An investigation into the causes and effects of childhood obesity amongst primary school children Abstract This investigation looks at how various factors such as activity levels and diet affect a child’s health status

An investigation into the causes and effects of childhood obesity amongst primary school children
Abstract
This investigation looks at how various factors such as activity levels and diet affect a child’s health status. For example, I expected to find that the less active and healthy a child is the more likely they are to be obese. I looked at how these factors could affect a child in later life through research. I provided parents of the children with a questionnaire, so I could see how their choices promoted the risk of obesity in their child. I looked at diet, activity level, screen time and amount of sleep to name a few. I also looked at dual career families as they tend to be more reliant on convenience foods due to a lack of time which can contribute to childhood obesity. I used qualitative and quantitative in my questionnaire.

Introduction
Childhood obesity is when abnormal or excessive fat accumulation may impair health (childhoodobesityfoundation.ca). Childhood obesity is on the rise globally. Current trends suggest it will get worse. This is evident in the United States for example, where the percentage of children and adolescents affected by obesity has more than tripled since the 1970s (www.cdc.gov). We know the main causes, effects and how to prevent it so why does it continue to rise? I looked further into many different causes of obesity, some that many people don’t realise have a big effect on obesity. I looked at how obesity not only affects the body physically but socially and mentally too. My main concern when gathering my data was that parents could give biased information as they don’t want to admit that their child is overweight or obese which would lead to inaccurate results. To prevent this from happening I ensured the questionnaires were made anonymous. Unfortunately, due to time restrictions I was only able to gather questionnaires from 40 children. More time would have allowed me to gather more questionnaires making my results more accurate and reliable.

Aim
To investigate the causes and effects of childhood obesity amongst primary school children
Objective
To survey 40 parents of primary school children about dietary and lifestyle factors
Literature review
The prevalence of obesity in childhood has approximately doubled in the last two decades (www.researchgate.net accessed 11/9/18). This is a serious public health challenge that appears to be overlooked by many people. Do we see obesity as the ‘norm’ nowadays? Statistics say that one in three children are currently overweight or obese (www.bbcgoodfood.com accessed 11/09/18). Could this be due to the increase in fast food restaurants, more academic focus rather than exercise or could it be parents? Parents play a vital role in a child’s diet. They must set a good example, prepare healthy meals and monitor their child’s diet carefully.

‘Overweight and obese children are likely to stay obese in adulthood and more likely to develop non communicable diseases such as diabetes and CVD’ (www.ncbi.nim.nih.gov accessed 8/9/18). Obesity tends to be caused by and energy imbalance where energy input from food is greater than energy output. ‘Snacks tend to be high in sugar and fat which can contribute to overeating and tip energy balance.’ (www.thensmc.com accessed 8/9/18). A poor diet with regular snacking, combined with not enough exercise makes children more likely to gain weight increasing their chances of obesity. Consuming more calories than needed leads to a positive energy balance (energy in is greater than energy expended). These excess calories are converted and stored as fat. ‘Being obese as a child increases the chances of a heart attack or stroke in adulthood.’ (www.nhs.uk accessed 8/9/18). A school in England found that nearly 1 in 5 of the kids in their last year of school were obese (www.thegaurdian.com accessed 8/9/18). Research suggests that food has more of an impact on energy balance than exercising does. ‘Obese and non-obese children shockingly have similar levels of activity’ (Beddome et al. 2001 accessed 11/9/18) This shows that increasing activity levels alone is not enough. There needs to be more of an effort made by parents to encourage healthy eating. Are parents actively taking action to make their child’s diet a better one? Are they monitoring their child carefully? Many parents tend to deny the fact that their child is overweight or obese. Many do not recognise a problem with their child. This may be an issue when it comes to the questionnaire. I may receive unreliable or bias information from children’s parents who do not want to admit that their child is obese. They may feel like it is their fault that their child is an unhealthy weight and so do not want to give the truth.

Parents have a big responsibility in ensuring their child is healthy. Many parents may not consider all of the factors that contribute to a healthy lifestyle due to a lack of knowledge. They must consider fruit and veg, portion sizes, snacks, drinks, exercise, sleep and screen time. Parents tend to give their children bigger portion sizes than recommended by the government. Children’s portion sizes have gotten bigger over the last 20-30 years. A 5-year-old needs about half the amount an adult does (www.safefood.eu accessed 11/9/18). Children should be given a small portion. By receiving a large portion, children often feel under pressure to finish the plate causing them to consume more than they need.

Screen time and sleep have a big impact on obesity. Are parents monitoring their child’s screen time? Are they ensuring their child gets the recommended amount of sleep? School-age kids need 10 to 11 hours of sleep a night (kidshealth.org accessed 11/9/18).
“Children who get insufficient sleep at night are more likely to become overweight,” reported BBC News.

The news was based on a study of 244 children, whose sleep patterns were assessed between the ages of three and five years old to see if they affected their body mass index (BMI) at the age of seven. The study found that, on average, children who slept for an hour less in their earlier years had a later BMI that was about 0.4 points higher. The study has some strengths, such as its use of objective measurements of sleep, but is limited by its small size. It is also difficult to be sure that sleep directly caused the differences seen in BMI.

It is clearly important that children get enough sleep, but it is not possible to say from the results of this study alone that interventions to increase children’s sleep will reduce their risk of being overweight. At present, the best advice to prevent a child becoming overweight is to make sure that they do enough physical activity and eat a healthy, balanced diet with the right amount of calories and nutrients for their age group.

experts say children should watch no more than 2 hours of television each day (www.nhs.uk)

Causes
Obesity can be caused by a variety of different factors. The most common causes are genetic factors, lack of physical activity, unhealthy eating, or a combination of these factors (webmd.com). many people are only aware of a few of the main factors but are oblivious to factors that impact on obesity such as premature birth, breast feeding or their weight as a baby.

It is commonly known that obesity results from an energy imbalance where energy intake is greater than energy expenditure. There are a range of factors that can affect this balance such as level of activity, metabolism, portion sizes, snacks and convenience foods. These factors are modifiable. However, there are many other factors that play a role in childhood obesity. Such factors are described as non-modifiable, for example, genetics.

Modifiable factors
Level of physical activity
Children should balance their energy input with energy output in order to maintain a healthy weight. If energy output is less than the energy taken in, then this excess energy will be stored as fat increasing the risk of obesity. Being physically active will help reduce the chances of obesity in adulthood. Children should participate in at least 60 minutes of physical activity daily for a healthy lifestyle (www.ncbi.nlm.nih.gov). A sedentary lifestyle is one of the main causes of obesity in children (www.who.int). With the internet and television becoming more and more popular, children are spending their free time being sedentary rather than physically active causing them to consume more. Each additional hour of television per day increased the prevalence of obesity by 2% (quizlet.com). Ads on TV promote eating making the viewer likely to consume more than they need. Unless this excess energy is used, it is stored as fat around the body leading to obesity. A lack of physical activity can also increase the risk of diseases such as diabetes and heart disease in adulthood. Children may not participate in physical activity due to safety concerns. Their parents may feel it is unsafe to take part in certain sports meaning children may not get the exercise they need.

Diet
Fast food/ convenience food consumption
Increased fast food consumption has been linked with obesity in the recent years. Many families consist of parents who both work. This often results in a lack of time and effort to prepare healthy meals. Therefore, many families choose the easy option of fast and convenience foods as they require no prep and often inexpensive. However, these foods tend to be high in calories with little nutritional value.
Sugary beverages
Sugary drinks tend to be high in calories. They are less filling than food and can be consumed quicker, which results in a higher caloric intake. Children who consume sugary drinks regularly—1 to 2 cans a day or more—have a 26% greater risk of developing type 2 diabetes in later life than people who rarely have such drinks (www.hsph.harvard.edu). These drinks are high in calories and sugar. They have no nutritional value. They provide quick calories meaning lots can be consumed leading to excess calories contributing to weight gain.

Portion size and snacking
Portion sizes have increased drastically in the past decade. Consuming large portions adds to a child’s calorie intake. By receiving a large portion, children often feel under pressure to finish the plate. Snacking also increases calorie intake. Snacking regularly throughout the day leaves less room for meals that contain important nutrition. Snacks such as crisps and sweets tend to be high in empty calories, they have little to no nutritional value.

Non-modifiable factors
Genetics
Genetics are one of the biggest factors examined as a cause of obesity. Some studies have found that BMI is 25–40% heritable. However, genetic susceptibility often needs to be coupled with contributing environmental and behavioural factors in order to affect weight. The genetic factor accounts for less than 5% of cases of childhood obesity. Therefore, while genetics can play a role in the development of obesity, it is not the cause of the dramatic increase in childhood obesity (www.jfmpc.com). Overweight or obese parents tend to pass their habits down to their children such as portion sizes meaning genetics is not solely to blame.
BMR
Basal metabolic rate is the rate at which energy is used within the body while at rest (www.thefreedictionary.com). BMR accounts for 60% of total energy expenditure in sedentary children. Overweight or obese children tend to have a low BMR. Those who are physically active tend to have a high BMR, reducing their risk of obesity. Being physically active helps to reduce a person’s BMR. Children tend to have a high BMR as they are growing and going through puberty but this tends to decrease with age so a healthy lifestyle must be adhered to in order to build good habits and lower the chance of disease in later life.

Environmental factors
Opportunities to be physically active and safe environments to be active in have decreased in the recent years. A study conducted in 2002 found that 53% of parents drove their children to school. Of these parents, 66% said they drove their children to school since their homes were too far away from the school. Other reasons parents gave for driving their children to school included no safe walking route, fear of child predators, and out of convenience for the child (www.researchgate.net). Those who do not live in safe, well-lit areas have fewer opportunities to be physically active than those who do have the opportunity to walk to school.

