Obesity as an issue, is gaining international recognition, with more emphasis on

childhood obesity itself. The World Health Organisation (WHO) defines Obesity as
excessive fat accumulation occurs, resulting in a Body Mass Index (BMI) of over 30
(WHO, n.d.). This condition increases the risk of health issues such as diabetes,
cardiovascular disease, cancer and many other chronic conditions. As an aside;
Childhood Obesity is a particularly strong concern. Experts believe that should current
trends continue, there will be 70 million obese or overweight children by 2025(WHO,
2014). Furthermore, if appropriate interventions are not implemented, obesity will
continue into adulthood. This could result in devastating implications for personal and
more widespread societal wellbeing.
Ultimately, obesity is caused by over consumption of food and lack of physical activity. It
can be argued that an individuals health reflects lifestyle choices of the individual
concerned. It would appear as if the overall issue lies with individual willpower. Though
children could be considered an exceptional case. They are impressionable, dependent on
others and not always capable of exercising choice effectively. People cannot be expected
to make the right choices without the correct knowledge, skills and resources to do so.
This is the basis of a number of issues to be covered when investigating whether the
poorer health of children reflects worse individual choice.
The WHO states that childhood obesity can be linked to choices made by mothers as
early as conception. Gestational diabetes in particular is linked to increased birth weight,
which is believed to result in an increased risk of obesity later on in a childs life (WHO,
2014). This effectively illustrates that obesity in children can reflect choices made outside
their control.
Furthermore, maternal nutrition is essential to modulating fetal growth (Koletzko, 2005).
Higher birth weight is associated with obesity complications in the future. These factors
are also outside the childs control.

Another concept currently being researched in animals by shows promising results.

Mouse model studies in which pregnant subjects were fed high amounts of junk food
resulted in offspring gathering a taste for similar foods (Bayol, Farrington and Stickland,
2007). Assuming these results are applicable in human subjects, it would imply that
mothers who eat unhealthy junk food during pregnancy predispose their children to
favouring unhealthy food. This indicates that childhood obesity is due to future choices
more influenced by maternal choice than the individuals.

UNICEF has been researching the uptake of breastfeeding and its influence on weight
(Unicef.org.uk, 2010). Early breastfeeding anytime within the first hour of birth to
exclusive feeding over the first 6 months have been linked to reduced levels of obesity. A
meta-analysis by Harder et al (2005) found, children who are exclusively breast fed for
the first six months, have lower obesity risk. The longer the duration exclusive of
breastfeeding, the lower the risk. Similar initial results were found in a systematic a
review by Owen et al (2005), which linked increased breastfeeding to reduced prevalence
of obesity. However it later concluded that the link between breastfeeding and obesity
risk is existent but not particularly strong, and subject to publication bias. Conflicting
views have been encountered in the literature. Perhaps the promotion of exclusive breastfeeding is preventive of obesity because in other avenues (e.g. excludes the risk of
overfeeding infants with formula milk or other nutrient and calorie rich alternatives). A
number of papers listed by UNICEF strongly encourage and enforce the relationship, but
perhaps the link will be more effectively portrayed with future work.

Children establish eating habitsearly in life (WHO, 2014). Therefore it is important to

encourage consumption of healthy food and restrict food high in salt, fat and sugar.
Growth and nutrition in infancy are particularly influential in relation to the childhood
Obesity epidemic (Singhal et al., 2010). The same study fount faster growth in infancy
was associated with increased fat mass later in life. Two intervention studies were carried
out. Participants were given normal or nutrient enhanced formula milk to provide for

infants. Nutrient enriched formulas were found to promote more weight gain in infancy
than counterparts. When participants were followed up, it was noted that children with
this increased initial weight gain had increased body fat measurements in the future (with
according adjustments for other variables) compared to those of smaller weight gains in
infancy. The results from this study and others have been promising in showing the
relationship between infant nutrition and future weight gain is causational. Similar links
between excessive infant nutrition and future weight gain have been found in animal
models (Ozanne and Hales, 2004). Thus, there is a growing evidence base to support the
hypothesis that excessive infant nutrition causes unwanted excess weight gain later on in
life. This implies that infant nutrition is significant in contribution to the obesity epidemic
as opposed to only worse individual choices.
Furthermore, young children are restricted to whatever food their parents provide. It is
the parents responsibility to ensure they provide appropriate types and volumes of food
for their children to eat. It is essential that parents introduce the correct practices early,
allowing children to make the correct decisions. It can be said that childhood obesity, in
this tender age, is indirectly not caused by poorer individual choices. However as
children age, there is an argument that they possess enough self-awareness to make
sensible decisions for themselves outside parental opinion, (e.g. what to have for a school
meal).

