

They implement this method in the selected schools and the results are much more like the same as we have seen so far in the previous school-based obesity prevention programmes. Critical Questions to Consider: After the in-depth analysis that I so far described, let me now move towards the most decisive and significant section of this thesis. There are questions which my thesis will consider in the backdrop of all of the study and research presented thus far. To list: Q1. Is the amount of research conducted so far not enough? Q2. Are the solutions suggested in all these studies implemented completely? Q3.

Are the solutions given so far not effective enough? Q4. What is the projection of the growth of this obesity epidemic? Q5. And, lastly, what are the final solutions or what then must we do? If these questions are intimidating then the answers are even more intriguing. Let me address these questions one by one: A1: The amount of research conducted so far is enormous and the volumes of research papers written till to date are humongous. A curious search on British Medical Journal website with the keywords ‘childhood obesity all papers’ displays an astounding 2, 76,532 results (BMJ; accessed on 08/05/2010).

This may be an approximate number (taking into consideration the fact that there are so many other databases across the globe which, if considered, would shoot-up this number almost to infinity) nonetheless a factual one. Hence the amount of research conducted is just not adequate or enough but has reached extravagant levels. A2: The answer would be a firm No. Even though the governments have brought about significant changes in their approach towards the childhood obesity, there exist a number changes which yet to be looked into, let alone the surety of their implementation.

What makes the deal murkier is the fact that the higher the number of solutions the lesser the possibility of their implementation since the policy makers will be caught between the perplexities of satisfying the both general public as well as corporate interests. Hence, just a few of the solutions get implemented and remaining others remains on papers. However, Dr Margaret Chan, Director General of WHO says: Our support to implement the Global Strategy on Diet, Physical Activity and Health will increase” (Speech to the World Health Assembly on 9th November, 2006).

But the facts and stats remain worrisome. A3: Despite the sheer ambiguity due to the gigantic volumes of solutions suggested, there is enough evidence to believe that the quality and efficacy of the suggestions are of superlative nature. No upheaval about this. A4: The projection is bleak. And, it is this very fact that makes my question 2 (and of course the aim of this thesis) and its corresponding answer worth re-visiting. Studies conducted worldwide time and again are confirming to the fact that the instances of overweight and childhood obesity increasing exponentially.

We must note that the current UK obesity trends imply that 34% of men and 38% of women will be obese by 2020 (IOTF; accessed on 08/05/2010). Following graph illustrates the stats effectively: The Vision 2020 of IOTF clearly shows an upwardly trend in the standards used for assessing the overweight and obesity in children and adolescents (N. Rigby et all: IOTF: P1-3). A5: The final solution would be to re-evaluate all the evaluations (such as this study) and shortlist the most effective solutions suggested by various researchers.

So much so that, the researches so far conducted have surely cast light on the finer aspects of this epidemic, but somehow, it seems as if the road to recovery has become topsy-turvy which nevertheless would have become an even trail. Sometimes the data itself creates such ambiguous situations that, it could even lead to wrong or false (though un-intentional, but surely non-voluntary) implications. And these connotations can further complicate an already complicated problem of this magnitude as the prevention of the prevalence of the childhood obesity.

One best instance of such slip-ups is described here. On 23rd November 2009 Gillian Merron, Minister of State, Public Health, (whose term in the office ended on 7th May 2010; barely 24 hours ago! ) issued a statement in the House of Commons thus (based on The NHS Information Centre’s information on 19th November 2009 given to her): “As a result of a detailed validation carried out during the production of the Health Survey for England (HSE), 2008, the following error has been identified in the Health Survey for England series.

The error pertains to childhood obesity data for the years 1995 to 2007 inclusive and will affect all publications during these years. Between 1995 and 2007 there was an error which meant that small numbers of children that should have been classified as either “overweight” or “obese” were omitted from these categories because of rounding of age and body mass index (BMI) thresholds. The revised percentages of those who were overweight in each year differ by 0. 1 to 0. 8 percentage points and for those who were obese in each year they differ by 0.

1 to 1. 1 percentage points from those originally published, and 0. 3 % to 1. 2 % of children in each year were misclassified” (Gillian Merron; Hon’ The Minister of State, Department of Health, House of Commons; Written Ministerial Statement; 23/11/2009; UK Parliament; accessed on 08/05/2010). This erratum clearly indicates that while handling data of such enormity, there bound to be some slip-ups. Hence there is an urgent need to treat such huge quantity of data pertaining to the childhood obesity in a logical manner.

For example, data where in well-known facts of nature are the main players can be set aside while taking into account only the data that has highest degree of variance against a set standard of normal parameters. Because there is a need to revisit a majority of the solutions and preventive measures suggested so far, does not mean that we must discard them and start the process from scratch. What it infers is the fact that solutions are there, but they are not properly implemented.

