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Literature Review On Childhood Obesity

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Literature Review on Childhood Obesity

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Obesity is a growing problem among U.S. children. In 1994, one in five children between the ages of 6 and 17 was overweight. This is double the rate of 30 years ago (National Center for Health Statistics, 1999). This adverse trend has potentially profound effects on children's health, including their long-term health. The terms "obese" and "overweight" often are used interchangeably. Technically, "obesity" is the upper end of "overweight." Obesity is clinically diagnosed as: greater than 90th percentile for weight for height; or greater than or equal to the 95th percentile Body Mass Index (BMI), age and sex specific. The gold standard is becoming the BMI, since this is also used for adults.

Obesity has wide-ranging impacts on a child's health. Obesity has been linked to several diseases and conditions in adults, such as heart disease, cancer and diabetes. Many risk factors associated with these diseases, such as high cholesterol, blood pressure and triglyceride levels, can be followed from childhood to adulthood. These points to a potential link between childhood health and long-term adult health. Overweight children are more than two times likely to have high levels of cholesterol. Aortic fatty streaks, the first stages of atherosclerosis, begin to appear in childhood, maybe even as early as three years old. Also, children with triceps skin folds greater than the 70th percentile have significantly higher blood pressures. In the past few years, Type 2 diabetes has risen dramatically among children and adolescents. Experts believe this increase is due to the high rate of overweight and obesity.

One of the biggest concerns is that obese children are more likely to become obese adults, with all of the health, social and psychological ramifications. Three important factors are age of onset, severity, and parental obesity. In a review of literature, Serdula (1993) found the risk for adult obesity was greater among children who had extreme levels of obesity. They also found that the risk was higher for those who were obese at older ages, such as in adolescence (Serdula, 1993). Parental obesity may double the risk for adult obesity too (Whittaker, 1997).

Obesity has social, psychological and emotional consequences. Our society emphasizes slimness, and we have many misconceptions about overweight and obesity. As a result, obese children often are treated differently. This may be the most devastating effect of obesity on children. Obese children may feel isolated and lonely. This can lead to self-esteem and identity problems. It is important to be sensitive to this issue and to understand that an individual's confidence, especially a child's, is affected by self-image and perceptions of peers.

Preventing and treating obesity is difficult. Causes are different from person to person and are still not fully understood. They include genetics, the environment and behavior. It has been shown that children with obese parents are more likely to be obese. But is it for genetic or environmental reasons? One estimate says that heredity contributes between 5 and 25 percent of the risk for obesity (Bouchard & Perrusse, 1993). The remaining risk is attributed to environmental and behavioral factors. Others believe that genetics may play a bigger role. Regardless, the interrelationship between genetics and the environment is clear: Parents provide genes, role models, and food. U.S. dietary patterns have changed significantly over the past few decades. Over nutrition has replaced under nutrition as the largest nutrition-related problem facing both children and adults. Although the percent of calories from total fat have declined over the past 30 years, total calories have increased. Soft drink consumption has also boomed, adding more calories and fewer nutrients to Americans' diets. Our environment also supports "oversize" through large portion sizes at restaurants. These trends play roles in the increasing rate of obesity, along with lack of physical activity.

Researches studies differ on whether obese consume more energy (calories) than non-obese individuals. Some show they do consume more; others show they may consumer fewer calories. The big difference may be in the type of nutrients that they consume, such as fat. For example, Gazzaniga, found that the percentage of body fat was positively correlated with total dietary fat. Still, other researchers suggest that the reasons are metabolic in origin and that obese individuals "process" foods differently resulting in an increase in body fat. Although how these factors affect obesity are not fully understood, one thing is clear: Obesity results when energy intake exceeds energy expenditure and is stored as fat.

Ellyn Satter (1987), author of Child of Mine: Feeding with Love and Good Sense, firmly believes in the importance of "the feeding relationship" and its implications for obesity. The feeding relationship is the interaction that takes place between parents and children around food. Obese children need to learn to listen to their internal cues of hunger and appetite. Parents and childcare providers must help them do so. This includes encouraging children to eat according to these cues, while acknowledging the emotional aspect of feeding and eating. A restrictive diet may make the child feel deprived and neglected, and exacerbate the overeating problem.

Children and adolescents who watched the most TV were more obese than peers who watched it less. (Dietz, Gortmaker, 1985) In general, the more TV they watched, the greater the prevalence of obesity. There are several ways television contributes to childhood obesity:

* Watching TV requires no energy above resting metabolic rates.

* TV reduces the time the child spends in energetic activities, such as running and playing. In other words, it's not what the child is doing but rather what he/she is not doing while watching TV.

* The foods most heavily advertised on TV are high in calories: candy bars, sugared cereals, etc.

* The slim figures of TV stars may indirectly suggest to children that high calorie food and drinks have little effect on weight.

* TV characters are typically snacking, not sitting down for well-balanced meals.

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