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ANALYZING CHILDHOOD OBESITY IN THE LIGHT OF SOCIO-ECOLOGICAL MODEL

  • Writer: Sadaf Amin
    Sadaf Amin
  • Nov 6, 2018
  • 8 min read

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Overview of childhood obesity:

Promoting health and well being of every child is a vital part of every community or state. Childhood obesity is a medical condition which causes abnormal or excessive accumulation of fat which may impair health. Body mass index (BMI) is a measure use to determine childhood overweight and obesity. Over weight is defined as BMI at or above the 85 percentile but less than 95 percentile whereas obesity is defined as BMI equals to or greater than 95 percentile in the children of same age and sex. Childhood obesity is associated with higher chance of premature death and disability in adulthood. Obese children are also prone to develop diseases like diabetes, Cardiovascular diseases, musculoskeletal disorders and certain types of cancer at very younger age. Globally, the number of obese infants and children (0 to 5 years) have been increased from 32 million in 1990 to 41 million in 2016, if this situation continues then the number of obese children will be 70 million in 2025 (Facts and figures on childhood obesity, 2017).

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What is socio-ecological model?

The socio-ecological model (SEM) is a theory-based framework used to understand interrelationships between various personal, social and environmental factors and their effects on health promotion and health of population. At the core of the model is the individual surrounded by four levels of influence includes interpersonal, organizational, community and policy levels.

In this blog, I am going to analyze the interrelationships of various factors responsible for childhood obesity by using socio-ecological model.

Intrapersonal level:


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It is the first level of SEM and includes individual factors like knowledge, attitude, age, gender and behaviors related to diet and exercise. At this level, the most direct determinant of children’s obesity is the equilibrium between consumption of food and physical activity. Children who are not consuming food according to dietary guidelines are more prone to obesity. They eat less fruits and vegetables as compared to sugar and fat containing food items. Parental knowledge about healthy food is vital at this stage because family preferences and choices of food determines the availability of food at home, having a direct influence on child’s eating habits and preferences.

Physical activity plays a major role in preventing obesity. The U.S department of health and human services recommend that children aged 12-17 years should perform moderate to vigorous activity for at least 60-minutes. Physical activity helps in preventing obesity by burning excessive calories, strengthening muscles and bones and can also prevent some cancers. Easy access to parks and playgrounds has a major role in encouraging physical activity in children. In an observational study of park use by children it was found that about one third of children took part in walking and one in nine children was engaged in vigorous activity. Sedentary life style has a direct effect on obesity. Research have found that children who have 2-hours of screen time tend to obese and have higher serum cholesterol level as compared to children who watch screen for one hour (Kirkey, 2012). There is also a role of genetics in childhood obesity. Many studies have shown that obesity runs in families and is largely due to genetic factors. In Canada, boys are three times more likely to be obese as compared to girls. Kirkey (2012) found 19.5% of boys aged 5 to 11 are obese compared to 6.3% of girls of same age. The difference may be due to different body structure, fat distribution pattern, energy consumption and differences in physical activity patterns.


Interpersonal level:


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This is the second level of SEM and includes child’s family members, home environment and social circle of peers which have a direct effect on child’s behaviour. Perez-Escamilla and Bermudez (2013) described two evidence-based cycles that helps in understanding the transfer of obesity from mother to child. The maternal cycle indicates that primiparous women are more likely to gain excessive weight during gestational period and retain that excessive fat after delivery and become more obese in their subsequent pregnancies. Offspring cycle indicates that newborns of obese/over weight women are most likely to gain excessive weight early in life and when they become pregnant, they are most likely to be obese/overweight. This risk increased if newborn is not exclusively on breast feeding for the first 6 months of life and is introduced to high calorie unhealthy foods and beverages. This in turn increase the chance that the infant will gain more weight in the first year of life and if a child is continuously exposed to high calorie unhealthy food in toddler, preschool and school age periods, there is a chance that the child will be obese in adolescent period. For maternal cycle, it is recommended that women should not gain excessive body weight in prenatal period and lose the weight in post partum period which was gained in gestational period. The aims for offspring cycle is to keep the new born on breast feeding in first 6 months of life then gradually add complementary feeding along with physical activity.

Developing healthy home environment is one of the key responsibility of parents, their own lifestyle should be healthy because parents are role model of their kids, whatever they do or eat their kids will follow them. Parents should have adequate knowledge of healthy diet plans and provide healthy food choices to their kids, set times for daily physical activity and avoid excessive screen time to prevent obesity. Children needs attention of both parents. Studies have shown that children living with single parent or grand parents are more obese, because they eat fast foods more frequently as compared to fruits and vegetables.

Studies suggest that presence of healthy eating peers can influence healthier food selection in children and if peers are participating in physical activities it encourages obese children to indulge in these activities. Obese children also face bullying and peer victimization on daily basis which develop stress, difficulty in learning, low self esteem and speech problems. Negative peer experiences may lead obese children to involve more in sedentary activities and less active behaviours. In Canada, WITS program is helping families, school and communities to deal peer victimization in school and promoting safe and healthy relationships.


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Organizational level:

There are many organizations working in Canada for the promotion of physical activities in children, YMCA is one of them. The aim of YMCA is to promote health of Canadians through physical activities, mental activities and development of sense of responsibility to global community. Childhood obesity foundation was founded in 2004, its mission is to lead a societal shift towards healthy eating and active lifestyles to prevent obesity. The Canadian park and recreational association is an organization working to promote importance of parks for the health of individuals, families and communities.

