obesity children

The Affect of Sugar-Sweetened Beverages on Childhood Obesity

Chapter One The number of children that are considered overweight or obese has doubled since the 1970’s. Besides the dangers to health that are linked with obesity, there is also significant psychological damage associated with the social discrimination that goes along with being overweight ( Escott-Stump & Mahan, 2004). It is estimated that 21 percent of American children and adolescents ages 12 to 19 are obese. What causes obesity may appear fairly simple most of the time; too many calories with too little energy spent. However, there are many factors. A dramatic rise in high calorie beverage consumption among children and teens occurred during approximately the same years as did the most significant increase in childhood and adolescent obesity, as stated by a USDA survey in 1994 entitled “What We Eat in America”. Children ages 2.5 to 4.5 who consumed sugar sweetened beverages consisted of 15.4% that were overweight as compared to 6.9% of those that did not (DuBois, Farmer, Girard, & Petersen, 2007). This research is an attempt to pinpoint one such obesity factor: the consumption of sugar-sweetened beverages.
Purpose of the Study
The purpose of this study is to demonstrate the affect of sugar-sweetened beverages on obesity in children.
Assumptions
Hypothesis
Children who consume sugar-sweetened beverages will be at higher risk for obesity; therefore, sugar-sweetened beverages have a direct affect on childhood obesity.
Conceptual Definitions Children are categorized from 4 to 10 years of age. The term overweight is used to describe children with BMIs in the 85-95% percentile, while obese describes children in the > 95% percentile. The BMI refers to the Body Mass index-for-age percentiles: boys 2 to 20 years of age and girls 2 to 20 years of age, which was developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion. Sugar sweetened beverages include those that contain 20-40 grams of sugar per 8 ounces.
Significance of the Problem
The prevalence of soft drink consumption has risen 500% over the past years (Ludwig, Gortmaker, & Peterson, 2001) Due to the increasing prevalence of both childhood obesity and consumption of sugar sweetened beverages among children, this study is needed to determine if a correlation exists between the two.
While adulthood obesity has been well-documented, much less attention has been given to childhood and adolescent obesity. It is estimated that 21% of American children and adolescents ages 12 to 19 are obese. According to the 1995 study "Childhood Obesity: Pathophysiology and Treatment” by the Baylor College of Medicine, adolescent obesity is associated with myriad factors, such as obese parents, a sedentary lifestyle, and young children 's tendency to eat away from home at a childcare center, a friend 's house and/or fast food restaurants.

Chapter Two: Review of Literature
The literature related to sugar-sweetened beverage consumption and its connection to weight gain/obesity is reported in this chapter. For organizational purposes, the literature is presented according to the following topics: themes and trends within beverage consumption and obesity studies, methodologies used to connect sugar-sweetened beverage consumption to obesity, results of the reviewed studies, and a summary.
The studies reviewed fell within the time frame of 1998-2007. A prevalent theme within the studies was the idea that sugar-sweetened beverages were connected to weight gain/obesity, whether they were being consumed by preschool aged children or French men. Welsh & Dietz (2005) as well as Schulze, et al. (2004) shared a common theme in that both studies associated the risk of weight gain in connection with sugar-sweetened beverage consumption to Type II Diabetes. Schulze, et al. (2004) took the study a bit further, looking at the associations between young and middle-aged women and Type II Diabetes. Although the proposal at hand is not considering an association with this disease, these studies were nonetheless relevant including a study completed by French, Lin, & Guthrie (2003) which examined the trend in the prevalence, amount, and source of soft drink consumption in children ages 6-17 years old in the years between 1977-78 and 1994-98. Very closely related in theme to this article is a study conducted by Dubois, et al. (2007) which examined the relationship between consumption of sugar-sweetened beverages and the prevalence of being over-weight among preschool-aged children living in Canada. The target audience of this study directly related to the proposal at hand. Although several of the studies related to audiences that did not fall within the proposed age range, they were great assets due to their methodological proceedings.
