CHILDHOOD OBESITY IN U.K.
Childhood Obesity: Health Promotion
Obesity is an ever-increasing problem in today’s society for both children and adults. The World Health Organization declared Obesity in 1998 as a global epidemic because of its long-term implications on health. The problem continues to increase today in the United Kingdom ( 2006, ). Obesity is a condition where weight reaches the point that it creates a serious threat to health ( 2003).
Health promotion is a process that aims to enable people to increase, and to improve their health. In order to obtain physical, mental and social well-being, an individual or group must be capable of identifying and of realizing aspirations, of satisfying needs, and of changing and coping with the environment ( 1986). Health promotion makes claims to know not only what constitutes healthy behaviour, but also the best way to go about encouraging people to achieve it. Health promotion needs an analysis of the different groups that constitute society: men and women; young and old; rich and poor; black and white. It relies on knowledge of these groups’ varying beliefs and attitudes, interests, and concerns. Health promotion, then, implicitly depends on sociological categories when pursuing its ends ( 2002, ). Health according to the Ottawa Charter, is created in everyday life through the way people work; play and love ( 1986). Health is socially constructed. Health promotion also usually involves some form of social interaction and the development of human relationships. Increasingly, there is a consensus that ‘good’ health promotion necessarily involves engaging people in the process ( 1999; and 1998).
Public health is the science and art of preventing disease and prolonging life, and promoting physical and mental health and efficiency, through organized community efforts. Any purposeful activity to create health, especially that which engages the social machinery requires political acts under four domains of politics. These domains of politics are:
o Politics is primarily concerned with the conduct and management of a community’s state.
o Politics is primarily concerned with the conduct and management of a community’s affairs in pursuit of the notion of the ‘good life’.
o Politics is concerned with the generation and resolution of conflict through compromise, conciliation, negotiation, and other strategies.
o Politics is about the production, distribution, and use of resources in the course of social existence, the nature of which is exercised through power relations ( 2002).
The increase of obesity among children over the past decades, together with the associated health problems and costs, is raising serious concern among health care professionals, policy experts, children’s advocates, and parents. Obesity is now a growing public health concern n the United Kingdom.
Childhood Obesity is in an alarming speed in many parts of the world. The table below shows the percentage of childhood overweight and obesity by World Health Organization Region.
Childhood Overweight and Obesity by WHO Region
Source: () 2006
A person is considered obese if his body weight is more than normal for a particular age, gender, and height. The degree of obesity can be assessed through BMI (Body Mass Index) calculations that are based on a person’s height and weight. A person gains weight when the energy input (food) exceeds output (exercise, activity). Every output comprises the thermal effect of food and activity. Even a small imbalance between energy input and output can lead to significant weight gain over time. Most obese children demonstrate a slow but consistent weight over several years ( 2003).
Body Mass Index (BMI) is a well-recognised measure for assessing obesity and overweight. BMI is calculated by dividing weight, in kilograms, by the square of height, in metres. BMI is easy to measure and is not invasive. There is still discussion as to the appropriateness of BMI as a measure of overweight and obesity, especially in children. At the individual level of an individual child a single BMI measure is difficult to interpret and needs to be used in conjunction with other findings, if it is to assist with the management of overweight and obesity (, 2006).
In 2001, it has been estimated that about 8.5 per cent of 6 year olds and about 15 per cent of 15 year olds are obese. The prevalence of obesity among children, aged 2 to 10, rose between 1995 and 2003, from 10 per cent to 14 per cent. The increase in obesity was most marked among older children aged 8 to 10, rising from 11 per cent in 1995 to 17 per cent in 2003 ( 2005). The increase in childhood obesity has become an increasingly important issue on the public health agenda, with concerns being raised not only about the risks to children’s health but also the current and future drain on the National Health Service (NHS) resources ( 2006).
Risk Factors: Sedentary Lifestyle and Unhealthy Eating Habits
While genetics play an important role, genes alone cannot account for the huge increase in obesity rates among children. Unhealthy eating habits and sedentary lifestyle are the considered main causes of obesity ( 2003). Most experts agree that watching excessive amounts of television is a significant risk factor associated with obesity; almost half of children ages 8-16 years watch three to five hours of television daily ( 2002, cited in 2003). Children who are most overweight watch the most television and eat too many snacks with a high fat content (, 2001 cited in 2003). Many children engage more in television viewing, video games, and Internet surfing than physical activities. The trance-life state associated with these activities can slow children’s metabolism so much that they resemble children at complete rest ( 2001/2002 cited in 2003).