We have already analyzed these all solutions and preventive measures in greater detail while reviewing the respective thesis papers in the preceding paragraphs, hence there is no need to repeat them here. Therefore, I firmly reiterate the need to revisit the various implementation norms that the governments and healthcare professionals are currently following. 5. Discussion: The general understanding of the prevalence of childhood obesity and its control have so far been dealt with critical analysis, however, a brief discussion of the general purpose of this thesis will provide a better indulgence.

I will discuss the efficacy of my thesis result in two parts: (1) Qualitative Implementation and, (2) Quantitative Implementation. 5. 1: Qualitative Implementation The need for the qualitative implementation of the childhood obesity prevention programmes is an extensive but concise exercise in that the involvement of the manpower and the selection of solutions will be limited. The general meaning of this statement is that, only resourceful and knowledgeable persons will take part in this part of the programme.

The intention is to ensure that the children will be exposed to only reliable and eloquent set of solutions. The participants must be selected from all segments of the society provided they meet the criteria set for the programme. A report from BMJ is worth mentioning here: “The BMA agrees with the International Obesity TaskForce that in order to halt the obesity epidemic, ‘interventions at the family or school level will need to be matched by changes in the social and cultural context so that the benefits can be sustained and enhanced.

Such prevention strategies will require a coordinated effort between the medical community, health administrators, teachers, parents, food producers and processors, retailers and caterers, advertisers and the media, recreation and sport planners, urban architects, city planners, politicians and legislators’. Environments that encourage healthy eating and active living are vitally important. The focus of such strategies should be to make it easier for the public to make healthy choices.

Such strategies require funding for implementation, but should ultimately lead to a reduction in the costs to the NHS from obesity related ill health” (BMA Report: 22nd June 2005). This report of BMA justifies the central argument of this paper. The involvement procedure, therefore, must be gauged through the prism of the three ‘induction’ qualities: 5. 1. 1 Nature Induction 5. 1. 2 Economic Induction 5. 1. 3 Philosophical Induction 5. 1. 1: Nature Induction

This will be the starter kind of programme which will introduce the children to the natural organization of food systems among different animals. The agenda of this part is to make the children appreciate the ‘food levels’ that Mother Nature has so meticulously designed. The participating adults need not be highly-qualified professionals but those who have naturalistic inclination in their personality as an embedded trait. This will effectively make the children realise the importance and sacredness of respecting the Natural Laws and staying adhered by them.

Making them understand the relationship between the food consumption and energy expense will be the prime goal of this part of the implementation. 5. 1. 2: Economic Induction Next in line, the ‘Economic Induction’ will target the parents of the children first and the children must be kept out of this section. Our civilized societies thrive on this concept called ‘money’ and it will be practically impossible to imagine anything without working out the financial implications beforehand. Hence, the need for such an induction.

The underlying aim is to ensure that the parents are well aware of the financial needs and are well-equipped to maintain the implementation completely without backing out. Because, we will initiate the focal implementation procedure in the second leg, it will be mandatory that the parents are not only ready for their part of action, but have also made proper arrangements. 5. 1. 3: Philosophical Induction: In this last section of the involvement procedure, there must be collective sessions for both parents and their children mainly on the lifestyle issues.

Critics may argue that the introduction of children to philosophy and expecting them to understand the complex jargon of philosophical facet of life might make them turn hostile towards the session, but let me assert that we are going to just talk about philosophical (which has undeniable influences on one’s behaviour – an adult and a child alike, only the channels of propagation of such philosophical communications between the Nature and Humans differ). 5. 2: Quantitative Implementation Note that we have not used the word ‘obesity’ (or any of its equivalents) anywhere in the induction part of the implementation process.

Intentionally we have kept it out of our vocabulary and have just got the children and their parents duly ‘Inducted’ into the implementation process (in a way, this shows how much our approach is naturally vivacious). The need of the hour as we all know is to work out more and more innovative solutions so that the huge reservoir of the preventive remedies suggested so far could be most appropriately implemented. In the book “Childhood Obesity: Contemporary Issues”, the author-doctors’ words are worth a mention here: “………..

I am struck, as a doctor, by the need of children who are already obese and the dire lack of services to meet them. The city of Leeds presents a typical picture. There are no specialist paediatric clinics, the hospital dietetic department has closed its doors to any referrals for obesity, and the community dieticians can offer only one or two appointments, with a follow-up phone call. At a meeting of professionals that was called in 2001 because of emerging concerns, it became clear that no additional resources and time were likely to be available, and, dare I say, there was no real inclination from any professional body to take lead.

Clearly, we needed to think “outside the box” for a solution (Noel Cameron, Et All; Childhood Obesity: Contemporary Issues, Volume 44: P192). Once the qualitative implementation is done perfectly, the remaining part of the implementation process can be smoothly performed. The transition must be effective but should never have any lumbering impact on the children. Here the principle strategy would be to make the parents and children realise how easy and healthy life could be if the naturalistic living is followed and how can one act simultaneously to perform this task and inspire others too.

