Literature Review: Prevention and Control of Childhood Obesity

Literature Reviews

Prevention and Control of Childhood Obesity

In quest of finding causes, preventions and control of childhood obesity, several health professionals have participated in the studies of obesity in children and teenagers. Below is a scrutiny of some data and pieces of information from few studies and articles. In the article Identification, Evaluation, and Management of Obesity in an Academic Primary Care Center, O’Brien et al performed a study to find out how other health workers were dealing with childhood obesity. The purpose of this study, according to the article, was to determine the rates of identification of obesity by pediatric residents, nurse practitioners, and faculty members in an academic primary care setting and to describe actions taken by these providers in their evaluation and management of obesity.
Using a large primary care practice that serves predominantly urban minority (70% African Americans) and Medical Assistance insured (90%) population, located in a tertiary-care academic pediatric hospital, a two month retrospective medical record review of all health supervision visits for children 3 months to 16 years of age, was performed between December 1, 2001 and February 28, 2002.
A weight greater than 120% of the 50th percentile of weight-for-height (for children5 years) was used to define obesity.
Of the 2515 visits reviewed, 244 patients met the study definition of obesity, yielding an estimated prevalence of obesity visits of 9.7% among health supervision visits for children 3 months to 16 years of age. Only 53% (129 visits) of the reviewed visits of the 244 patients was documented as obesity by providers. Of the charts (69%) which contained adequate dietary viewing, only 15% included a description of the child’s activity level and Television viewing. Obesity was noted in the physical examination in 39% of cases.
For the 129 children identified with obesity, 81% of cases contained an adequate dietary history, whereas 27% contained a description of the child's activity level or television viewing. Obesity was noted in the physical examination in 64% of cases. Most children identified as obese by their providers received some management specific to their obesity, including education, screening, and specialist referral. Dietary changes were recommended for 71%, increased activity for 33%, and limitation of television viewing for only 5%. Eighty-three percent of providers recommended close follow-up monitoring. Other recommendations included referral to a dietitian (22%), screening laboratory studies (13%), a food diary (9%), endocrine referral (5%), or preventive cardiology referral (3%). Provider identification of obesity was affected by the age of the patient and by the degree of obesity. Obesity identification was lowest among preschool children (31%) and highest among adolescent patients (76%).
Although the prevalence of childhood obesity has reached epidemic proportions, the study showed that it was under recognized and undertreated by pediatricians. They failed to identify obesity in one-half of the visits, only few of them recommended laboratory studies and other necessary screenings and follow up.
This study highlights the need for increased awareness and identification of obesity in the primary care setting, especially among younger children and those with mild obesity. However, it is not a clear cut evidence of the management of obesity by pediatricians.

In the article Obesity threatens a generation- Catastrophe of Shorter Span, Higher Health Cost, Susan Levin and Rob Stein points out the likely effect of obesity on life expectancy and health care cost in U.S. The article states that the rate of increase in obesity has tripled in children between the ages of 6 and 19 years in the last decade. According to W. H. Dietz, director of the Division of Nutrition, Physical Activity and Obesity at the federal Centers for Disease Control and Prevention, a huge burden of disease can be anticipated from the growing obesity in kids (Washingtonpost.com). Doctors are confirming more and more boys and girls in elementary school with high blood pressure, hypercholesterolemia, painful joints conditions, soaring incidence of type II diabetes and a spike in child gallstone, affecting mainly the minority youth. As studies indicate, many will never overcome their overweight- up to 80% of obese teens become obese adults - experts fear an exponential increase in heart disease, strokes, cancer and other health problems as the children move into their 20s and beyond. The evidence suggests that these conditions could occur decades sooner and could greatly diminish the quality of their lives. Many could find themselves disabled in what otherwise would be their most productive years. The cumulative effect could be the country's first generation destined to have a shorter life span than its predecessor. A 2005 analysis by a team of scientists forecast a two to five year drop in life expectancy unless aggressive action manages to reverse obesity rates. However, children have only gotten fatter since then. With one in three children in this country overweight or worse, the future health and productivity of an entire generation and a nation could be in jeopardy.
In addition, according to a study by Thomson Reuters the article notes’, treating a child with obesity is three times more costly than treating an average child. With the expected dramatic rise in the ER visits, inpatient hospitalization and outpatient visits, the country's overall expense of care for overweight youth is pegged at $14 billion annually adding billions of dollars to the U.S. healthcare bill.
This article explains that obesity in children is among the leading factors to the increase in healthcare cost we see today United States and also the decrease in life expectancy.

