Childhood Obesity Problems

Capstone Project

By

Femi Folorunsho

Introduction

Childhood obesity is on the rise everywhere around the

world. There are multiple explanations available for why

this is occurring and what can be done to address it. It is

a growing concern for the health care system and health

psychologists because of the effects that childhood obesity

has on childhood exposure to chronic health risk factors and

diseases, and the negative impact it has on self-esteem.

With obesity statistics on the rise, addressing this issue

from as many angles as possible has become of paramount

importance.

As a health psychologist who works with children on a

daily basis, and with two children of my own, the growing

childhood obesity epidemic is a major concern to me. I work

with families in my job who struggle with many of the

factors I found in my research. Understanding these

contributing factors to the epidemic and how to address them

will help guide me in my work with these children and their

families, and also in ensuring that my own children do not

end up obese.

Problem Statement

According to the CDC (2009), childhood obesity rates

have almost tripled in the last two decades from around 6.5

percent in 1980 17 percent in 2006, making childhood obesity

a leading concern in public health. An article on the

KidsHealth (2009) site indicates that as many as one in

three American children are overweight or obese, and

Robinson (2009) notes that the prevalence of childhood

obesity continues to be on the rise. A recent article in

the MMWR (2009) indicates that there are disparities in the

youth experiencing obesity issues, with lower-income and

minority children being at a greater risk. The greatest

increases in childhood obesity are being seen in African

Americans, Latinos, and middle to lower class children

(Cecil-Karb and Kaylor, 2009). Annesi, Pierce, Bonaparte,

and Smith (2009) note that Mexican American children have

the highest rates of being overweight and obese, with a 43

percent prevalence rate.

The terms overweight and obese are reliant upon

calculation of the child’s body mass index (BMI) score (CDC,

2009). Brannon and Feist (2007) define BMI score as a

calculation based on body weight in kilograms divided by the

child’s height in meters squared. BMIs of between 25 and

29.9 (or above the 85th percentile) are considered

overweight and BMIs greater than 30 (or above the 95th

percentile) are considered to be obese. They note that BMI

scores do not account for age, body type, fat distribution,

or gender, which can make them misleading in identifying

obesity.

Massey-Stokes and Meaney (2006) indicate that in 2006,

around nine million children between the ages of 6 and 19

were considered obese, representing a major crisis. The CDC

contends that in one study of 5 to 17-year old children,

around 70 percent were found to be suffering from

cardiovascular disease risk factors, and many had joint and

sleep issues, psychological problems such as low self

esteem, and social stigmatization problems. Additional

consequences of childhood obesity include risk of chronic

health problems such as hypertension, asthma, insulin

resistance, Type 2 diabetes, high blood pressure, high

cholesterol, atherosclerosis, eating disorders,

psychological disorders related to negative body image and

shame, orthopedic disorders, poorer school performance, and

greater obesity and health risks in adulthood. All of these

health risks have major implications for both public health

and the health care system.

Because childhood obesity is seen to have many

contributing factors, addressing it in a variety of settings

and from multiple perspectives is important to addressing it

adequately. These areas include in the home, at the school

level, and at the community (to include socioeconomic and

cultural considerations) level. Social change factors are

implicated as having the most ability to affect changes in

the home, school, and community environments, but also as

being the most difficult to implement because of existing

political structures world-wide (O’Neill, 2005). Proper

definition of the problem is considered to be important in

addressing the inequalities that arise from problems within

social structure that require social change in order to make

a significant difference in outcomes. Overall, social

change policies are seen as being the most needed in

addressing the factors contributing to childhood obesity,

but as being the least likely to actually happen.

Integrated Literature

Childhood obesity is on the rise within the United

States and other countries worldwide (CDC, 2009). As a

global factor, there are multiple explanations available for

why this is occurring and what can be done to address it

within the global community. Childhood obesity is a growing

concern for the global health care system and health

psychologists because of the effects that childhood obesity

has on childhood exposure to chronic health risk factors and

diseases, and the negative impact it has on self-esteem. As

noted earlier, the CDC (2009) contends that in one study of

5 to 17-year old children, around 70 percent were found to

be suffering from cardiovascular disease risk factors, and

many had joint and sleep issues, psychological problems such

as low self esteem, and social stigmatization problems.

Additional consequences of childhood obesity were noted to

include risk of chronic health problems such as

hypertension, asthma, insulin resistance, Type 2 diabetes,

high blood pressure, high cholesterol, atherosclerosis,

eating disorders, psychological disorders related to

negative body image and shame, orthopedic disorders, poorer

school performance, and greater obesity and health risks in

adulthood. The childhood obesity epidemic is of extreme

importance within financially strained global communities

who have to provide increasing amounts of medical care

funding for younger populations, and whose job it is to

determine and implement prevention strategies. Addressing

the social, economic, behavioral, and other environmental

dimensions of this issue is an important step in understand

how best to intervene.

In a recent study, Massey-Stokes and Meaney (2006)

found a direct relationship between minority and low income

families (those with higher rates of deprivation) and

increased rates of both obesity and health disparities.

They found that lower income families have limited resources

and focus on food purchases that give them more for their

money----usually low nutrition, pre-packaged choices. They

found that fresh foods were seen as treats, only to be

purchased when the family had a few extra dollars to

splurge. They also found that parents in these groups had

greater disparities in lack of knowledge about the benefits

of both nutrition and exercise, and how to prepare healthy

meals at home. They also found that children in their study

are also often unsupervised in the kitchen and therefore

grab whatever is available or desirable to them.

Similarly, Duffin (2009) found that many families in a

study she did in London were only sending in sweets for

their children to eat at lunch time. She found that lower

income families were more likely to be purchasing cheaper,

bulk foods such as macaroni and cheese, lunchbox cakes, and

other pre-packaged foods with little nutritious value, and

that they perceived purchase of fresh fruit and vegetables

to be an occasional “treat” or splurge for their families.

Duffin (2009) adds that racial disparities play a role in

childhood obesity, mainly in that childhood obesity can be a

result of differing body types, noting that some black

communities may have higher rates of obesity because their

bodies are adapted to the regions they are from and

therefore need less food. Annesi, Pierce, Bonaparte, and

Smith (2009) note a similar trend for Mexican Americans in

that they usually become obese once they are exposed to a

westernized diet.

Environment can play one of the biggest roles in both

contributing to and preventing childhood obesity. Home

environment has a significant influence on a child’s

development of diet and exercise habits. Low income and

minority families are at a greater disadvantage because they

lack resources and have deficits that impede the development

of good habits. Massey-Stokes and Meaney (2006) noted that

many of the children in their study did not own a

toothbrush, suffered abuse and neglect issues, and were

exposed to unhealthy lifestyle behaviors such as alcoholism,

drugs, and smoking. Parent deficits in knowledge about

healthy behaviors and lack of access to basic food and

medical resources were also noted. Many children are from

single-parent families, increasing the financial burden and

creating a home environment with less supervision when it

comes to both food and activity choices.

Massey-Stokes and Meaney (2006) advocate for prevention

efforts that focus on pre-adolescent children and their

families as this is when habits that follow through to

adulthood are typically formed. They advocate for programs

that target lower income and minority parents and provide

them with education on nutrition and serving sizes, shopping

that affords them a healthier diet, and the benefits of

incorporating physical activity into their lifestyles.

Parents could also be given ideas to get their children out

from in front of the TV and engaged in healthier activities.

They indicate that schools are probably best suited to

setting up these types of programs and targeting appropriate

families. Schools have the capacity not only to send home

educational newsletters addressing diet and nutrition, but

also to provide safe and free family fun and fitness events

for students and their families.

School environments also serve many other avenues for

effecting childhood obesity rates. Duffin (2009) points out

that school lunches should be monitored and nutritional

standards enforced. She also states that school facilities

could be opened to family uses for physical exercise and

more school nurses could be hired to manage obesity

monitoring, education, and referral services. Massey-Stokes

and Meaney (2006) contend that college students should be

educated in the needs of their particular communities in

addressing obesity and could facilitate school programming

to address these needs. Annesi, Pierce, Bonaparte, and

Smith (2009) indicate that school programming can be

expanded to include more physical education opportunities

and afterschool programs, like those at the YMCA, that meet

community needs by hosting fitness programs and workshops

for attending children.

The CDC (2009) contends that monitoring childhood

obesity rates is of paramount concern to public health

officials at this time. They advocate for prevention

strategies that address environmental influences such as

access to healthy foods through community programs such as

WIC, and through nutritional standards for federally funded

food programs offered to schools and child care facilities.

The CDC (2009) also advises policy creation that promotes

exercise and nutrition for families, communities, schools,

and daycare programs.

Critical Analysis Narrative

Causes and effects of childhood obesity vary,

depending on the focus of the research article. Most

literature contains at least one of the following, while

most combine more than one cause: diet, exercise,

socioeconomic status, environment, or psychological causes.

Diet and exercise as causes tend to be influenced by the

other sited causal factors.

The major sited causes of childhood obesity are the

behavioral components of diet and exercise. The CDC site

(2009), the AAP (2009), the Massey-Stokes and Meaney study

(2006), and the Duffin study (2009) agree that obese

children tend to have diets too high in calories, eat too

few fruits and vegetables, and are given too many sugary

drinks and fast food meals by their parents. The AAP (2009)

also points to the lack of fiber in the diet of obese

children and the fact that they do not get a nutritious

breakfast at home as playing further causal roles in the

dietary component of the problem. The Massey-Stokes and

Meaney (2006) study adds the fact that many of the parents

in their study lacked information on general nutrition,

healthy food choices, and even preparing meals at home as

contributing to the poor diets of obese children. Their

study also pointed out the interesting finding that many of

the children in their study were largely unsupervised in the

kitchen and permitted to grab whatever was convenient and

available to them. The Robinson (2009) study contributed

the finding that parents of obese children tend to reward

their children with food rather than affection or non-food

rewards. Each of these studies provided adequate support

from peer-reviewed studies of the causal role of diet in the

issue of childhood obesity.

Physical activity and sedentary behavior are the

complementary causal behavior to diet in the problem of

childhood obesity. The Annesi, Pierce, Bonaparte, and Smith

(2009) study and the CDC (2009) site both provide support

for the finding that poor diet and low levels of physical

exercise are directly responsible for the continued surge in

prevalence of obesity among children. Massey-Stokes and

Meaney (2006) add that lifestyle habits form in early

childhood, so families with poor eating and exercise habits

have children who develop into adults with the same habits.

The Robinson (2009) study adds that families who try to

“blame” genetics need to be educated on the fallacy of this

view and on how food and physical activity choices can

mediate genetic predispositions to obesity. Each of these

studies provides empirical support for the role of low

physical activity as a primary causational factor in

childhood obesity.

Socioeconomic status is seen as another causal factor

in childhood obesity. It also plays a role in the

environmental factor, as having a lower economic status

affects where a family lives, the type of household

environment, the neighborhood environment the family is

exposed to, and the school environment the child is exposed

to. The major role of socioeconomic status in childhood

obesity is the type of foods the family is likely to

purchase (thus influencing dietary factors). As noted

earlier, the Massey-Stokes and Meaney (2006) study found a

direct relationship between minority and low income families

(those with higher rates of deprivation) and increased rates

of both obesity and health disparities. They found that

lower income families have limited resources and focus on

food purchases that give them more for their money----

usually low nutrition, pre-packaged choices. They found

that fresh foods were seen as treats, only to be purchased

when the family had a few extra dollars to splurge.

Similarly, the Duffin (2009) study found that many families

in a study she did in London were only sending in sweets for

their children to eat at lunch time. As stated earlier, she

also found that lower income families were more likely to be

purchasing cheaper, bulk foods such as macaroni and cheese,

lunchbox cakes, and other pre-packaged foods with little

nutritious value, and that they perceived purchase of fresh

fruit and vegetables to be an occasional “treat” or splurge

for their families.

Environment can play one of the biggest roles in both

contributing to and preventing childhood obesity. Home

environment has a significant influence on a child’s

development of diet and exercise habits. The Massey-Stokes

and Meaney (2006) study, the CDC (2009), the AAP(2009), the

Cecil-Karb and Grogan-Kaylor (2009) study, and the Robinson

(2009) study all concur the low income and minority families

are at a greater disadvantage because they lack resources

and have deficits that impede the development of good

habits. The Massey-Stokes and Meaney (2006) study also

noted that many of the children in their study did not own a

toothbrush, suffered abuse and neglect issues, and were

exposed to unhealthy lifestyle behaviors such as alcoholism,

drugs, and smoking. The Massey-Stokes and Meaney (2006)

study, the Robinson (2009) study, the Hawkins et al (2009)

study, and the Duffin (2009) study note parent deficits in

knowledge about healthy behaviors and lack of access to

basic food and medical resources and that many children are

from single-parent families, increasing the financial burden

and creating a home environment with less supervision when

it comes to both food and activity choices.

School environments serve as avenues for effecting

childhood obesity rates. Duffin (2009) pointed out that

school lunches should be monitored and nutritional standards

enforced, as many of the food choices being offered to

students lack nutritional value. The Massey-Stokes and

Meaney (2006) study added that school food service has a

negative impact on dietary choices because high sugar, high

fat “extras” like giant cookies and bags of chips are offer

to students in addition to the French fries, pizza, and cake

offered as daily menu options. Both studies also note that

many schools have cut physical education and recess from the

curriculum, which impacts the amount of physical exercise

students are getting.

Neighborhood environments are also noted as

contributing to childhood obesity. The Massey-Stokes and

Meaney (2006) study and the Cecil-Karb and Grogan-Kaylor

(2009) study indicate poor neighborhoods have fewer accesses

to healthy food resources and higher crime rates limit

exposure to outdoor physical activities for children.

Transportation issues, particularly for the lowest

socioeconomic status families, were seen as exasperating the

problem. Increased crime in the neighborhood environment is

also seen in both studies as contributing to psychological

factors of stress and anxiety that increase cortisol levels

and lead to weight gain.

The Massey-Stokes and Meaney (2006) study, the CDC

(2009), the AAP(2009), the Cecil-Karb and Grogan-Kaylor

(2009) study, the Duffin (2009) study, and the Robinson

(2009) study all agree that childhood obesity leads to many

negative effects on health and psychological factors. As

noted earlier, they state that childhood obesity is a

growing concern for the global health care system and health

psychologists because of the effects that childhood obesity

has on childhood exposure to chronic health risk factors and

diseases, and the negative impact it has on self-esteem.

These studies indicate findings that obese children are more

likely to be suffering from cardiovascular disease risk

factors, joint and sleep issues, psychological problems such

as low self esteem, and social stigmatization problems.

Additional health consequences of childhood obesity

indicated by the CDC (2009) site include increased risk of

hypertension, asthma, insulin resistance, Type 2 diabetes,

high blood pressure, high cholesterol, atherosclerosis,

eating disorders, psychological disorders related to

negative body image and shame, orthopedic disorders, poorer

school performance, and greater obesity and health risks in

adulthood. Most of the studies I looked at agreed that the

childhood obesity epidemic is of extreme importance within

financially strained global communities who have to provide

increasing amounts of medical care funding for health and

psychological treatments for these younger populations.

Problem Resolution

The focus of this paper has been that childhood

obesity is on the rise everywhere around the world. There

are multiple explanations available for why this is

occurring and what can be done to address it. As noted

several times, it is a growing concern for the health care

system and health psychologists because of the effects that

childhood obesity has on childhood exposure to chronic

health risk factors and diseases, and the negative impact it

has on self-esteem. Potential resolutions for preventing

and treating childhood obesity generally address issues with

diet and level of physical activity.

Research supports the theory that earlier intervention

is better for prevention and treatment efforts against

childhood obesity. Johnson, Bellows, Beckstrom, and

Anderson (2007) point out that early childhood food choices

are indicative of food choices later in life. They indicate

that increased interventions with food choices in early

childhood can have a positive impact on healthy eating

habits that form and carry through the lifespan. As

discussed earlier, Massey-Stokes and Meaney (2006) indicate

that prevention efforts should focus on pre-adolescent

children and their families as this is when habits that

follow through to adulthood are typically formed. They

advocate for programs that target lower income and minority

parents and provide them with education on nutrition and

serving sizes, shopping that affords them a healthier diet,

and the benefits of incorporating physical activity into

their lifestyles. Parents could also be given ideas to get

their children out from in front of the TV and engaged in

healthier activities. They indicate that schools are

probably best suited to setting up these types of programs

and targeting appropriate families. Schools have the

capacity not only to send home educational newsletters

addressing diet and nutrition, but also to provide safe and

free family fun and fitness events for students and their

families. Hawkins et al (2009) add that education for

working moms on the effects of employment on child diet and

physical activities could be addressed through school

workshops. KidsHealth (2009) points out that “quick and

easy” has become the motto in many American homes. Mothers

could be given skills to improve dietary choices and to find

ways to fit physical activity opportunities for themselves

and their children into their busy schedules.

School environments also serve many other avenues for

effecting childhood obesity rates. Duffin (2009) points out

that school lunches should be monitored and nutritional

standards enforced. She also states that school facilities

could be opened to family uses for physical exercise and

more school nurses could be hired to manage obesity

monitoring, education, and referral services. Most schools

at present lack implementation of these standards.

Implementation of these steps in school would ensure

children were exposed to nutrition and exercise benefits for

at least half of their waking hours during the school week.

The school-based resolution to this problem has the

potential to be the most realistic and achievable of the

possible solutions sited in the literature. The advantages

of this solution are that it has the potential to

effectively reach the majority of the target population,

parents and children, as most every child attends school.

Schools also gather income information from families and are

best able to identify those families that fit the target

lower income brackets. The school environment is also well

suited to the proposed informational interventions,

workshops, and family fitness activities. Family

educational events could be backed up with increased obesity

prevention education to children during the school day.

This solution could reach the most families and have the

best results if implemented in all of the areas suggested by

the literature.

The school-based resolution to the issue of childhood

obesity does have several challenges and barriers to

implementation. One of the major disadvantages of this

solution is that it could be potentially expensive to

administer (costs workshops and fitness activities, extra

employee hours, and materials). The school would have to

apply for and justify grant funds to add the extra expenses

to the budget. Another challenge and expense would be that

staff might have to undergo additional training hours.

Staff would need to be made to understood why this program

is so important and administrators would need to get them on

board with putting in some extra long days every few weeks

to make the program doable. A third challenge to the

success of the program would be that there is no guarantee

that parents will read information that is sent home or make

time to attend workshops and events. Administrators would

need to really promote the program and the benefits to the

children. Even then, they would not be able to guarantee

that every child’s family would participate.

Conclusions

This paper has discussed the problem of childhood

obesity in the context of contributing factors from the

home, school, and community environments. Diet and exercise

interventions in all of these areas would serve to address

the problem from two of the primary sources. Using the

school environment has been discussed as the ideal solution

to addressing these key components while addressing issues

in all three environments. The school environment has been

shown to have the capacity to address diet and nutrition

issues with parents, particularly those with in low income

home environments. The school environment has also been

shown to be capable of increasing its own attention to these

issues and to be able to provide safe, educational

environmental situations for children and families to

increase their physical activity experiences, as well as to

fill in deficits in knowledge about diet and nutrition with

target populations.

Before starting this project, I had been aware that

childhood obesity was a growing problem. As I worked my way

through the literature, I gained a lot of insight into

contributing factors to the problem that I hadn’t

necessarily thought of before. I work for Head Start as a

Social Worker and over ninety percent of our families fall

below the federal poverty guidelines. This project has

enriched my abilities to educate the parents of the pre-

school population that I work with on a daily basis. I have

learned that it isn’t just a matter of telling parents to

feed their children more fruits and vegetables and to get

them exercising. I have learned that many families have

barriers such as an unsafe neighborhood environment, lack of

access to resources and fresh foods, and lack of education

about such basic things as serving sizes and cooking healthy

meals that also need to be addressed.

I have been able to draw from the knowledge I have

gained during this project to truly become a scholar-

practitioner affecting social change, perhaps more so than I

ever imagined. As a result of my new found knowledge on

childhood obesity I worked with our Parent Involvement

coordinator to set up two programs, one addressing diet and

one addressing physical activity. We set up a workshop for

parents on healthy shopping and nutrition that included

information on accessing programs that assist low income

parents with fresh foods at reduced prices. We also set up

a “fitness challenge” for the over five hundred families

served by the program that I work for (all but a few chose

to participate!). The challenge involved parents and

children filling out weekly “fitness logs” together and

competing with other families in the program for fitness

prizes (such as fitness equipment and month long memberships

to fitness related activities) that they otherwise would

probably not be able to afford. The challenge ran for

twelve-weeks and was a huge success. The program plans to

use the nutrition workshop and the “fitness challenge” again

next year. I really was excited to be able to use what I

was researching in practice to address this issue with

parents and families.

In addition to the programs I instituted at work, I

also joined a committee in my community to address the

community need for additional food programs for the poor. I

was able to contribute my research as data for applying for

grants to fund this effort. I probably would not have

thought to join this committee before because I didn’t

really understand the problem or its contributing factors.

I have learned that I can not only research and theorize

about problems and their solutions, but that I can

effectively put my research into practice in meaningful

ways. This course has truly been an eye-opening experience

for me.

References

American Academy of Pediatrics (AAP) (2009). Prevention and

treatment of childhood

overweight and obesity. Retrieved April 1, 2010 from

http://www.aap.org/obesity/index.html.

Annesi, J. J., Pierce, L. L., Bonaparte, W. A., & Smith, A.

E. (2009). Preliminary effects

of the Youth Fit for Life protocol on body mass index

in Mexican American

children in YMCA before- and after-school care

programs. Hispanic Health Care

International, 7(3), 123-129.

Brannon, L. & Feist, J. (2007). Health psychology: An

introduction to behavior and

health (6th Ed.). Belmont, CA: Thompson Wadsworth.

Cecil-Karb, R. & Grogan-Kaylor, A. (2009). Childhood body

mass index in community

context: Neighborhood safety, television viewing, and

growth trajectories of BMI.

Health and Social Work, 34(3), 169-177.

Center for Disease Control (CDC) (2009). Healthy youth!

Retrieved May 4, 2010

from http://www.cdc.gov/HealthyYouth/obesity/.

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London. Pediatric Nursing, 21(6),

8-9.

Hawkins, S. S. et al. (2009). Poor diet more common in

children of mothers who work.

Journal of Epidemiology and Community Health, 10, 1136.

Johnson, S. L., Bellows, L., Beckstrom, L., & Anderson, J.

(2007). Evaluation of a social

marketing campaign targeting preschool children.

American Journal of Health Behavior, 31(1), 44-55.

KidsHealth (2009). Overweight and obesity. Retrieved

December 26, 2009 from

http://kidshealth.org/parent/general/body/

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community: An exploratory study of parent, teacher, and

student perceptions

about childhood obesity. The Health Educator, 38(2), 53-60.

MMWR Weekly (July 24, 2009). Obesity prevalence among low-

income, preschool-

aged children---United States, 1998-2008. MMWR Weekly,

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O’Neill, P. (2005). The ethics of problem definition.

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13-20.

Robinson, F. (2009). Tackling childhood obesity. Practice

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