When lifestyle modifications don’t work to overcome obesity in children cognitive behavioural therapy, drugs and surgery are recommended. Cognitive behavioural therapy can be delivered by any health professional who has adequate training in CBT. The goal of cognitive behavioral therapy is to change patterns of thinking or behavior which are responsible for the condition (obesity) and developing the thoughts to adopt healthy life style. In cognitive behavioral therapy, parent’s participation is encouraged because oftentimes parents are taking decisions about daily routine activities of children.

Orlistat is the only US food and drug administration (FDA)- approved drug to treat obesity in children > 12 years and adolescent. Criteria for prescribing Orlistat to adolescent and children is BMI > or equal to 95 percentile. Orlistat works by inhibiting pancreatic lipase, an enzyme that breaks down lipids into triglycerides which results in prevention of absorption of fats from diet. Orlistat may also associate with severe to moderate gastrointestinal side effects and dangerous drug interactions.

Surgery is recommended in children or adolescents who are suffering from severe co-morbidities like non-alcoholic fatty liver disease or cardiovascular diseases. The most common surgical procedure for childhood or adolescent obesity is Laparoscopic gastric banding (aka Lap band) which divides stomach into upper smaller pouch and lower bigger pouch. The small upper pouch limits the amount of food that child eats by making him or her feel full much sooner.


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Community level:

This level describes interconnected businesses in communities and links between organizations. The community environment is becoming obesogenic day by day, fast food outlets and convenient foods are easily available everywhere which also provides free delivery of food at home, walking pathways are becoming narrow because of increase in traffic and public transport is just a phone call away. All these factors have a major role in promoting obesity. Community leaders, schools, childcare providers, parents and individuals must work together to create an community environment which supports healthy life style.

Schools can also promote health outside the classroom, by surrounding students giving opportunities to stay healthy and active. School based prevention programs can easily encourage students to eat better, stay more active and achieve healthier weights. Serving fruits, vegetables, cereals, whole grains, eggs, foods containing curb sodium, saturated fat and trans fat along with water in lunch rooms and limiting the availability and marketing of sugar containing high calorie foods and beverages, increasing the physical activity time are some of the ways to prevent obesity at school level.

In 2011, Center for disease control and prevention (CDC) funded 3 community grantees and one evaluation center to conduct Childhood Obesity Research Demonstration Projects (CORD 1.0), which covered different levels of SEM. These projects worked together with pediatric health care settings to prevent and manage childhood obesity at schools, childcare centers and community level. CORD 0.1 focused on communities with a high proportion of children from low income families. In 2017, U.S Preventive Services Task Force (USPSTF) found that clinicians should screen children ages 6 and above for obesity and if necessary than refer them to healthy weight programs. CORD 2.0 specifically focuses on clinical and weight management programs to refine nutrition and physical activity behaviors in children of working families or low-income families facing problems of overweight or obesity. These programs are struggling to strengthen the clinical community collaborations to increase screening and counselling services for children in selected communities and when appropriate refer them to community based healthy weight programs (center for disease and control prevention).

Policy level:

The Canadian government is doing its best in promoting healthy food choices, physical activity programs and healthy weight - providing national leadership, policy and coordination, improving surveillance, helping build capacity in communities, supporting knowledge development and exchange, providing information to the public, and monitoring and evaluating interventions and innovations.

  • Individual level interventions: In 2006, Canadian clinical practice provide guidelines on the management and prevention of obesity for adults and children on individual basis which includes; behavioural modifications or therapy, dietary interventions such as energy reduced diet, daily physical activity, dietary plus physical activity therapy and bariatric surgeries and medications for some individuals.

  • Community level interventions: Social marketing campaigns are important in promoting health at community level. Canada’s partcipACTION is a national non-profit organization originally launched as Canadian Government program in 1970, to promote physical fitness and healthy living. PartcipACTION is famous for its television public service announcements and segments such as Body Break. Body Break is a series of 90 seconds television program whose purpose is to inform audience about the ways to keep yourself fit and healthy. I love 5 to 10 servings a day is a social marketing campaign launched in 2004 to raise awareness on the importance of fruits and vegetables for health. From the past 14 years, this campaign is working to promote healthy in children and adults. Its latest advertising efforts is showing people that how easy is to add fruits and vegetables in our meals.

  • Public policies: Some of the public health policies of Canada that have been implemented to deliver the key influence on diet, physical activity and obesity are as follows;

1. Subsidy programs for healthy eating.

2. Land development, urban planning, transportation planning to promote Recreational physical activity.

3. Food labelling and to understand of that food on health.

4. Limited marketing of energy dense, poor nutrition food and beverages.

5. Financial incentives to promote physical activity.

6. Financial disincentives on unhealthy food (government of Canada, 2011).


Conclusion:

Analyzing obesity in the light of SEM reveals that there are many factors at each level of SEM which are interconnected with each other and have a great impact on weight gain and healthy life styles of children. Steps should be taken at community, provincial and federal level to control weight gain promoting factors at each step and to overcome obesity.


References:

Campbell, M. (2015,oct). Biological, environmental and social influences on childhood

Center for disease and control prevention. (2018, sept). CDC childhood obesity research

demonstration project. Retrieved from

Government of Canada. (2011, June). Obesity in Canada- opportunities for intervention.

Kirkey, S. (2012, sept 21). Obesity rates three times higher among Canadian boys than girls.

Myrick, K. (2014, dec). Assessing the social and ecological factors contributing to

childhood obesity. Retrieved from:

Parez-Escamilla, R. Kac G. (2013, may) childhood obesity prevention-a life course framework.

World health organization (2017, oct) facts and figures on childhood obesity retrieved from:







 
 
 

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