Somewhat off the topic but reviewed for its methodologies was the study conducted by Dallongeville, et al. (1998) which serves as a model or tool for setting up a similar study. The researchers used trained nurses that tested various body weights according to the BMI scale as well as measuring waist-to-hip ratios and waist girth. The only other study that actually included any type of measurement was Dubois, et al. (2007) which included measurements of weight and height that were taken at home by trained, registered dietitians. Their measurements were analyzed using the BMI scale, with overweight being defined as having a BMI at or above the 95th percentile.
Both of the aforementioned studies as well as the others reviewed included questionnaires and this creates a great relevance to the proposal at hand. Dubois, et al. (2007) delivered self-administered food frequency questionnaires (FFQs) as part of their nutritional assessment which were addressed to the children’s mothers and father’s. They were answered by the person most knowledgeable about the child, which was generally the mother. The information retrieved from the FFQ was used to categorize the children studied by frequency of sugar-sweetened beverage consumption, focusing on the consumption taking place between meals. Children were then defined as non-consumers, daily consumers, or regular consumers based upon their responses. A similar method was used by Welsh & Dietz (2005) in which women were mailed a questionnaire every two years to determine weight and morbidity from 1991-1999. A FFQ was mailed every four years, including questions regarding how often the participants consumed sugar-sweetened beverages over the past year. The mean weight change in the women, grouped by beverage consumption, was categorized by consistently low (/=1 per day), increased from low to high, and decreased from high to low. Schulze, et al. (2004) also administered a biannual questionnaire to women ages 24-44 regarding the specifics of beverages that they consumed, including type, portion sizes, and consumption frequency.
Similar to the questionnaire but different in nature is the 24 hour recall method used by French, Lin, & Guthrie (2003). Data was collected for two nonconsecutive days using the recall process. Each food on the diet recall was listed separately to determine the actual amount of soft drink consumption. As part of the USDA food consumption survey, the researchers has questions regarding where the food was obtained, grouping sources into categories such as home, fast food and restaurants, vending machines, school cafeterias, and others.
Three of the studies included statistical software that was used to calculate the prevalence, mean, and ratios. Dubois, et al. (2007) and Dallongeville, et al. (1998) both used the SAS statistical software while French, Lin, & Guthrie (2003) used SUDAAN. The indication of the use of statistical software has great importance to future study replication and to serving as a model study.
Each study reviewed held very important information for the outcome of this proposal in their results. Results from four of the relevant studies, excluding Dallongeville, et al. (1998) indicated that there is a relationship between sugar-sweetened beverage consumption and the state of being overweight. An excellent view of trend rates comes from French, Lin, and Guthrie (2003) which finds that the overall prevalence of soft drink consumption for children ages 6 to 17 years was 48% higher in 1994-98 as in 1977-78. The quantity of soft drinks consumed was increased 51% during these same years. Results from both Welsh &Dietz (2005) and Schulze, et al. (2004) indicate that there is a positive association with sugar-sweetened beverages and weight gain. These studies also examined that as consumption rates rose from low to high in participants, their total energy consumption followed suit. For Schulze, et al. (2004) the study led to an additional question of whether or not these drinks can cause an increase in hunger. On the reverse, women who decreased their consumption from high to low in this study did not gain significant weight and had decreased total energy consumption. Welsh & Dietz (2005) saw this pattern of caloric intake as well, in women whose consumption rose from low to high from 1991 – 1995. There was an average increase of total caloric intake of 358 calories per day. This is a unique aspect to consider.
The study conducted by Dubois, et al. (2007) had the most relevance to this proposal with their results, which indicated that 17.2% of children consumed sugar-sweetened beverages daily at the age of 4.5 years. In comparison with children who were non-consumers, more than twice the children who were regular consumers were overweight at 4.5 years. The proposal at hand relates to the connection between sugar-sweetened beverage consumption and obesity in children ages 4-10, but the results of the reviewed studies gives great indication as to what we can expect from this study.
In summary, the themes, methods, and results found by the research that we reviewed will all contribute as models for this proposal. Some of the articles reviewed, such as Dallongeville, et al. (1998) were off topic in the aspect of type of beverage consumption studied and the addition of factors such as Type II diabetes but offer much relevance and specific ideas for how to organize future, similar studies.
