The Childhood Obesity Epidemic

Since the 1970s, the percentage of children in the United States (US) affected by obesity has almost tripled. 1 Childhood obesity is one of the most serious public health challenges we are facing today, particularly in urban settings. 2 As many as 17% of children between 2 and 19 years of age in America are obese. 3 Children who are obese are at much greater risk for chronic health conditions including asthma, type 2 diabetes, sleep apnea, and bone and joint problems. 4 Children with obesity are also much more likely to suffer from depression and social isolation than non-obese children. 5 What is causing the high prevalence of childhood obesity in the US?

Many neighborhoods in the US do not have access to fresh, healthy foods. The US Department of Agriculture (USDA) defines a “food desert” as any community in which one third of the population (or at least 500 people) live more than one mile from the nearest grocery store. 6 Some studies have identified an association between food deserts, poor nutrition, and obesity. 7 Others have identified “food swamps” as a major threat: neighborhoods where convenience stores and fast food restaurants crowd out healthy choices with their inexpensive, high calorie offerings. 8 In 2017, the presence of food swamps has become a stronger predictor for obesity rates. 9

There are several lifestyle factors that contribute to childhood obesity. For example,
one study in Japan found that eating dinner alone is associated with being overweight among adolescent girls. 10 Another study in the US found that children who watched more television and ate fewer family meals were more likely to be overweight by third grade, and that children who came from neighborhoods perceived as less safe for outdoor play were more likely to be overweight. 11 Sedentary lifestyle, lack of physical activity, and eating junk food while watching TV can all contribute to childhood obesity. 12 13 14 A number of behavioral studies have found that US children, who watch an average of 28 hours of television a week, are affected by junk food ads; such advertisements increase total consumption among adolescents. 15 Advertising aimed at children does not address the importance of proper nutrition for health, but exposes them to unhealthy foods: children are exposed to an estimated 10,000 advertisements for food per year, 95% of which are for fast food. 16

Simply addressing food deserts and food swamps may not be sufficient to change eating habits. Some studies have suggested that the introduction of new grocery stores with healthy options does not significantly change eating behaviors, 17 and others have indicated that family income and educational status play a stronger role than food availability when making poor nutritional choices. 18 Regardless, it is clear that access to healthy food choices is a necessary component of a healthy diet.

The childhood obesity epidemic is complex. As the prevalence of obesity and being overweight among children increases, so does the need to promote more active lifestyles and reduce sedentary behaviors. 19 Medical interventions may not be an easy answer, and solutions will require multi-step approaches based in community and principles of equity. We must examine messages aimed at children and parents about food behaviors, especially those distributed by mass media, if we are to effectively address the negative effects of social marketing. 20 Interventions to curb childhood obesity should take a multi-level approach, including addressing food deserts and swamps, and promoting healthier lifestyles. 21 22 23

 

Notes:

