Literature Review on Childhood Obesity and Treatment

Obesity has become a huge problem within the Western World over recent years. (34% of the adult population in the US in 2007 (Barness (1986: 75)). It is known from the general media that the incidences of childhood obesity are also on the increase. This review aims to evaluate the ideas and concepts from two Journals. Barness, L.A. (2007) ‘Obesity in Children’. Ells et al, (2005) ‘Prevention of Childhood Obesity’.

Childhood Obesity

According to Barness (1986: 75-76), there are a number of tools used to define the obese child. weight for height is the most common used as it uses a chart and the skinfold thickness becomes very erroneous in the obese child due to errors in measurement. The BMI uses charts to which take into account the gender and age of the child which then encompasses more of the variables within children (not apparent in adults) resulting in increased accuracy. There is some debate as to causes of obesity. Some causes are thought to be (Ells et al. (2005: 443)) gender, race, socioeconomic status, special educational needs, environmental factors and genetics (although Ells et al. (2005: 442) states that ‘fewer than 1% of childhood obesity cases are directly caused by a genetic disorder’).

There are also a number of disease states causing secondary obesity which need to be ruled out prior to attributing the unexplained weight gain to the above causes. These include neurological lesions, endocrinopathies and congenital syndromes (Barness (1986: 82)). There are various factors affecting the obese child including psychological as Obese children often suffer from low self esteem and some can go on to develop depression (10% become clinically depressed Barness (1986: 77)) whereas others ‘comfort eat’ leading to obesity.

There are a number of risk factors which can result from an obese child which include hypertension, diabetes mellitus and dyslipidemia. (Chu et al. (1998: 1141) Dyslipidaemia includes hyperlipidaemia, elevated low-density lipoproteins, and decreased high density lipoproteins (Barness (1986: 81)).

Sleep apnoea a common cause of pulmonary insufficiency Barness (1986: 77). The child can wake up many times a night resulting in constant sleep deprivation. This can be life limiting as it puts a strain on the heart also. It has been reported that some children can benefit from tonsillectomy and adenoidectomy Barness (1986: 77). However, Zafer et al. (1999: 33) have concluded that this treatment is associated with an increase in weight, height and BMI.

Obesity Treatment

As the causes of obesity are varied, so the treatment also needs to be varied. As well as dealing with the causes of obesity there maybe other health issues to be dealt with also. (see above) . The major treatment options involve diet, exercise and behaviour modification (Barness (1986: 83). The dietary requirements need to be under strict medical supervisions as the child is still growing and requires essential nutrients for growth. Barness (1986: 83) states that a protein-sparing modified fast (PSMF) diet has been used and appears safe and can stimulate the respiratory system and blunt the appetite due to ketones being released as the diet is also low in carbohydrates. Barnes does not, however, go into details of behaviour modification or exercise programmes.

Obesity Prevention

There a number of factors which cause obesity, as stated above. A holistic approach is required to ensure obesity does not occur in the child. According to Ells et al. (2005: 441) evidence supports measures which ensure physical activity and a healthy diet as well as adequate behavioural support for the child to reduce the risk of obesity. Interventions which will aid children to live and grow healthily can come from a number of different sources.

School Intervention

Schools can influence a child’s behaviour and therefore help in the health prevention of obesity. Ells et al. (2005: 444) that a review highlighted a number of health prevention programmes. One of these was based on children being taught via a national curriculum to reduce their sedendatory behaviour. This showed a reduction in obesity. Another two were based on physical activity programmes which showed that there was no significant reduction in obesity over a control group. The multi-faceted approach of nutrition, education, behavioural therapy and physical activity showed that this may help to reduce obesity, especially in girls. Ells et al. (2005: 444) concluded that much more research is needed in this area. Research carried out by Nauta, Byrne and Wesley (2009: 16-17) concluded that school nurses had an awareness of childhood obesity but were unable to set up treatment programmes.

Family Intervention

There are a number of different behavioural causes within the family environment, including the mother’s knowledge of nutrition and opportunities to share family meals. Ells et al. (2005: 445 – 446) also cited studies undertaken to examine the efficiency of family – based behaviour modification programmes and health promotion which did not support any significant decrease in weight in the obese child. Goodfellow and Northstone (2008: 117) found out that children from the Isle of Man were more likely to be obese than in Avon, showing that external influences will have a bearing on the family and individual’s health.

Preschool / Anti-Natal Intervention

A significant number of children are obese at pre-school age. However there is little evidence to support the need for intervention within the pre-school age chilidren. Ells et al. (2005: 446 – 447) questions whether obesity prevention should begin during the ante-natal period and cited a study finding maternal weight to correlate to preschool obesity but another found that breast feeding had a protective effect on childhood obesity. A study by Rossem et al. (2010: 7) supports the link between breast feeding and reduced obesity in the child. Morgan (1986: 34)) cited that expectant parents should be alerted to the dangers of childhood obesity as there is a strong link with a parent and child’s body weight.

Government Policies

Ells et al. (2005: 449) indicates that in order to prevent the growing trend of obesity Governments must have a key role. For instance Ells et al. (2005: 449) a number of UK police documents including the Health Select Committee Report on Obesity (2004).

Monitoring To Ensure Prevention is Working

It is vital that preventative measures in place are monitored to ensure that they are reducing both the incidence and severity of childhood obesity so that resources can go to the appropriate measures.

Ells et al. (2005: 449) stated that monitoring in most countries consists of only occasional surveys. The UK Essential Core Database for child health have recommended that monitoring (BMI) be carried out on children at entry and exit from both primary and secondary schools. Research carried out by Levine et al. (2008: 255), however, showed that monitoring of primary school children was achievable but that of secondary schools was not.

Conclusion

It can be concluded that childhood obesity is a large, increasing problem within the western world which will follow on into adulthood. This essay has aimed to give an overview of the theories and evidence surrounding childhood obesity including associated diseases, treatments, preventative measures and people involved in supporting the obese child as well as those factors thought to cause the obesity in the first place. This is a complex issue with evidence currently emerging.

This review was mainly focussing on the use of two articles Obesity in Childhood and Prevention of Childhood Obesity which between then cover all the issues surrounding childhood obesity. Where there is further supporting or refuting evidence I have added this. The literature included here is by no means comprehensive and the reader may wish to research an aspect of childhood obesity in greater depth.