Childhood Obesity

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Childhood Obesity: Prevalance, Treatment and Prevention
Doyeon Kim, M.S. and Len Kravitz, Ph.D.

Introduction
The prevalence of obesity in children is rapidly increasing in the United States, and other parts of the world, although the tracking of this phenomenon is somewhat complicated by variability in the definitions for obesity and overweight in children (Janssen et al., 2005). Body Mass Index (BMI) of children serves as the relevant reference standard for obesity and overweight status for research and epidemiological purpose, with overweight in youth often being defined as pre-obese (BMI=25.0-29.9 kg/m2) and obese (BMI&Mac179;30.0 kg/m2). In a comparison of pre-obese and obese youth ages 10-16 from 34 countries, the highest was seen in Malta {islands in the Mediterranean Sea south of Italy} with 25.4% pre-obese and 7.9% obese, followed by the United States (25.1% and 6.8%, respectively) (Janssen et al., 2005). Among children aged 6 through 19 years, the most recent National Health and Nutrition Examination Survey (NHAMES) {collected 1999-2002} shows that the prevalence of overweight is three times greater than the goals established in Healthy People 2010 (Hedley et al., 2004). Along with this rise are some deleterious health consequences to obese youth (see Table 1). Although physical activity patterns and diet are contributing factors to this increase in overweight youth, a true understanding of all contributing factors is presently unclear. This article will examine the known associations with youth obesity and recommended prevention and treatment options.

Causes of Childhood Obesity
Physical Activity: Youth Aren’t Playing Like they Used To
One of the hypothesized factors contributing to the rapid climb in childhood obesity has been the change in the physical activity behaviors of children. Physical activity has reduced with decreases in middle school and high school physical education physical activity. As well, children no longer play the way that they used to play (Burdette & Whitaker, 2005). In fact, Burdette and Whitaker argue that the current emphasis on increasing exercise and physical activity in youth is less important (in dealing with overweight and obesity in youth) than encouraging today’s youth to play more. These researchers continue that unstructured outdoor play has the potential to improve all aspects of children’s well being, including emotional, social, cognitive and physical. In addition, the parents of many of these overweight youth may often associate exercise with failed attempts at weight loss, which often contrasts considerably different to their positive associations they may have with play. Indeed, Janssen and colleagues (2005) support the idea of promoting multiple strategies for increasing physical activity with overweight youth (around the world), in an effort to combat the prevalence of obesity in children.

Effect of Media Use (Television, Computers, Video Games…)
One strategy employed to better understand childhood obesity has been to compare changes in sedentary behaviors such as media use. Media use is typically described as the use of video games, computers, television viewing, and audio devices like CD players and MP3 players. Dietz and Gortmaker published one of the first reports of an direct relationship between television viewing (measured by time spent watching) and childhood obesity in 1985. Since 1985, many more media use devices have become integral in the lives of children. In 29 out of 33 countries studied, a strong association is seen with the effect of media use and childhood obesity, as well as media use with decreases in physical activity (Janssen et al., 2005). It appears that television watching is also highly associated with increased rates of consumption of energy-dense foods (Ebbeling, Pawlak and Ludwig, 2002). Ebbeling, Pawlak and Ludwig add that children in the U.S. now spend 75% of their waking hours being inactive with only about 12 minutes of vigorous activity per day.

Environmental factors
Monitoring changes in a child’s environment may also play a role in the youth’s physical activity behaviors today as compared to the past few decades ago (Ebbeling, Pawlak and Ludwig, 2002). Some environmental factors that may affect physical activity include the expense of the participation in some physical activities (and sports), the parents’ lack of time to facilitate the child’s active interests, and concerns about neighborhood and playground safety. As well, more and more schools are cutting physical education programs in the schools, and the physical education programs being offered are not providing as much physical activity.

Prevention and Treatment of Childhood Obesity: Guidelines for the Fitness Professional and Personal Trainer
Physical activity and play are important components for the prevention and treatment of childhood obesity. Most American guidelines encourage youth (overweight and normal weight) to get 30-60 minutes of physical activity (that produces a ‘sweat’) on most or all days of the week. Janssen et al. (2005) highlight the importance of physical activity, comparing the American guidelines to youth activity recommendations of Great Britain (60 minutes of daily physical activity on at least 5 days/week) and Canada (all adolescents gradually increase their daily physical activity participation by 90 minutes). Importantly, the concept of designing or ‘tailoring’ the physical activity or play to the child (or children) is necessary. For instance, creating a 12,000-steps/day incentive program for boys and girls may entail a very different strategy for youth in New York City, NY (very urban environment) as compared to their counterparts in Monterey, CA (very suburban environment).