  1. Ogden C, Lamb M, Carroll M, Flegal K. Obesity and socioeconomic status in children and adolescents: United States, 2005-2008.  NCHS Data Brief. 2010: No. 51.
  2. WHO: Childhood overweight and obesity. 2017. http://www.who.int/dietphysicalactivity/childhood/en/
  3. Troiano RP, Flegal KM.Overweight children and adolescents: Description, epidemiology, and demographics. Pediatrics 1998: 497–504.
  4. Freedman D, Khan L K, Dietz W, Srinivasan S, Berenson, G. Relationship of childhood obesity to coronary heart disease risk factors in adulthood: the Bogalusa heart study. Pediatrics. 2001: 108(3).
  5. Reeves GM, Postolache TT, Snitker S. Childhood Obesity and Depression: Connection between these Growing Problems in Growing Children. International journal of child health and human development : IJCHD. 2008;1(2):103-114.
  6. “USDA Defines Food Deserts.” American Nutrition Association, americannutritionassociation.org/newsletter/usda-defines-food-deserts.
  7. Wilde, P.E., Llobrera, J. & Valpiani, N. Curr Obes Rep (2012) 1: 123. https://doi.org/10.1007/s13679-012-0022-y
  8. Wilde, P.E., Llobrera, J. & Valpiani, N. Curr Obes Rep (2012) 1: 123. https://doi.org/10.1007/s13679-012-0022-y
  9. Cooksey-Stowers K, Schwartz MB, Brownell KD. Food Swamps Predict Obesity Rates Better Than Food Deserts in the United States. International Journal of Environmental Research and Public Health. 2017;14(11):1366. doi:10.3390/ijerph14111366.
  10. Shirasawa T, et al. Effects of eating dinner alone on overweight in Japanese adolescents: a cross-sectional survey.  BMC Pediatrics. 2018; 18:36.
  11. Gable S, Chang Y, Krull J. Television watching and frequency of family meals are predictive of overweight onset and persistence in a national sample of school-aged children. Journal of the American Dietetic Association. 2007: 107(01), 53-71.
  12. Andersen RE, Crespo CJ, Bartlett SJ, Cheskin LJ, Pratt M. Relationship of Physical Activity and Television Watching With Body Weight and Level of Fatness Among ChildrenResults From the Third National Health and Nutrition Examination Survey. JAMA. 1998;279(12):938–942. doi:10.1001/jama.279.12.938
  13. M.T. Hamilton, G.N. Healy, D.W. Dunstan, T.W. Zderic, N. Owen, et al. Too little exercise and too much sitting: inactivity physiology and the need for new recommendations on sedentary behavior. Curr Cardiovasc Risk Rep, 2 (4) (2008), pp. 292-298
  14. Owen N, Healy G, Matthews C, Dunstan, D. Too much sitting: the population health science of sedentary behavior. Exercise and Sport Sciences Reviews. 2010: 38(3),105-113.
  15. Jeffrey, D. B., McLellarn, R. W., & Fox, D. T. (1982). The development of children’s eating habits: The role of television commercials. Health Education Quarterly, 9(2-3), 174-189.
  16. Horgen KB, Choate M, Brownell KD.  Television food advertising: Targeting children in a toxic environment. In: SingerDG, SingerJL (eds). Handbook of Children and the Media. Sage: Thousand Oaks, CA, 2001, pp 447–461.
  17. Elbel B, Moran A, Dixon LB, et al. Assessment of a government-subsidized supermarket in a high-need area on household food availability and children’s dietary intakes. Public Health Nutrition. 2015;18(15):2881-2890. doi:10.1017/S1368980015000282.
  18. Handbury, Jessie, et al. “Is the Focus on Food Deserts Fruitless? Retail Access and Food Purchases Across the Socioeconomic Spectrum.” National Bureau of Economic Research, 2015, doi:10.3386/w21126.
  19. Gallo AE. (1996).The Food Marketing System in 1995. US Department of Agriculture, Economic Research Service, Food and Consumer Economics Division. Agriculture Information Bulletin no. 731. http:www.ers.usda.govpublicationsAIB731AIB731.pdf
  20.  Schwartz, M. B. and Puhl, R. (2003), Childhood obesity: a societal problem to solve. Obesity Reviews, 4: 57–71. doi:10.1046/j.1467-789X.2003.00093.x
  21.  Schwartz, M. B. and Puhl, R. (2003), Childhood obesity: a societal problem to solve. Obesity Reviews, 4: 57–71. doi:10.1046/j.1467-789X.2003.00093.x
  22. Gable, S. and Lutz, S. (2000), Household, Parent, and Child Contributions to Childhood Obesity*. Family Relations, 49: 293–300. doi:10.1111/j.1741-3729.2000.00293.x
  23. Youfa Wang; Cross-national comparison of childhood obesity: the epidemic and the relationship between obesity and socioeconomic status, International Journal of Epidemiology, Volume 30, