Running head: THE CHILDHOOD OBESITY EPIDEMIC

The Childhood Obesity Epidemic: What Can We Do?

Elizabeth McKinney
Ohio Northern University

THE CHILDHOOD OBESITY EPIDEMIC

The Childhood Obesity Epidemic: What Can We Do?

Childhood obesity is a growing concern for people around the world, especially
considering that obesity rates reached 17 percent for children aged 2 to 19 years in 2011,
according to the Center for Disease Control and Prevention (CDC 2014). Groups who are at an
increased risk include African Americans, Hispanic Americans, and Native Americans (Bukatko
& Daehler, 2012, p. 181). Obesity is most often measured and determined by the body mass
index (BMI). An individuals BMI is found by dividing his or her weight by the square of his or
her height. Although BMI cannot provide a completely accurate measurement, it can point
towards the amount of body fat an individual has (CDC 2014). A BMI higher than 30 is
considered to be obese (Bukatko & Daehler, 2012, pp. 181-82). Obesity affects many aspects of
an individuals life, including physical health, psychological health, and future health risks.
There are many factors that contribute to obesity. Genetics can cause children to be
predisposed to obesity, and there are at least five single gene disorders which can be connected
to the early onset of obesity (Bukatko & Daehler, 2012, p. 182). Additionally, males are
approximately 6% more likely to be obese than females (Liu, Chen, Liang, & Wang, 2013, p. 5).
Another causal factor is energy imbalance (Frerichs, Araz, & Huang, 2013, p. 1). Individuals are
taking in an excessive amount of energy through their diets but are more sedentary. In fact,
"nearly two-thirds of high school students report not meeting recommended levels of daily
physical activity" (Bukatko & Daehler, 2012, p. 182). One problem that has caused this decrease
in activity is a concern about the safety of the neighborhoods in which individuals live, work,
and go to school. Another factor is that many schools have cut physical education classes
because of budgetary reasons. The lack of opportunity for physical activity leads to increased

THE CHILDHOOD OBESITY EPIDEMIC

sedentary activities, which in turn increases individuals' BMI (Bukatko & Daehler, 2012, p. 18283).
Family and social factors also have an impact on obesity risk. Parenting style, for
example, influences children's habits, which can lead to obesity. Authoritarian style places strict
demands on their children and use strict disciplinary methods but tend to be insensitive
emotionally, which is more likely to lead to child obesity. Furthermore, children who are
overweight tend to respond to external cues in regards to diet rather than paying attention to their
internal cues (Bukatko & Daehler, 2012, p. 183).
Medical professionals and scientists alike have made it clear that being overweight puts
an individual at risk for a plethora of health issues. The American public is, or at least has the
ability to be, aware of these risks. Obesity can lead to the development of cardiovascular diseases
and diabetes.
Although weight was once associated with social status, today in Western cultures,
children often face ridicule because of their weight (Bukatko & Daehler, 2012, p. 184). The
negative stigma that goes hand-in-hand with obesity can lead to low self-esteem, body
dissatisfaction, and even depression (Mansfield & Doutre, 2011, p. 24).
There are three significant types of prevention: primary, secondary, and tertiary. Primary
prevention involves the steps taken before a disease is present in order to inhibit the disease from
developing. Secondary prevention takes place after a disease has developed but before the
individual notices anything is seriously wrong. Finally, tertiary prevention targets the symptoms
and the disease itself in order to stop further damage and to help the individual recover (CDC
2007).