Parental knowledge is key to lifestyle choices that children make at young ages.
Childrens food choices are within parental control for the majority of their meal times.
The knowledge they have before attending school will come solely from parents or
guardians that raise them. This limited knowledge could have detrimental effects on
decision making, particularly if parents are unaware of what healthy eating is or are
overweight themselves. So, taking this into consideration, children cannot be held wholly
responsible for decisions they make regarding food choices unless they are provided with
the correct knowledge and guidance from their carers.

Parental weight status in particular can influence a childs choices. If obese family
members surround children, children are more likely to engage in similar eating and
lifestyle habits to these relatives (Clark et al., 2007). This could be through simply seeing
and copying actions of the parents, or from having no option but to eat unhealthy food
offered in the home environments. Once more, this indicates that worse individual
choices made by children are not the problem with regards to childhood obesity. They are
in fact decisions heavily influenced by the surrounding home environment and what a
child may perceive as normal weight and eating habits for a parent.
Children gain a sense of autonomy as their age and level of education and self-awareness
increases. So on the contrary, it could be argued that children are actually capable of
making better decisions for themselves even without parental influence. If children are
being given the appropriate knowledge and skills to make healthy choices, it could be
argued that they should be capable of doing this whenever the opportunity arises. So
when a child reaches a particular age and level of intelligence, perhaps the problem of
obesity and weight gain IS in fact due to worse individual choice.

Family environment and neighbourhood a child is brought up in can also have varying
impacts on the decisions they make. Children are much more likely to become obese if
their family members are also obese (Reilly et al., 2005). Furthermore, Parental neglect is
associated with obesity and influences can inadvertently result in bad feeding habits for
children (Lissau, 1994). Parental obesity will directly influence children as they deem a
norm for themselves to follow. Unfortunately, children will make similar choices to
parents; negative choices made by parents will transfer into decision-making processes of
children. So it can be argued that it is not the childs fault if their behaviours have been
influenced this way; individual choice has once more been hampered by other
surrounding influences.
One would associate a neighbourhood in which children have access to parks, play areas
and there is a lack of crime, with happier and healthier residents. The proximity of these

facilities would make it easier for children to engage in more rigorous outdoor play in a
safe environment. However a study by (Burdette, 2004) found that the proximity of
neighbourhood to these facilities and reduced crime levels actually have no significant
correlation with obesity and weight trends. Perhaps more research would be required to
fully support this claim, as there are a vast number of factors that actually affect a childs
weight.

Our modern world is one in which computers and electronics are abundant and ever
accessible to the entire population; children are exposed to this technology from birth.
The wide availability of technology could be having a more negative effect on childrens
weight trends than initially perceived.
The increase in number of digital devices results in children choosing these forms of
entertainment over more old-fashioned forms of physical outdoor play (WHO, 2014).
The long-term behaviour patterns created by our culture of digitalization are having a
profound effect on childrens activity levels. Watching >2h of television per day increases
preschool childrens risks of becoming overweight (Mendoza, Zimmerman and
Christakis, 2007). But it is difficult to argue whether the presence of technology itself is
leading to children making choices not to participate in physical activity, or whether it is
due to a broader underlying issue of educating children to choose certain activities over
others.
A problematic area that contributes to the ever-growing issue of childhood obesity is food
advertising. Cleverly marketed, unhealthy foods appeal to children, who are not always
able to understand the future consequences of purchasing and consuming such foods on a
long-term basis. A paper by Nestle (2006) found that American children spend large
proportions of pocket money on well-advertised, unhealthy snack food. The appeal
results due to effective character endorsement and intense advertising. These
advertisements are often so successful in nature, children persuade parents to buy them

over their own choice. In this case, it would appear that worse decisions are being made
purely on account of the child.
Not all children are capable of fully understanding information given through intense
advertising, which leads to unhealthy choices being made. In addition, children do not
really consider harmful long-term consequences of unhealthy food consumption. To a
child, the choice may appear like the most appropriate one because they lack maturity
and forward thinking. In order to protect these children and prevent worse individual
choices being made, perhaps it would be beneficial to adopt policies such as in Australia,
where food advertising is banned for children under 14 (Nestle, 2006).
It is difficult to conclude for certain whether obesity is increasing solely due to an
individual childs choices, or whether external factors are more to blame. There are many
factors that influence the lifestyle choices children makes so it can be difficult to isolate
one. Additionally, younger children are more vulnerable to changing their mind based on
parental influence. Older children have increased self-awareness and intellect to make
decisions, but might be influenced negatively by peers. So it is already a complex matter
to conclude whether any choice is really an individual choice in this context.
A well-educated child has daily opportunities to eat healthily in school, alongside
attending healthy eating classes. This child also has a stable family environment with
both parents maintaining healthy lifestyles. The individual is assumed to have sufficient
information and intellect surrounding the topic, to make him capable of making the
correct decision. If a child chooses to reject the food, they have made the correct decision
for their health based on the acquired knowledge. But if the child instead chooses to
spend money on unhealthy snack foods, they have seen advertised via the television or
social media (regardless of the positive education they have had) we could argue in this
case that future health implications are purely down to worse individual choice.
On the contrary, an educated child is forced to take packed lunches to school and does not
fully apply himself to his healthy eating classes. His parents are both overweight and

unaware of the health risks that arise from their weight; their poor diets and behaviours
are transferred to their child. The child is exposed to effective advertising endorsing the
same unhealthy snack foods, and decides to buy them. This case is perhaps more complex
as the childs decisions are inadvertently influenced by his surroundings. Can we really
argue that poorer individual choice is the result of future problems in this situation? If the
child is not provided with the sufficient knowledge, skills and environment to make
decisions over their food and lifestyle, we cannot argue that obesity is caused by worse
individual choice.

