The Rise In Childhood Obesity And Ways To Decrease Childhood Obesity

There are a multitude of reasons for a child being obese with the most significant ones being, leading a sedentary lifestyle, unbalanced diet and genetic factors. A sedentary lifestyle is the state of involving little exercise or physical activity into daily life (Lifespanfitness.com, 2017)13. It is recommended by the NHS that children between the ages of five and 18 should exercise for 60 minutes a day.6 However in 2016, excluding school-based activities, 22% of children aged between five and 15 met the physical activity guidelines of being at least moderately active for at least 60 minutes every day.7 One possible reason for the lack of activity in children today compared to children 30 years ago is the introduction of modern technology. This technology encourages children to stay inside on computers, ipads and game consoles, as opposed to going outside in their free time. Furthermore, another reason for this statistic is due to socio-economic and ethnic factors. Studies have shown that racial and ethnic minority and lower-income youth groups are less likely to take part in recreational physical activity.8 Racial and ethnic minority groups tend to have lower activity levels due to discrimination and lack of role models. Whilst children in low income families have low activity levels due to being unable to afford the expenses of sports equipment, lack of education for the importance of exercising and lack of transport. Researchers at the University of South Australia used running speed as a simple proxy for aerobic fitness, because it measures cardiovascular health and endurance and their investigation showed that children today take 90 seconds longer to run a mile than kids did 30 years ago, according to data from 28 countries (Npr.org, 2013)14. One disadvantage with this source is that it the children used are not specifically form the UK, instead children around the globe have been studied. Whilst it is not specific to the UK we can still expect there to be the same trend as the studies have shown.

A low socio-economic status also has links to a poor unbalanced diet. The government’s guidelines for a healthy balanced diet is to consume at least 5 portions of fruit and vegetables a day and does not involve the consumption of foods very high in sugar and fats 9. In contrast, studies show that in 2011 just 18% of children consumed 5 portions of fruit and vegetables per day.10 30 years ago, the average preparation for a meal time fell from an hour to 20 minutes between 1980 to 1999 (Woods, 2007).15 This shows that in the past 30 years families have become more dependent on readily made meals and takeaways saturated in salts, sugars and saturated fats, in contrast to preparing food from fresh, raw ingredients and being healthier – in comparison to the current, more popular ready made meals. Furthermore, the fast-paced lives that we lead today have increased the consumption of snacks high in sugar and salt as they are convenient. This is having an effect on our children whilst preparing packed lunches for school. Thirty years ago, meal times were far more regulated with snacking being a less familiar concept. This demonstrates that snacking takes a large amount of responsibility when considering the change in diets in the past 30 years (Petty and Petty, 2017).16

Disregarding lifestyle related factors, genetics are also involved in persons weight. To investigate this scientists can study identical twins in order to compare environmental and genetic factors affecting a person’s weight. A study made in 2010 by Hasselbalch AL (AL, 2010) investigated the genetics of dietary habits and obesity. The study found that the influence of genes on dietary traits was between 20-50%.11 However, the influence of genetic factors upon a person’s weight remains constant, therefore this statistic would still be the same 30 years ago. So, we cannot make a comparison of genetic factors since there is no variance in its effect.

One factor that has control over a child’s weight is breastfeeding at the early ages of development. One reason for this is that exclusive breastfeeding eliminates the early introduction to foods that can lead to childhood obesity. Formula milk is higher in protein and energy which leads to and increased body weight during the neonatal period. Furthermore, a study demonstrated that exclusive breastfeeding may be associated with lower blood cholesterol concentrations in later life, whilst formula-fed infants had a higher blood cholesterol in comparison 17. This is an example of a trustworthy source since 17,498 participants took part, so it shows genuine data and it is unbiased. One improvement that could be made to the study is an even amount of participants taken from each group. In this study 12 890 participants were breastfed, whilst 4608 were formula-fed. This may be due to the fact that formula-fed participants were less available and did not want to take part in the study. However an even distribution would allow more reliable results from the study. As of 1995, 60% of new mothers initiated breastfeeding, with 20% still breastfeeding at 6 months (The journal of nutrition, 2001)19. Today, breastfeeding initiation is at 81%, while at six months 34% of others are still breastfeeding (Baby Friendly Initiative, 2010)18. This increase in mothers breastfeeding is very positive and should be continued to increase further. The increase in breastfeeding rates whilst childhood obesity rates also rise provides evidence that breastfeeding is not the most important factor when considering the reasons for the rise in childhood obesity levels.

The risks of a child being obese

The long term effects of childhood obesity greatly increases the risks of non-communicable diseases, with the most common being type 2 diabetes, cancers and heart disease. A study taken in Finland investigated how gaining, losing or maintaining weight over time impacts risk for heart disease (Cardiosmart.org, 2018)20. The study tracked the health and weight of 2,631 particants between the years of 1980 and 2011. Participants were 6–18 years old at the start of the study and 34–49 years at their latest follow-up. Out of all the participants, 4% of those who started out overweight or obese were able to lose weight by their final weight check in 2011 and were able to shift into the healthy weight category. The 4% that were able to achieve this healthy weight had a much lower risk of heart disease compared to those who continued to be overweight or obese. Additionally, they had the exact same risk for high blood pressure and high cholesterol as those who were never overweight. Unfortunately, those who lost weight still faced an increased risk for unhealthy arteries and type 2 diabetes in later life. This is an example of a very successful study as it demonstrates the lasting effects of childhood obesity even if later on a normal weight is achieved. A useful follow up study could consider why the risk of type 2 diabetes and unhealthy arteries still remains high. This data collected would be very useful to publish and present to children because it quantitatively demonstrates the lasting effect. One way this study could be improved is to take a greater amount of participants and also from a variety of countries to eliminate the effect of genetic factors specific to certain countries or areas. Additionally, a study taken in 2014 by University of Colorado Cancer Center stated that it may be that childhood obesity changes the way the whole metabolism is working (ScienceDaily, 2014)21. ‘It may be that childhood obesity changes the way the whole metabolism is working — and changes it during a critical developmental time frame’ says Kristen Nadeau, MD, investigator at the CU Cancer Center, associate professor of Pediatric Endocrinology at the CU School of Medicine. During his studies, he came across the difficulty that childhood obesity has only become a major problem in the past 30 years therefore it is difficult to study the effect of childhood obesity on later life. Therefore, he can only suggest that childhood obesity changes the way the whole metabolism works since a successful study would need to gather data over a far greater period of time. If Nadeau’s hypothesis is correct it will demonstrate why those who are obese as a child, have overwhelming chances of remaining in their obese state as an adult (Claire McCarthy, 2017)22.

Not only is a child’s physical health negatively impacted, a child suffering from obesity is also more likely to suffer from mental health illnesses. Numerous studies report a link between childhood obesity and depression. A study taken in 2007 by the American Psychosomatic Society investigated whether adolescent obesity is associated with risk for development of major depressive disorder (MDD) or anxiety disorder (Psychosomatic medicine, 2007). 23 The study took 776 obese participants aged 9-18 at the start of the investigation in 1983. The participants were monitored for their mental health over the course of 20 years. The results demonstrated that females were at an increased risk of depression or anxiety disorders, whilst males showed no significant increase. The difference between the sexes may be due to the fact that there is less of a stigma around male obesity, whilst females may feel a greater pressure to look a certain way- hence the increase in the diagnosis of depression and anxiety disorder. One fault with this investigation is that only diagnosed mental health conditions are considered, therefore undiagnosed mental health illnesses and issues such as low self esteem are not considered in the investigation. To improve, the study should also investigate psychological issues that cannot be diagnosed such as low self esteem. Furthermore, those who are overweight or obese are more susceptible to bullying (HealthyChildren.org, 2017)24, therefore are more likely to have a lower school attendance compared to those who are not bullied. The effect of a low school attendance is a very important issue that comes along with childhood obesity because a child’s education suffers – impacting further education and potentially job opportunities if very severe.

When gathering research for this project, I decided to conduct my own primary research. The sample I used was of ten 16-17 year olds- 8 females, 2 males. In the form of an online questionnaire, I asked the participants ‘Have you seen a link between childhood obesity ( in others or yourself) and poor mental health?’. The purpose of my primary research was to gather the opinions of other teens and to understand the awareness of the psychological effects of childhood obesity. The data gathered is displayed in a pie chart [appendix 1] to become more easily understandable. The study showed that 60% did believe there was a link between childhood obesity and poor mental health, whilst 40% did not. Additionally I asked for reasoning for the participants answers. A common answer amongst those who responded ‘No’ was that they predict it does occur however they have not seen it personally. Interestingly, all male participants responded ‘No’ which could suggest that males are less aware of mental health issues. Out of those who responded ‘Yes’, a common reasoning was that they predicted overweight children would feel more self- conscious especially in a school environment. Interestingly, 20% of the responses suggested that obese children may confide in food in order to comfort themselves. Seeking in food for comfort, can sometimes lead to binge eating disorder which leads to further weight gain. To improve this investigation, I should use a greater sample of participants to draw any reliable conclusions as a limited sample can introduce bias. I specifically chose to only use participants aged 16-17 because they are children themselves, and at the ages of 16 and 17 they are often very aware of mental health issues. Furthermore, another improvement that could be made is to ask an even proportion of obese children and normal-weighted children. This would be more useful since I could compare facts (from the obese participants) to opinions (from the normal-weighted participants).