6. Conclusion This study exhibits two inherent (though they appear to be eccentric) qualities: Being Explicit and Being Implicit as well. It is like a face-off between the ambiguous and the unambiguous methods. However, these comparisons are nice from the literature angle but the science (and especially the medical science) has no room for such sentiments and niceties for it constantly looks for logical methods which can be empirically proved.

This research satisfies this stringent norm in that we have successfully managed to show that the quantity of the already proposed solutions is vast and all that we have to think about is to find newer ways which are feasible to implement these solutions. Whatever is the remedy and whatever be the domain of the society that is suggested for improvement, the focal point of the research must not shift. The figure below would be worth a thousand words of conclusion of this thesis: The figure represents the entire theme of this thesis in a poignant way.

This thesis took the studies of the past, processed the findings and understandings of those studies, gathered the results and solutions of these findings and eventually devised a model for implementing these solutions. Throughout the research, the approach was to investigate the areas of interest and that of conflict to understand the problems perfectly or more importantly scientifically without sacrificing the delicacy of humanity. Noel Cameron quotes one of the participants in the program in her book thus: ‘It’s like being middle aged as a child. It’s like, well yeah, it’s like being old before your time.

You can’t … you can’t do everything that everybody else can do…… ’ (Noel Cameron, Et All; Childhood Obesity: Contemporary Issues, Volume 44: P55). I assume that this research paper has been driven by such humane feelings and a strong investigative approach dissecting some major research works in this field and devising an assembled dual approach of implementation of solutions in order to prevent the prevalence of the childhood obesity. Hence, after successfully arriving at the conclusion of dual implementation, I firmly believe that my thesis argument stands vindicated. References

Chinn S, Rona R. “Prevalence and Trends in Overweight and Obesity in Three Cross Sectional Studies of British Children”, 1974–1994. BMJ 2001; 322: 24–26. WHO Expert Committee. Physical status: the use and interpretation of anthropometry. Report of a WHO Expert Committee, World Health Organization. Tech Rep Ser 1995; 854: 1–452 Kuczmarski RJ, Ogden CL, Grummer-Strawn LM, Flegal KM, Guo SS, Wei R, Mei Z, Curtin LR, Roche AF, Johnson CL. CDC growth charts: National Center for Health Statistics, Hyattsville, MD. U S Adv Data from Vital and Health Stat 2000; 314: 1–27. Dietz WH, Bellizzi MC.

Assessment of childhood and adolescent obesity: results from an International Obesity TaskForce workshop, Dublin, 16 June 1997. Am J Clin Nutr 1999; 70: 117S–175S. Stephenson J, Imrie J. Why do need randomised controlled trials to assess behavioural interventions? BMJ 1998; 316:611–613. Melissa Wake et al. The LEAP Trial Janet James et all. CHOPPS Trial McCallum Z, Wake M, Gerner B, et al. LEAP (Live, Eat and Play): can Australian general practitioners tackle childhood overweight/obesity? — Methods and processes from the LEAP Live, Eat and Play) randomised controlled trial. J Paediatr Child Health. 2005; 41:488–494

Ebbeling CB, Feldman HA, Osganian SK, Chomitz VR, Ellenbogen SJ, Ludwig DS. Effects of decreasing sugar-sweetened beverage consumption on body weight in adolescents: a randomized controlled pilot study. Pediatrics 2006; 117:673-80 Tam CS, Garnett SP, Cowell CT, Campbell K, Cabrera G, Baur LA. Soft drink consumption and excess weight gain in Australian school students: results from the Nepean study. Int JObes 2006; 30:1091-3) SmithWestD, Bursac Z, Quimby D, Prewitt TE, Spatz T,NashC, et al. Self-reported sugar-sweetened beverage intake among college students. Obes Res 2006; 14:1825-31. Rush E, Schutz Y, Obolonkin V, Simmons D, Plank L.

Are energy drinks contributing to the obesity epidemic? Asia Pac J Clin Nutr 2006; 15:242-4 Mrdjenovic G, Levitsky DA. Nutritional and energetic consequences of sweetened drink consumption in 6 to 13-year-old children. J Pediatr 2003; 142:604-10). James J, Thomas P, Cavan DA, Kerr D. Preventing childhood obesity by reducing consumption of carbonated drinks: cluster randomised controlled trial. BMJ 2004; 328:1237-9. Janet James Et All, CHOPPS Trial, Page 3, Table 1 Evans et all, Changing Perceptions; Am J Health Behav. 2006; 30(2):169 U. S Department of Health and Human Services, Centers for Disease Control and Prevention, National

Leave a Reply

Your email address will not be published. Required fields are marked *