The Prevention of Childhood Obesity amongst Pacific Children under 5 years of age in New Zealand
Obesity represents a major public health problem in both developed and developing countries, which has increased rapidly in prevalence in the past 2 decades. After the suggestion that nutrition in early life might influence the risk of subsequent obesity, some reports suggested that initial breastfeeding might protect against obesity in later life, whereas others failed to confirm the association.
Inconsistency in results could reflect variation in the statistical power of different studies or differences in the extent of adjustment for potential confounding factors, particularly maternal obesity, smoking, and socioeconomic background, Differences in the age of outcome assessment, calendar year of infant feeding, country, and method of assessment of infant feeding could also be important (Cook, 2005).
Selective reporting or publication, particularly of small studies with extreme results, could also be an important factor. In an attempt to establish the extent to which infant feeding influences obesity, we reviewed the published literature on the relationship between infant feeding and obesity, to examine the overall consistency of reported associations, the extent of potential publication and reporting biases, and the potential contributions of confounding factors (Cook, 2005).
International trends show an increase of overweight and obesity in youth, but accurate and representative New Zealand data are scarce. There is so little information about childhood obesity because it had been almost impossible to study infants and children. However, it is likely that young New Zealanders are following overseas trends. The importance of the promotion and sustained consumption of physical activity by youth to manage population overweight and obesity should not be underestimated.
The increasing prevalence of overweight and obesity in the population is a serious problem with profound long-term repercussions for the New Zealand health system. Conservative estimates are that obesity costs New Zealand at least $135 million annually. This does not include downstream costs associated with lifestyle diseases. Type II diabetes alone costs more than $280 million a year. Worse, predictions for increases in lifestyle-related diseases and health-care costs related to these diseases are alarming (Croteau, 2005).
A growing body of research indicates that low activity rather than overeating may be a significant basis of the obesity problem. As a national research priority, New Zealand must establish a regular national public health surveillance program, which concurrently measures youth nutrition, physical activity and body composition, and accounts for the ethnic diversity in New Zealand. Objective measures of physical activity are essential to understand how much the youth move (Croteau, 2005).
For measures of body fatness, national cross-sectional data for our youth is required as a matter of urgency. Public health surveillance in this area has been weak. It is hard to either justify program funding, or track the success of programs at any level without such data. Identifying at-risk groups is also an important outcome of such measurement. New Zealand is unique in its combination of the Pakeha, Maori, Pacific and, more recently, Asian ethnic groups. These groups have different lean muscle and body fatness characteristics that need to be considered in population measurement of body fatness. A national database is required if ethnic body mass index comparisons and ethnic-specific overweight/obesity cutoffs are to be developed (Croteau, 2005).
There is evidence to suggest that the problem of overweight and obesity in New Zealand youth has as much to do with sloth as it does gluttony. New Zealand is very skinny when it comes to research and understanding of obesity and its relationship to physical activity. New Zealand lags behind virtually every other Western country in understanding its national lifestyle and its relationship to chronic disease. This is especially so for the youth. A clear picture of overweight/obesity, physical activity and nutrition patterns across the range of ethnicities in New Zealand must be a national research priority (Croteau, 2005).
Before considering how lifestyle health problems in New Zealand can be solved, the nature and extent of the problem needs to be better understood. Little cross-sectional population data simultaneously examining body fatness, dietary habits and physical activity are available in any New Zealand age group.
Much of the physical activity data that does exist has not been collected using well-validated and reliable measures, as was the case in the research published by the New Zealand Ministry of Health (2003) in NZ Food NZ Children. In this research, physical activity in primary school-aged children was measured using self-report and proxy report data, which has been recognized as being unreliable because children of this age are unable to accurately report on their own behavior. No large-scale objective monitoring of physical activity in New Zealand youth has occurred using sensible measures. As a consequence, policy makers have little understanding of either overall activity levels or important changes that occur throughout adolescence (Croteau, 2005).
Overnutrition during the prenatal period may lead to an abnormally high number of fat cells, and an obese newborn may be the result. This situation can occur when the unborn baby is exposed to high levels of glucose, which may be the case if the baby's mother has poorly controlled diabetes. Obese infants born to diabetic mothers are frequently obese later in life. While any woman of reproductive age can, by entering prenatal care as early as possible in her pregnancy, help prevent obesity in her baby, special efforts should be made regarding minority women (Clinton & Smith, 1999).
There are many serious health risks associated with obesity in adulthood, including heart disease, diabetes, cancer, arthritis and many more (Marieb, 2004). Adults who were obese as children have poorer social, educational, and economic prospects. However obese children may not just be storing up problems for their later life, these children often face health and social problems while they are still quite young. Diabetes type 2, which until recently has mainly been associated with adults, is now affecting obese children. These children are placed in a position where they are at risk of developing eye, heart and kidney disease.
Many obese children also suffer from orthopaedic problems because although bones and cartilage have the ability to stretch slightly, they cannot cope with the excess weight and conditions such as bow legs and abnormalities in bone growth often occur. The obese child may also be at increased risk of developing asthma, which itself in certain cases can be a killer (Marieb, 2004).