In regards to methodology, several of the studies included various categorizing methods that were very helpful in disseminating the information. The act of performing a recall and completing questionnaires will be very beneficial to this proposal, as it was to the studies that we reviewed. There are a few weaknesses that could be recognized in these methods. First, lifestyle changes must be considered when participants are reporting soft drink consumption because that could greatly influence the results. Secondly, underreporting can become a concern because previous research done by French, Lin, and Guthrie (2003) indicated that foods high in sugar were more underreported than others. Lastly, attrition rates must be accounted for as well as the probability of non-response when using questionnaires.
Although there has not been a study conducted on the age group of 4-10 years, it is clear to see that this proposal will not be done in vain. The study conducted by Dubois, et al. (2007) relates most to this proposal, finding that preschoolers’ regular sugar-sweetened beverage consumption, particularly between meals, is positively related to being overweight. The results were satisfactory in that they support this proposal’s hypothesis.

Chapter Three: Methods The incidences of overweight children and sugar-sweetened beverage consumption have both been on the rise for several decades. In the study regarding sugar-sweetened beverage consumption between meals (Dubois et. al, 2007), researchers were unable to examine the effects of subcategories of sugar-sweetened beverages because they were combined into a single question on the applied food frequency questionnaire. Also, studies have been limited to pre-school aged children, teenagers, and women. It is necessary to examine the subcategories of sugar-sweetened beverages as well as obtain an overview of children ages 4 to 10. This is a vital period in child development when personal choices become lifestyle factors.
Subjects
Volunteer participants, aged 4 to 10, will be recruited from six counties in Arkansas. There will be a total of 210 participants from three of the largest Arkansas counties according to population (Pulaski, Faulkner, and Washington) and three of the smallest Arkansas counties according to population (Newton, Perry and Sebastian). Thirty children of each age will be selected: fifteen girls and fifteen boys. Participants will be acquired through the local Boys and Girls Club of America programs in the listed counties as well as from the Head Start programs offered in each county. The legal guardian of each participant will be informed of all testing procedures and will be required to sign a consent form.
Operational Definitions Children are categorized from 4 to 10 years of age. The term overweight is used to describe children with BMIs in the 85-95% percentile, while obese describes children in the > 95% percentile. The BMI refers to the Body Mass index-for-age percentiles: boys 2 to 20 years of age and girls 2 to 20 years of age, which was developed by the National Center for Health Statistics in collaboration with the National Center for Chronic Disease Prevention and Health Promotion. Sugar sweetened beverages include those that contain 20-40 grams of sugar per 8 ounces. The questionnaire utilized in this study consists of a series of questions and other prompts that will gather information about the participants regarding their food frequency habits and will ultimately determine their overall sugar-sweetened beverage consumption.
Data Collection Procedures All 210 participants will have their weight and height determined by students at the University of Central Arkansas who have completed at least one year of the nursing program and have clinical experience obtaining these measures. These measurements will be taken from January 7-11, 2008. The Head Start children will have their measurements taken from 3:00 - 4:00 pm. The children from the Boys and Girls Club will have their measurements taken from 4:30 – 6:30 pm. Their height will be measured using a standard tape measure and their weight will be taken using a scale. From this information, the nursing students will calculate the participants’ BMI. Guardians will then be asked to complete a self-administered food frequency questionnaire (FFQ) regarding their participant’s consumption habits. A table will be set up for guardians to fill out the FFQ when they pick up their children. The information retrieved from the FFQ will be used to classify children based on overall frequency of sugar-sweetened beverage consumption.
Instruments
The type of scale that we plan to use for weight measurements is the Health-o-Meter 402EXP Professional Economy Beam Scale. BMI calculations will be performed by Nutrition Assistant2, developed by CompuCal for Palm Pilot. It is made to assess both children and adults. The FFQ is a short 3.5 page, 28-item questionnaire that we will self-administer. It will be developed using recommendations from the American Dietetic Association as well as advice from local registered dieticians. This questionnaire will ask about usual sugar-sweetened beverage intake over the past year as well as amount and type of beverage consumed. The following question is an example from the FFQ: “In the past year, on average, how often during the week or how many times per day did your participant consume the following…” Guardians will choose from the following responses: none, one to three times per week, one time per day, twice per day, three times per day, or four or more times per day. Children will then be defined as non-consumers, daily consumers, or regular consumers based on the given responses. Types of beverages considered will be sugar-sweetened soft drinks, fruit juices, fruit punches, and diet soft drinks.
Limitations
Guardians may not remember or be embarrassed to tell the truth on the FFQ, so subject recall and honesty may be a limitation.
Delimitations
This study will be delimited to the state of Arkansas. Also, the age range is 4 to 10 years old. Also, the time period of January 7-11, 2008 will be a delimitation.
Data Analysis The criterion for accepting or rejecting the hypothesis will be the 0.05 level of significance. Data will be analyzed by computer at the Data Processing Center at the University of Central Arkansas to determine the correlation between amount of sugar-sweetened beverage consumption and BMI.

References
Dubois, L., Farmer, A., Girard, M., & Peterson, K. (2007). Regular sugar-sweetened beverage consumption between meals increases risk of overweight among preschool-aged children. Journal of the American Dietetic Association, 107, 924-934.
Dallongeville, J., Marecaux, N., Ducemeteire, P., Ferreires, J., Arveiler, D., Bingham, A., et al. (1998). Influence of alcohol consumption and various beverages on waist girth and waist-to-hip ration in a sample of French men and women. International Journal of Obesity, 22, 1178-1183.
Escott-Stump, S. & Mahan, L. K. (Eds.) (2004). Drause’s Food, Nutrition, & Diet Therapy (11th ed.) (pp. 275- 277). (Alexopoulos, Y.) Philadelphia: The Curtis Center.
French, S., Lin, B., & Guthrie, J. (2003). National trends in soft drink consumption among children and adolescents age 6 to 17 years: Prevalence, amounts, and sources, 1977/1978 to 1994/1998. Journal of the American Dietetic Association, 103, 1326-1331.
Ludwig, D., Gortmaker, S., & Peterson, K. (2001). Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. The Lancet, 357, 505-509.
Schulze, M., Manson, J., Ludwig, D., Colditz, G., Stampfer, M., Willett, W., et al. (2004) Sugar-sweetened beverages, weight gain, and incidence of Type 2 Diabetes in young and middle-aged women. The Journal of the American Medical Association, 292, 927-934.
Welsh, J. & Dietz, W. (2005). Sugar-sweetened beverage consumption is associated with weight gain and incidence of Type 2 Diabetes. Clinical Diabetes, 23, 150-152.

References: Dubois, L., Farmer, A., Girard, M., & Peterson, K. (2007). Regular sugar-sweetened beverage consumption between meals increases risk of overweight among preschool-aged children. Journal of the American Dietetic Association, 107, 924-934. Dallongeville, J., Marecaux, N., Ducemeteire, P., Ferreires, J., Arveiler, D., Bingham, A., et al. (1998). Influence of alcohol consumption and various beverages on waist girth and waist-to-hip ration in a sample of French men and women. International Journal of Obesity, 22, 1178-1183. Escott-Stump, S. & Mahan, L. K. (Eds.) (2004). Drause’s Food, Nutrition, & Diet Therapy (11th ed.) (pp. 275- 277). (Alexopoulos, Y.) Philadelphia: The Curtis Center. French, S., Lin, B., & Guthrie, J. (2003). National trends in soft drink consumption among children and adolescents age 6 to 17 years: Prevalence, amounts, and sources, 1977/1978 to 1994/1998. Journal of the American Dietetic Association, 103, 1326-1331. Ludwig, D., Gortmaker, S., & Peterson, K. (2001). Relation between consumption of sugar-sweetened drinks and childhood obesity: a prospective, observational analysis. The Lancet, 357, 505-509. Schulze, M., Manson, J., Ludwig, D., Colditz, G., Stampfer, M., Willett, W., et al. (2004) Sugar-sweetened beverages, weight gain, and incidence of Type 2 Diabetes in young and middle-aged women. The Journal of the American Medical Association, 292, 927-934. Welsh, J. & Dietz, W. (2005). Sugar-sweetened beverage consumption is associated with weight gain and incidence of Type 2 Diabetes. Clinical Diabetes, 23, 150-152.