Depression and anxiety
Depression in childhood can be a cause or a consequence of obesity. Children may comfort eat due to stress in school or relationship breakdown. By comfort eating, children are overeating causing them to gain weight. The foods consumed tend to be high in calories, fat and sugar. ‘Experts now agree that about 75% of overeating is caused by emotional eating’ (www.heartmath.org)this means that a lot of people are using food to cope with their emotions helping to relieve stress. By gaining weight this can further increase comfort eating due to a poor self-image. The risk of depression increases with obesity as it can lead to low self-esteem and negative thoughts. ‘Studies have shown that obese people are about 25 percent more likely to experience a mood disorder like depression compared with those who are not obese.’ (www.everydayhealth.com). This can cause problems in school as it can lead to social isolation and a lack of concentration while doing school work leading to a poor performance and low grades.

Consequences of childhood obesity
Childhood obesity can affect children’s physical, social, and emotional health. The child may experience a low quality of life with poor performance at school and lack the capability to take part in activities that all children do at primary and secondary school age.

Socio-emotional consequences
In addition to being implicated in numerous medical concerns, childhood obesity affects children’s and adolescent’s social and emotional health. Obesity has been described as being “one of the most stigmatizing and least socially acceptable conditions in childhood.”38 Overweight and obese children are often teased and/or bullied for their weight. They also face numerous other hardships including negative stereotypes, discrimination, and social marginalization.46 Discrimination against obese individuals has been found in children as young as 2 years old.28 Obese children are often excluded from activities, particularly competitive activities that require physical activity. It is often difficult for overweight children to participate in physical activities as they tend to be slower than their peers and contend with shortness of breath.25 These negative social problems contribute to low self esteem, low self confidence, and a negative body image in children and can also affect academic performance.46 All of the above-mentioned negative effects of overweight and obesity can be devastating to children and adolescents.

The social consequences of obesity may contribute to continuing difficulty in weight management. Overweight children tend to protect themselves from negative comments and attitudes by retreating to safe places, such as their homes, where they may seek food as a comfort. In addition, children who are overweight tend to have fewer friends than normal weight children, which results in less social interaction and play, and more time spent in sedentary activities.25 As aforementioned, physical activity is often more difficult for overweight and obese children as they tend to get shortness of breath and often have a hard time keeping up with their peers. This in turn inevitably results in weight gain, as the amount of calories consumed exceeds the amount of energy burned.

Academic consequences
Childhood obesity has also been found to negatively affect school performance. A research study concluded that overweight and obese children were four times more likely to report having problems at school than their normal weight peers.38 They are also more likely to miss school more frequently, especially those with chronic health conditions such as diabetes and asthma, which can also affect academic performance (www.ncbi.nlm.nih.gov).

Medical consequences
Childhood obesity has been linked to numerous medical conditions. These conditions include, but are not limited to, fatty liver disease, sleep apnea, Type 2 diabetes, asthma, hepatic steatosis (fatty liver disease), cardiovascular disease, high cholesterol, cholelithiasis (gallstones), glucose intolerance and insulin resistance, skin conditions, menstrual abnormalities, impaired balance, and orthopedic problems.25,46 Until recently, many of the above health conditions had only been found in adults; now they are extremely prevalent in obese children. Although most of the physical health conditions associated with childhood obesity are preventable and can disappear when a child or adolescent reaches a healthy weight, some continue to have negative consequences throughout adulthood.46 In the worst cases, some of these health conditions can even result in death. Below, three of the more common health problems associated with childhood obesity are discussed, diabetes, sleep apnea, and cardiovascular disease.

Effects
Adult Obesity2) Type 2 Diabetes3) Hypertension4) High Cholesterol5) Cancer6) Sleep Apnea7)Heart Disease8) Bone-Joint problems/Gout9) Non- Alcoholic Fatty liver Disease (NAFLD)
(truweight.in)
Health Risks Now
Childhood obesity can have a harmful effect on the body in a variety of ways. Obese children are more likely to have:
High blood pressure and high cholesterol, which are risk factors for cardiovascular disease (CVD). In one study, 70 percent of obese children had at least one CVD risk factor, while 39 percent had two or more.
Increased risk of impaired glucose tolerance, insulin resistance and type 2 diabetes.
Breathing problems, such as sleep apnea and asthma
Joint problems and musculoskeletal discomfort
Fatty liver disease, gallstones and gastro-esophageal reflux (i.e., heartburn).
Obese children and adolescents have a greater risk of social and psychological problems, such as discrimination and poor self-esteem, which can continue into adulthood.
Health Risks Later
Obese children are more likely to become obese adults. Adult obesity is associated with a number of serious health conditions including heart disease, diabetes and some cancers.
If children are overweight, obesity in adulthood is likely to be more severe.

(health.ucsd.edu)