In the article Markets and Childhood Obesity Policy, The Future of Children, John Cawley examines how the market may have contributed to the rise of childhood obesity. He proposes that the problem for researchers is not figuring out what could have caused the rise in childhood obesity, but that too many things could have caused it. He notes that several strands of research investigate how markets may contribute to increased calorie consumption, sedentary lifestyles, or overweight and how changes in those markets may have contributed to the recent rise in childhood overweight. He mentioned that James Hill and several of his colleagues calculate that the rise in obesity in the United States could have been caused by a daily surplus of just 15 calories for the median person, with 90 percent of the population increasing their intake by 50 or fewer calories a day. To put this in perspective, the rise in weight for the median person could have been caused by consuming an extra three tablespoons of skim milk or walking 120 fewer yards each day. It will likely be impossible to determine which changes are responsible for such a small increase in daily calorie surplus, but the possible contributors he considered are; • Changes in the cost of food: Cawley claims that this is the most obvious contributor to the increasing calorie surplus. One study attributes 40 percent of the recent rise in weight to lower food prices. • Changes in where Americans eat their food: Relative to food at home, food away from home has on average, lower fiber and calcium density, similar sodium density and higher cholesterol density. Although there are promising changes in both, away-from home food have improved less than home food. • Changes in portion size: One study of portion sizes looks at package labels and manufacturers’ information and concludes that the portion sizes of virtually all the packaged food and beverages it examined have increased during the past three decades. The increase in portion sizes, combined with people’s tendency to eat more when served larger portions, implies that the amount of food consumed at one sitting has increased. • Changes in farm policies: Agriculture policy may contribute to obesity by promoting lower prices and greater production of certain commodities. • Increased food advertising to children: Gerard Hastings and several colleagues conclude that over time advertisements for fruits and vegetables have disappeared and have been replaced by ads for fast-food restaurants, breakfast cereals, soft drinks, and snacks (G. Hasting et al, 2003). • Differences in local availability of food and exercise opportunities: Some researchers have argued that racial and socioeconomic disparities in weight may be due in part to differences in the availability of food and exercise opportunities.

In the article Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender, Lowry and co. linked the cause of obesity with television viewing. Specifically, the article states that television and a sedentary lifestyle are two major factors for childhood obesity. The author also indicated that along with increased TV time, decreased physical activity, and unhealthy dietary behavior among children and adolescents represent a modifiable cause of childhood obesity (Lowery et al 2002).
They also looked at the effect of race, ethnic, and gender specific differences on obesity among high school students in the United States. Data from the 1999 national Youth Risk Behavior Survey, a representative sample (N = 15,349) of US high school students was evaluate. Logistic regression tested for significant associations. From their findings, TV viewing on an average school day exceeded 2 hours/day among 43% students, made up of 74% Blacks, 52% Hispanic and 34% White students. In total, 11% of students were overweight, 31% sedentary (i.e., did not participate in moderate or vigorous physical activity at recommended levels), and 76% ate less than five servings/day of fruits and vegetables. The study showed that TV viewing for more than 2 hours/day was associated with- being overweight, being sedentary, and eating insufficient fruits and vegetables among White females; being overweight and eating insufficient fruits and vegetables among White males; being overweight among Hispanic females and greater participation in physical activity among Black males. No significant associations were found among Black females and Hispanic males (Lowery and et al, 2004).
Lowery et al suggested that the presence of cultural factors should be consider when developing interventions to promote physical activity, healthy eating, and healthy weight through reduced TV viewing among adolescents.

Reference: • O’Brien SH, Holubkov R, Reis EC. Identification, evaluation, and management of obesity in an academic primary care center. Pediatrics. 2004 Aug; 114(2):e154-9. PMID: 15286251 [PubMed-Indexed for MEDLINE]. Retrieved July 11, 2008.

• Susan Levin and Rob Stein: Obesity threatens a generation- Catastrophe of Shorter Span, Higher Health Cost. Washington post, May 17, 2008.

• John Cawley: Markets and Childhood Obesity Policy, The Future of Children, Spring 2006.

• Lisa R. Young and Marion Nestle, “The Contribution of Expanding Portion Sizes to the U.S. Obesity Epidemic,” American Journal of Public Health 92, no. 2 (2002): 246–49.

• Gerard Hastings et al, “Review of Research on the Effects of Food Promotion to Children” (Centre for Social Marketing, University of Strathclyde, Glasgow, U.K., 2003).

• Lowry R, Wechsler H, Galuska, DA, Fulton JE, Kann L. Television viewing and its associations with overweight, sedentary lifestyle, and insufficient consumption of fruits and vegetables among US high school students: differences by race, ethnicity, and gender. J.Sch.Health, 2002 Dec: 72(10):413-21. PMID: 12617028 [PubMed-indexed for MEDLINE].