Methods to reverse increase

The epidemic of childhood obesity has been well-recognised by the government of the United Kingdom as a major issue, and for this reason the government has implemented many initiatives in order to combat obesity at such a young age. Since 2013, the government published national guidance for a voluntary Front of Pack Nutrition Labelling Scheme for pre-packaged products. The guidelines are for colour-coded labels which use green, amber and red to identify whether products contain low, medium or high levels of energy, fat, saturated fat, salt and sugar (Apps.who.int, 2018)25. One improvement to this method would be, to make it compulsory to display this colour-coded system on the front of packages. The colour coded system is a successful way of engaging children into becoming aware what is healthy and unhealthy, since the understanding of red being bad and green being good is a simple concept to be grasped. One key figure in decreasing rates of childhood obesity is Jamie Oliver. One major initiative that Oliver greatly supported was the ‘Sugar Tax’ implemented in April 2018. The ‘Sugar Tax’ increases the cost of fizzy drinks to consumers with the aim of encouraging companies to reformulate their soft drinks. The tax on soft drinks has resulted in over 50% of manufacturers reducing the sugar content of drinks since it was announced in March 2016 – the equivalent of 45 million kg of sugar every year (GOV.UK, 2018)26. For this reason we can say that the soft drinks levy has been very successful, and demonstrates an example of the positive effect of taxing products high in sugar. This should be mirrored in other types of products to expand the positive effect. Additionally, another strategy taken by the government and further promoted by Jamie Oliver is the control over school meals. All children in reception, Year One and Year Two qualify for free school meals in England and Scotland (BBC News, 2018)27. Furthermore, eligibility for free school meals from year 3 above is linked to benefits and social situation. This is an effective way to focus on a specific group since, as mentioned previously, children who come from low socioeconomic backgrounds typically consume a less balanced diet.

In order to decrease the rate of childhood obesity growing, current techniques must develop, whilst new actions are taken. One way of finding new approaches is by taking inspiration from other countries policies, successful in tackling childhood obesity. France, Hungary and Mexico are amongst many countries to have adopted the technique of taxing sugar-dense products including drinks and snacks 28. The purpose of this is to decrease sales in certain products, forcing companies to reform the composition of the products. As I mentioned above, this would be a good contributor to aid the decrease in childhood obesity levels. One fault with this taxation policy however, is that customers may seek sugar consumption in cheaper products, yet greater quantities. The government’s control of quantity of consumption is very difficult when considering at home environments given that it is greatly down to the individuals own decisions.

Whilst there are restrictions upon primary school lunches in the United Kingdom, in Japan children’s lunches are taken very seriously with the use of the Shokuiku school lunch programme. This programme creates emphasis on the education around food and nutrition intended to not only combat childhood obesity, but also in anorexia. The four principal goals of the school programme are:

‘1) develop a proper understanding of diets and healthy eating habits in daily life

2) enrich school life and nurture sociability

3) aim at rationalisation of diets, nutritional improvement and health promotion

4) enhance a sound understanding on food production, distribution and consumption’ (M, 2012) 29

Almost all elementary schools (age six to 12 ) and approximately 80% of junior high schools ( up to age 15) take part in the Shokuiku programme (PIIF, 2015)30. Not only are children educated on nutrition, the importance of hygiene, manners and well sourced produce are also didactically taught. Japan has a highly established ‘walking to school practice’, implemented since 1953. The majority of students travelling in urban areas will travel on foot, with a small minority using a car, bus or train to travel (Mori et al. 2012)31. In schools participating in the school lunch programme in Japan, a positive impact has been observed in terms of awareness and interest in dietary requirements amongst parents and children. It is also reported by the School of Health Education Division in Japan that fewer children are skipping breakfast, and quality of life has been improved (Tanaka & Miyoshi, 2012)32. Whilst Japan’s system of school lunches may seem almost militaristic from an outsider’s perspective, the extremely positive results from the system lead a model example for United Kingdom’s government to follow. Not only does the Shokuiku school lunch programme greatly assist the prevention of childhood obesity rates growing, but it also raises awareness around essential topics of knowledge such as nutrition and hygiene that would be greatly beneficial if adopted in the UK. One difference between the UK’s system and the Japanese system is that school meals are regulated up to the age of 15. Alternatively in the UK, meals consumed in schools (including packed-lunches and school meals) have very little regulations in comparison. The Japanese method of school lunches creates a positive culture around healthy food, whilst many children in the UK are of the opinion that healthy food is less desirable. The evidence shown above demonstrates the positive effect that following Japan’s lead can have, on not only the health of the children but also the awareness of nutrition and hygiene.