Very few children become obese because of an underlying medical problem. Children are more likely to be obese if their parents are obese. Many believe that obesity is caused by share eating and activity habits in the family. Most children put on excess weight because their lifestyles include an unhealthy diet and a lack of physical activity ( 2007). Childhood Obesity is often link to sedentary lifestyle and poor eating habits. Poor eating habits are often acquired by the children from their parents. The habit learned from parents are significant. Learned unhealthy lifestyle choices continue into adulthood. Lack of physical activity is another factor that contributes to childhood obesity ( 2007). Children raised in families who do not regularly prepare and eat family meals together are more likely to be obese. Children are more likely to be obese if they lack opportunities to participate in active recreation and sports and/or are not encouraged to engage in physical activities. Children who spend several hours daily watching television, playing video games, or working on the computer are at greater risk for weight gain ( 2004).
Parents are responsible for developing a home environment that promotes healthy eating and physical activity among children. Parents form their children’s dietary practices, physical activity, sedentary bahaviours and their weight status in many ways. Parents’ knowledge of nutrition; their influence over food selection, meal structure, and home eating patterns; their modeling of healthful eating practices; their levels of physical activity; and their modeling of sedentary habits are all influential in their children’s development of lifelong habits that contribute to normal weight or to overweight and obese ( 2004).
Children develop their food habits through exposure and repeated experience. It has been suggested that individual differences in the physiologic regulation of energy intake appear as early as the preschool years and that parents have enormous influence on these differences ( 1998). Another important influence on the types of food young children consume is a household’s food choices. At an early age, children will eat what their parents, especially their mothers, eat ( 1992). And if parents overeat, their children may too. Parents’ eating behaviour may contribute to the development of obesity in children ( 2000).
Current Policies to Prevent Childhood Obesity in the United Kingdom
Prevention and management of childhood obesity needs a series of coordinated policies to improve diet and physical activity levels in the early years, at schools, and in families and communities. Among the policies that are important in the prevention and management of obesity among children in the United Kingdom are:
1. Infant Feeding – the National Health Service (NHS) aims to increase breastfeeding by 2 per cent each year. This initiative focuses on women from disadvantaged groups. The Department of Health (DoH) has an infant feeding initiative to this end ( 2003).
2. Healthy Start – an initiative launched in 2004. The program aims to provide the means for disadvantaged families to buy fruit and vegetables, cereal-based and other foods for weaning, as well as providing milk and infant formula ( 2003).
3. Sure Start – focuses on families and children up to age four living in the most deprived areas. The program aims to provide family support, nurturing advice, health services and early learning ( 2003).
School Based Programmes
School provides an ideal setting for initiatives to improve dietary and physical patterns. The framework for such initiatives is provided by the National Healthy Schools Standard (NHSS), an accreditation scheme for schools, funded jointly by the DoH and the Department of Education and Skills (DfES) ( 2003).
The Ottawa Charter
Fundamental for reinforcing the issue of empowerment in respect of health, the Ottawa Charter defined health promotion as ‘the process of enabling people to take control over and to improve their health’, and identified five key levers which health promotion should employ:
- Building Healthy public policy
- Creating supporting environments
- Strengthening community action
- Developing personal skills and capacities
- Reorienting health services ( 2003)
Objectives of Health Promotion
Good health is a major resource for social, economic and personal development and an important dimension of quality of life. Political, economic, social, cultural, environmental, behavioural and biological factors can all favour health or be harmful to it. Health promotion action aims at making these conditions favourable through advocacy for health.
Health promotion focuses on achieving equity in health. Health promotion aims at reducing differences in current health status and ensuring equal opportunities and resources to enable all people to achieve their fullest health potential. This includes a secure foundation in a supportive environment, access to information, life skills and opportunities for making healthy choices.
Health promotion demands coordinated action by all concerned; by the governments, by health and other social economic sectors, by nongovernmental and voluntary organization, by local authorities, by industry and media.
Childhood obesity is one of the major public health issues in the United Kingdom. It is considered by the World Health Organization as a global epidemic. Childhood obesity in England continues to rise at an alarming speed. Obesity is a condition where weight gain reached a point that it poses a serious threat to health. A child is considered obese if his/her body weight is more normal for his/her age, gender and height.