Clearly, all sources recommend dietary modification that ensures healthy eating habits that are appropriate for the growing child, while providing optimum nutrition for the maintenance of good wellbeing. A focus on variety, adequacy and portion sizes is encouraged. In addition, the incorporation of healthier snacks, such as fruits and vegetables, which are also low-calorie foods, is recommended.

Because of its strong association to childhood obesity, limiting television viewing and other media use devices appears to be warranted. This may be one of our biggest challenges, as advancing technologies inspire so much of children’s 21st century lifestyles. Yet, accurate, honest and relevant education to children may be the key to success with this strategy. As youth begin to truly realize the health consequences of childhood obesity (Table 1), hopefully they will be motivated to balance their lives with more play and physical activity.

As our societies flourish, so must our advocacy to protect our open spaces for recreational use as well as the development of bike paths, parks and safe playgrounds for all people. Lastly, since the severity of obesity is a serious concern for adults as well as children, perhaps now more than ever is the time to start initiating activities that provide the ‘family unit’ with play, physical activity and enjoyment to be shared together.

Final Thoughts for the Fitness Professional and Personal Trainer
As conscientious fitness professionals and personal trainers, we can play a leadership role in helping to deliver health-promoting activities and programs for our youth in efforts to treat and prevent childhood obesity. We can individually bring about positive impact on this critical public health problem by working with schools, fitness clubs, training studios, hospitals, public health centers, and city and state governments. Our enthusiastic efforts in dealing with this important health concern can be a significant role in the resurgence of play and physical activity for today’s youth.

Table 1. Health Consequences of Childhood Obesity
A) Known ill health effects associated with childhood obesity
Abnormal blood lipids
Atherosclerosis
Chronic inflammation
Elevated insulin levels
Endothelial dysfunction
Heart disease
Hypertension
Increased tendency for blood clotting
Kidney dysfunction
Liver dysfunction
Neurological complications
Type 2 diabetes
B) Known psychosocial effects associated with childhood obesity
Adoption of high-risk behaviors
Decline in self-esteem
Loneliness
Nervousness
Sadness
Negative self-image
Source: Ebbeling, C.B., Pawlak, D.B., and Ludwig, D.S. (2002). Childhood obesity: public-health crisis, common sense cure. Lancet, 360: 473-482.

References:
Burdette, H.L. and Whitaker, R.C. (2005). Resurrecting free play in young children. Archives of Pediatric Adolescent Medicine, 159: 46-50.
Dietz, W.H. and Gortmaker, S.L. (1985). Do we fatten our children at the television set? Obesity and television viewing in children and adolescents. Pediatrics, 75(5): 807-812.
Ebbeling, C.B., Pawlak, D.B., and Ludwig, D.S. (2002). Childhood obesity: public-health crisis, common sense cure. Lancet, 360: 473-482.
Hedley, A.A., Ogden, C.L., Johnson, C.L., Carroll, M.D., Curtin, L.R., and Flegal, K.M. (2004). Prevalence and overweight and obesity among US children, adolescents and adults, 1999-2002. Journal of the American Medical Association, 291(23): 2847-2850.
Janssen, I., et al. (2005). Comparison of overweight and obesity prevalence in school-aged youth from 34 countries and their relationships with physical activity and dietary patterns. Obesity Reviews, 6: 123-132.

Biographies:
Doyeon Kim, MS, is a doctoral student in the exercise science program at the University of New Mexico, Albuquerque (UNMA). He earned his master ’s degree in exercise and sport science in 2005 at the University of Utah and has research interests in the childhood obesity, body composition, sports training adaptation and exercise prescription.

Len Kravitz, Ph.D., is the Program Coordinator of Exercise Science and Researcher at the University of University of New Mexico where he recently won the "Outstanding Teacher of the Year" award. Len was honored with the 1999 Canadian Fitness Professional “International Presenter of the Year” and the 2006 Canadian Fitness Professional “Specialty Presenter of the Year” awards and chosen as the American Council on Exercise 2006 "Fitness Educator of the Year”.

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