Coronary artery disease rarely ever occurs in children (Ganong, 2001). However, the process begins in early childhood; it is now well established that deposits of fat and fibrous tissue are present in the blood vessels of children as young as 4 or 5 years old. While a heart attack caused by this process would be unusual in a child or adolescent, it would not be in a 30-or 40-year-old. The important thing is that, even though the process of atherosclerosis may be inevitable, the rate at which it occurs probably can be slowed down, and the death and disability that it causes can be delayed (Clinton & Smith, 1999).
With such a worrying trend, what steps can be taken to try to tackle the issue of childhood obesity? Parents can take an active part. If obesity is to be prevented, all elements of a community must clearly identify the reasons why so many children do not or cannot have acceptable physical activity and fitness levels, and devise ways to correct this problem together. A starting point would be for parents and adults to set good examples of physical exercise based on recent recommendations (Clinton & Smith, 1999).
Researchers recommend that children should never be forced to eat when they say they are full. By encouraging children to finish everything on their plates, parents can take away the child’s ability to naturally regulate how much they eat. If a child insists that he or she is still hungry it is better to make an effort to encourage them to wait a few minutes because it can sometimes take a little while for messages telling a child they have had enough to reach their brains.
Growing children should be encouraged to eat a good mixture of foods, to ensure they gain a good range of nutrients essential for their health. Parents can encourage children to eat healthily by setting a good example themselves. Low fat diets, which have become popular in adults, are seen by some well-meaning parents as the way ahead. Nevertheless it is important to include some fats in a child’s diet because they are needed for their hormones and the growth of the brain and eyes. Encouraging children to become healthier eaters is more likely to succeed if it is applied to life as a whole and followed on a daily basis.
Children can become easily confused when they are faced with conflicting messages, therefore it is important that the whole family become involved. Rewarding children with food can sometimes lead to the child associating certain food types as a treat and these treats may become sources of comfort. Instead use non-food rewards. Instead families should encourage non food rewards and become more active by taking regular exercise such as walking, swimming and riding.
A logical question in the pursuit of an explanation of the recently increased rates of childhood obesity is “Have our young people spent less time engaged in physical activity and has such activity been less intense in recent years?” If so, then implementing measures to increase activity levels might help prevent obesity.
Although data on physical activity levels and physical fitness over time are not as extensive as those on energy intake, several studies have identified some consistent patterns:
1. In recent years, schoolchildren's participation in all types of physical activity has decreased as they grow older. Studies show that 70 percent of 12-year-old children report that they regularly engage in vigorous physical activity. But by the time they become 21 years old, only 42 percent of men and 30 percent of women say that they are vigorously active.
2. About one-fourth of young people 12–21 years of age say they never engage in any vigorous physical activity.
3. Female adolescents are much less physically active than male adolescents.
4. Daily enrollment in physical education classes among high school students declined from 42 percent in 1991 to 25 percent in 1995. But enrollment doesn't tell the whole story: only 19 percent of all high school students report that they are physically active for 20 minutes or more in physical education classes every day of the school week.
5. In the 1990 Youth Risk Behavior Survey, more than 35 percent of students in grades 9–12 reported watching television for 3 hours or more each school day.
Prevention of obesity during the period of adiposity rebound, at adolescence, and at other times requires even more parental involvement. In my experience, the family can be the strongest factor in preventing obesity during childhood. The parent has the capacity to exert far more influence on dietary and physical activity behavior than schools or governments (Clinton & Smith, 1999).
The promotion of physical activity in children and adolescents is crucial because evidence shows that physical activity not only directly improves health status during childhood, but also plays a part in delaying the onset of some chronic diseases in later life. Specifically, adequate levels of physical activity in childhood are related to decreased prevalence of coronary heart disease risk factors, incidence of overweight and obesity, improved bone health, and psychological well-being (Croteau, 2005).
Childhood obesity carries health risks in both the long and short term. The alarming rise in the numbers of obese children has far reaching effects. One of the most significant risks associated with childhood obesity is that it often continues in adulthood.
When obesity occurs at such a young age it is not just the body that suffers. Children and teenagers become particularly susceptible to emotional stress, stigmatisation, discrimination and prejudice. All children develop a sense of who they are by observing responses from family, friends and the wider society. They can quickly become aware that obesity is socially undesirable and can as a result face exclusion from the very things that could help them overcome their obesity.
Obese youngsters are left out of active play by others and instead spend much time on their own and this can inevitably lead to comfort eating. Others stereotype obese children as being lazy and unclean and this attitude towards them can cause severe psychological problems. Research has linked obesity to low self image, low self esteem and even depression (Binns, 2004).
Clearly, childhood obesity is an important issue for parents, teachers and health professionals. The support for school-based prevention is currently not consistent across the three groups with health professionals clearly advocating for schools to play a major role. Strong and consistent support exists for traditional curriculum-based activities. This provides an opportunity to support teachers and enhance the effectiveness of current classroom and structured physical activity. While acknowledging the strength of the framework in supporting health behaviors, environmental changes to support classroom curriculum remain the challenge. The child's home is likely to have the greatest influence on a child's eating and physical activity behaviors. Supportive school interventions can only reinforce and complement any effort to prevent obesity that happens in the home.
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