THE CHILDHOOD OBESITY EPIDEMIC

For obesity, as well as many other health issues, primary prevention is the most critical
step in health care. In fact, this is the case especially for obesity because the traditional secondary
and even tertiary prevention methods have not shown promising long term efficacy . . . for
controlling the obesity epidemic, according to Morandi et al. (2012, p. 2). Many researchers are
now insisting prevention needs to start immediately after birth, and one of the best ways to do
this is to educate the parents (Frerichs, Araz, & Huang, 2013, p. 1). Other researchers insist
prevention programs would be more effective if children under the age of 2 could be identified as
an at risk target (Morandi et al., 2012, p. 6).
There have also been many programs initiated with different focuses, all trying to prevent
or reduce child obesity. For example, Michelle Obama recently began a campaign called "Let's
Move!" The program develops hip-hop songs with lyrics that encourage healthy diet and
behavior. The organizations involved, such as the Partnership for a Healthier America and Hip
Hop Public Health, also hope the hip-hop music will encourage children to dance and become
more active. Olajide Williams said "Hip-hop was born as a platform to bring our interventions to
the youth" (Flock, 2013). Let's Move! distributed the music videos to school across the United
States so teachers can use them in physical education classes.
Another program implemented in many states that is considered a secondary treatment
required schools to measure the BMI of their students and send a letter to each student's parents
with details of their child's health in regards to their weight. The letter encourages the parents to
seek further medical attention for their child. There are many pros and cons to this program, and
it has received a very strong opposition from parents. These letters have been dubbed "fat
letters," which creates an even stronger negative social stigma for overweight children. Despite
the opposition, this program has a lot of potential for making a difference with childhood obesity.

THE CHILDHOOD OBESITY EPIDEMIC

The letters canand shouldbe used as "an additional awareness tool to promote conversations
about healthy eating habits, exercise, and weight" (Bidwell, 2013). Questions about
confidentiality and appropriateness for this sort of measurement to be done in schools have risen,
but because the school environment is a critical piece of any child's development, it is fitting for
schools to also play an active role in their health. Additionally, parents are often unable to
accurately judge their child's weight, so it can be critical for the parents and child to receive an
objective medical opinion (McMurty & Jelalian, 2010). However, it is imperative parents
understand the information they are receiving, otherwise they may interpret the letter incorrectly
and react negatively, which could lead to further problems with the child. Furthermore, the CDC
suggests a BMI report program would need to have a surveillance component that would collect
and analyze data and a screening component in order to identify at-risk children who would
benefit from the program (Flaherty, 2013, p. 403).
This form of prevention takes place when the individual is aware of their disease and is
taking steps to prevent further damage. Concerning obesity, the individual at this stage would be
taking steps to either lose or maintain weight. Many of the studies I examined for this research
paper discuss the effectiveness of tertiary treatment methods.
I reviewed several case studies, experiments, and news stories for this research project.
Many of the case studies and experiments were interesting and provided a new perspective or
new evidence in the discussion of childhood obesity. There is a great deal of information lacking
in the field of childhood obesity. Many of my sources have pointed this out in their own research
as the reason for their particular studies. In particular, there seems to be a lack of studies about
minority ethnicities as individual cultures, about the influence of genetics, and how different
domains influence and interact with each other.

THE CHILDHOOD OBESITY EPIDEMIC

For example, Cunningham, Ellis, and Naar-King (2010) did a case study with an African
American family using a Multisystemic Therapy (MST) approach in order to treat an obese 15year-old boy. According to the authors, African American youth have a prevalence of obesity of
19% by age 5, which is 2 percent higher than the average for American youth, and these rates
increase to 33% for African American youth by the age of 17 (Cunningham, Ellis, & Naar-King,
2010, p. 141). The authors have found a lack [of] studies that include African American youth.
In general, there is a clear need for interventions designed for adolescents, and African
Americans, specifically, that can adequately address the myriad of factors across systems that
affect diet and exercise on a case-by-case basis (Cunningham, Ellis, & Naar-King, 2010, p.
142).
Another example of new research is revealed in Morandi et al.s article Estimation of
Newborn Risk for Child or Adolescent Obesity: Lessons from Longitudinal Birth Cohorts. The
study provides the first example of predictive tool for assessing the risk of developing early
obesity phenotypes, based on readily available traditional risk factors about newborns (Morandi
et al., 2012, p. 6). The authors stressed avoiding restricting dietary intake for infants as a way to
prevent childhood obesity, but other primary prevention methods must be enacted (Morandi et
al., 2012, pp. 6-7).
Frerichs, Araz, and Huang (2013) researched the effects of a combination of influences
on individuals and how this combination relates to obesity. Specifically, they considered the
interactions of human biology, behavior, environment, social ties, capital, and stress (Frerichs,
Araz, & Huang, 2013, p. 1). Their study was also one of the first to consider simultaneously
"peer and adult transmission of behaviors for childhood overweight and obesity" (Frerichs, Araz,
& Huang, 2013, p. 2). The authors found "that the combination of prevention and treatment