While genetics play an important role, genetics alone cannot account for the increase in obesity rates among children. Two of the primary factors that contribute to the obesity epidemic are unhealthy eating habits and sedentary lifestyle. Poor eating habits are often acquired by the children from their parents. Unhealthy lifestyle choices are also learned from parents. Parents and Schools also play an important role in health promotion efforts.
Health promotion is one of the solutions to combat childhood obesity and promote healthy eating and living. Health promotion is a process that aims to enable people to increase, and to improve their health. Health is socially constructed. Health promotion involves some form of social interaction and the development of human relationships. Health promotion should
o Build Healthy public policy
o Create supporting environment
o Strengthen community action
o Develop personal skills and capacities
o Reorient health services
Parents and schools have a big impact on children’s eating habits, lifestyle and behaviour. Health promotion efforts should involve parents and school staff. With the help of healthcare professionals, health promotion programs should encourage children and parents to eat and live healthy.
Health Promotion: Development of Personal Skills
Health promotion supports personal and social development through providing information, education for health, and enhancing life skills. By so doing, it increases the options available to people to exercise more control over their own health and over their environments, and to make choices conducive to health. Enabling people to learn, throughout life, to prepare them for all of its stages and to cope with chronic illness and injuries is essential. This has to be facilitated in school, home, work and community settings. Action is required through educational, professional, commercial and voluntary bodies.
Nutrition education should address not only the immediate health benefits of nutritious eating, but also how eating fits into a healthy social context, in which meals are part of a stable pattern. It is crucial to ensure that consistent messages about healthy eating at home, in school and from food advertisers. Schools and parents should be at the core of any health promotion schemes as they are essential for the success of such initiatives. The educational needs of children with regard to food knowledge and behaviour can be addressed in schools.
Parents play a key role in the development of internal factors that will govern their children’s behaviour. Interventions that target children’s beliefs, attitudes, knowledge and behaviours must also involve parents. Information campaigns aimed at parents should not only emphasise both the physical and psychological consequences of obesity, but also how they can be more effective parents ( 2005).
Parents as Agents of Change
Behaviour modification programs where parents take key responsibility and act as agents of change can be used to help children lose weight. Parents should be instructed on strategies for supporting the weight-loss efforts of children, including altering family dietary and activity patterns and improving parenting and communication skills. Family-based programs should actively increase physical activity, provide dietary education and target reduction in sedentary behaviour.
Schools are considered as the most important venue in tackling childhood obesity. Interventions regarding childhood obesity should utilize the school as a mode of intervention ( 2005).
Programs that educate as well as influence diet and physical activity should be promoted. These programs should target the entire school community including parents, teachers and catering staff. The programs should include teacher training, modification of school meals, and the development and implementation of school action plans designed to encourage healthy eating and physical activity.
Collaboration between Parents and Schools
Schools and parents can collaborate to promote physical activity as children travel to and from school. A program that seeks to increase opportunities for physical activity by encouraging children to walk and bike to school in groups accompanied by adults and to encourage communities to build coalitions to create an environment that supports safe walking and bicycling to school. Using brochures, newsletters, and homework assignments that parents must sign, educators can inform parents of programs to increase children’s after-school activity levels. Schools can provide alternatives for children during the afternoon television-watching period, providing a clear signal tom parents that schools are serious about confronting the sedentary options now available to children. Teachers can help parents stay informed about national and local programs and strategies targeted toward childhood obesity ( and 2004).
3. Health Care Professionals
Registered dieticians are in good position to tackle obesity by having the skills to provide advice and support for families as well as training other healthcare professionals, who should recognise the key roles of balanced nutrition and exercise in the prevention and management of disease and the promotion of good health. Obesity is a chronic condition that requires on-going management and is imperative that the whole family engages in lifestyle change. All healthcare professionals should, whenever possible, provide advice on healthy living to the child and parents that is relevant, manageable and directed to their individual circumstances ( 2005).
Family pediatricians can provide children and parents with leaflets aimed at educating both parents and children. The leaflet can include general information regarding obesity and associated risks, general advice on healthy eating and an invitation to practice some physical activity. Family pediatricians can also provide children and parents with information on a specific diet, detailed guidelines regarding physical activity and active parental commitment, and a food diary with instructions for use.
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