Poverty is a limiting factor when it comes to making decisions regarding food and
lifestyle; it ultimately culminates in a lack of choice for people. We can divide this topic
into monetary poverty and time poverty. People who have little money obviously have
less to allocate on food spending. There is an abundance of cheap, calorie dense food that
is easily accessible for people with limited funds (Drewnowski and Darmon, 2005),
which provides instant gratification. Healthier and fresh foods are often more expensive
(literally) or more time consuming to purchase and prepare than cheaper processed items.
Children are obviously not in control of the budgets that govern what foods are going to
be purchased and provided for them. Therefore it is evident they are not fully in control
of their own choices regarding foods these decisions are actually more influenced by
the actions of parents and guardians. This clearly is not a case of willpower or poor
decision-making. A child is not in charge of budgets and initial purchases. Therefore they
cannot be held accountable for the choices they make with the options given to them.
Giving individual freedom through pocket money to children and allowing them to make
their own decisions is a completely different issue. Children are prone to making choices
without thinking because there is an innate attraction towards sweet and calorific food.
Peers might influence how children use their pocket money, what foods they buy, and so
on. Additionally, the ability to make choices correctly leads back to the issue of education
and proper knowledge regarding food. If children are not provided with the skills and
knowledge to exercise decisions well themselves, they cannot be blamed for worse health

consequences. Conversely, if children ARE provided with the appropriate information to

make decisions, yet they still choose to consume unhealthy items, we can conclude that
consequences stemming from this are due to worse individual choice alone.
School environments are essential to this issue, as they are where children spend a large
proportion of their time. In Scotland, there have been several curriculum implementations
and health promoting schemes to tackle the ever-increasing burden of childhood obesity.
Healthy options are a compulsory requirement in schools throughout the country,
alongside class education. There are also many initiatives such as

Free fruit for

Schools Scheme (Scottish Centre for Social Research, 2005) to introduce children to
healthy food from young ages. Schools are regulated now so that food served on
campuses is of a sufficient standard, healthy snacks are available and these options are
integrated into the curriculum. Where such school provide information, skills and the
means to heat healthily (especially for lower in come groups, e.g. through free school
meals), we remove other factors that have impacts on childrens abilities to make
decisions. Children are left on a more level environment in which they can effectively
exercise their own choices. Only now can we see that individual choice (despite
education, recommendations, guidance from parents, etc.) could be the leading cause of
obesity. We could only ascertain that worse individual choices are made when all children
have already been exposed to the same, appropriate levels of education.
Appropriate education regarding food is essential both in home and school environments.
Conflicting messages could result in negative impacts on childrens food decisions.
Holistic approaches need to be taken to ensure healthy eating education takes place in a
coordinated manner between home and school. Initiatives such as the Free Fruit Scheme
have been successful in changing attitudes of children and teachers alike (Scottish Centre
for Social Research, 2005). If children are given conflicting messages in different
contexts, this results in individual choices being flawed. Children could be making the
wrong choices without it being their fault. Conversely, if children choose to make these
decisions despite being given correct information and nurturing care, it is the individuals
responsibility. But as mentioned previously, it is difficult to say what age children

become capable of developing independent views and reasoning processes. Therefore it is

important to support children no matter what their circumstance, because obesity is such
a problematic issue.

In summary, childhood obesity arises from a multitude of factors. It is evident that worse
individual choices cannot be solely blamed in this incidence. Children are a vulnerable
group to make the appropriate individual choices, they must be looked after an
educated accordingly regarding lifestyle choices. Mothers should make an effort to
increase their own health and prevent future complications arising from poor diets.
Parents must acquire appropriate knowledge regarding breastfeeding and formula milk; it
is important to understand future implications regardless of which option is chosen.
Nourishing diet and health patterns should be established from infancy, to encourage
healthy eating habits to continue throughout childhood. If children then choose to make
worse choices despite education, family support and a nurturing environment, it can be
deemed their fault and responsibility. However it is apparent that the poor health of this
vulnerable group does not primarily reflect worse choice on the individuals, but more so
poor choices by parents on guardians on their behalf. This results in children making
poorer choices that are ultimately outside their control, meaning that they cannot be
blamed solely for increasing obesity trends.
Word Count: 2999

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