THE CHILDHOOD OBESITY EPIDEMIC

interventions may need to consider the social transmission context for optimum impact" and
"alternatives that included treatment intervention impact versus a prevention intervention impact,
resulted in lower childhood overweight and obesity prevalence after 10 years" (Frerichs, Araz, &
Huang, 2013, p. 12).
As Liu, Chen, Liang, and Wang (2013) state in their article, genetic as well as
environmental factors have been researched to determine their effects on obesity. However, the
subdomains that comprise these two domains are much more complex than traditional research
has considered. Liu et al. offer one of the first studies that analyze the correlation between
parents and their children and their weight. By studying BMI, weight status, genetic
backgrounds, level of parental influence, and diets, as well as other biological, social,
environmental, and behavioral factors, the authors found a positive correlation between parent
obesity and child obesity rates, though the correlation varied among genders (Liu, Chen, Liang,
& Wang, 2013, p. 1).
Along similar lines, Ludwig, Rouse, and Currie (2013) studied the relationship between
weight gain during pregnancy and childhood body weight. The authors found that the amount of
weight gained by the mother during pregnancy did correspond to the child's body weight both at
birth and during childhood (Ludwig, Rouse, & Currie, 2013, p. 5). Therefore, pregnant women
are encouraged to be aware of their weight gain during pregnancy and ensure they are gaining
enough to keep their fetus healthy but not enough to increase the risk of the child becoming
obese later in life.
Williams, Henley, Williams, Hurst, Logan, and Wyatt analyzed three separate treatment
methods: physical activity only, diet only, and physical activity with diet. They found that the
physical activity treatment plans and the diet treatment plans each produced only a small, non-

THE CHILDHOOD OBESITY EPIDEMIC

significant reduction in BMI (Williams et al.). Additionally, the treatments that combined
physical activity and diet found a non-significant reduction (Williams, Henley, Williams . . . &
Wyatt, 2013, pp. 16-17). The authors further recommend physical activity and diet be combined
with additional components such as sedentary behavior and psychological factors and be
maintained over a long period of time in order to be effective (Williams et al.).
Veldhuis, van Grieken, Renders, HiraSing, and Raat's (2014) analysis of home
environment and screen time found that interventions should be completed by the parents early
in the child's life. However, the authors state "the relationship between parenting style, the social
and physical home environment and children's screen time remain largely unknown" (Veldhuis et
al., p. 2). This does not mean, though, that parenting style and screen time are unrelated; rather,
further studies need to be completed in order to determine the extent of the relationship.
A study done by Huen, Harley, Beckman, Eskenazi, and Holland (2013) considered the
connection between the polymorphism paraoxonase 1 (PON1) and obesity heritability. PON1, a
high density lipoprotein, is associated with high oxidative stress diseases, such as obesity,
cardiovascular disease, and diabetes (Huen et al.). The authors found very little research in this
field, which they felt needed to be rectified; it was also the first study that "accounted for
potential confounding by genetic ancestry" (Huen et al., p. 8). The results of their study included
finding that "lower PON1 activity was associated with shorter gestational age and smaller head
circumference in newborns" (Huen, Harley . . . & Holland, 2013, p. 2). Another conclusion was
that increased PON1 levels were associated with increased obesity but varies quite a bit among
different ethnicities (Huen et al.).
BMI reporting has received criticism because it does not meet all of the criteria
established by the American Academy of Pediatrics that determine whether a given health

THE CHILDHOOD OBESITY EPIDEMIC

condition should be screened in schools. The reports address "an important public health problem
with a high prevalence rate" and screening can be carried out in a sensitive, confidential manner,
and schools do provide an appropriate environment for screening, which are all required criteria
(McMurty & Jelalian, 2010). However, there is no referral component, treatment programs are
not available to students, and the effectiveness is not yet clear.
There are many factors that contribute to childhood obesity, an epidemic that is causing a
great deal of problems for today's youth. Many of these factors are not well researched and are
therefore not well understood, but more studies are being conducted to increase awareness about
childhood diabetes. Genetics and environment clearly play nearly equal roles in obesity risk, and
once researchers and medical professionals understand how these domains interact, better
treatment and prevention methods will be able to be implemented.

THE CHILDHOOD OBESITY EPIDEMIC

10

References
Bidwell, A. (2013 Aug 19). Report: 'Fat Letters Necessary to Fight Childhood Obesity. US
News. Retrieved from: http://usnews.com/news/articles/2013/08/19/report-fat-lettersnecessary-to-fight-childhood-obesity
Bukatko, D, & Daehler, M. W. (2012). Brain, Motor Skill, and Physical Development.
In Child Development: A Thematic Approach (pp. 181-187). Belmont, CA: Wadsworth.
Center for Disease Control and Prevention. (2014). Childhood Obesity Facts. Retrieved from
http://www.cdc.gov/obesity/data/childhood.html
Cunningham, P. B., Ellis, D. A., & Naar-King, S. (2010). Treating pediatric obesity using and
empirically supported treatment: A case report. Journal of Clinical & Adolescent
Psychology, 39 (1), 141-150. doi:10.1080/15374410903401211
Flock, E. (2013 Aug 5). Michelle Obama's Newest Initiative: Using Hip-Hop to Fight
Obesity. US News. Retrieved from: http://www.usnews.com/news/articles/2013/08/05/
michelle-obama-newest-initiative-using-hip-hop-to-fight-obesity
Frerichs, L. M., Araz, O. M. & Huang, T. K. (2013). Modeling social transmission dynamics of
unhealthy behaviors for evaluating prevention and treatment interventions on childhood
obesity. Plos ONE, 8 (12), 1-14. doi:10.1371/journal.pone.0082887
Huen, K.., Harley, K., Beckman, K., Eskenazi, B., & Holland, N. (2013). Associations of pon1
and genetic ancestry with obesity in early childhood. Plos ONE, 8 (5), 1-9.
doi:10.1371/journal.pone.0062565
Liu, Y., Chen, H., Liang, L., & Wang, Y. (2013). Parent-child resemblance in weight status
and its correlates in the United States. Plos ONE, 8(6), 1-12.
doi:10.1371/journal.pone.0065361

THE CHILDHOOD OBESITY EPIDEMIC

11

Lo, J. C., Chandra, M., Sinaiko, A., Daniels, S. R., Prineas, R. J., Maring, B., & Greenspan,
L. C. (2014). Severe obesity in children: Prevalence, persistence and relation to
hypertension. International Journal of Pediatric Endocrinology, 2014 (1), 1-19.
doi:10.1186/1867-9856-2014-3
Ludwig, D. S., Rouse, H. L., & Currie, J. (2013). Pregnancy weight gain and childhood body
weight: a within-family comparison. Plos Medicine, 10 (10), 1-9.
doi:10.1371/journal.pmed.1001521
Mansfield, D., & Doutre, G. (2011). Food for thought: Children's view on the psychological
aspects of childhood obesity. Educational & Child Psychology, 28(4), 23-2. Retrieved
from: http://web.a.ebscohost.com/ehost/pdfviewer/pdfviewer?sid=4a12864d-eb02-4c689001-46a697fb7167%40sessionmgr4005&vid=8&hid=4209
McMurty, M, & Jelalian, E. (2010). Reporting Body mass index in the schools: Are we missing
the mark? Brown University Child and Adolescent Behavior Letter, 26 (1). Retrieved
from: http://www.bradleyhasbroresearch.org/child-adolescent-behaviornewsletter/2010/january/Reporting-Body-Mass-Index/
Morandi, A., Meyre, D., Lobbens, S., Kleinman, K., Kaakinen, M., Rifas-Shiman., S. L., &
Froguel, P. (2012). Estimation of newborn risk for child or adolescent obesity: lessons
from longitudinal birth cohorts. Plos ONE, 7 (11), 1-9. doi:10.1371/journal.pone.0049919
Veldhuis, L., van Griekin, A., Renders, C. M., HiraSing, R.A., & Raat, H. (2014). Parenting
style, the home environment, and screen time of 5-year-old children; The 'be active, eat
right' study. Plos ONE, 9 (2), 1-9. doi:10.137/journal.pone.0088486
Williams, A., Henley, W. E., Williams, C., Hurst, A., Logan, S., & Wyatt, K. (2013). Systematic

THE CHILDHOOD OBESITY EPIDEMIC

review and meta-analysis of the association between childhood overweight and obesity
and primary school diet and physical activity policies. International Journal of
Behavioral Nutrition & Physical Activity, 10 (1), 101-122. doi:10.1186/1479-5868- 10101

12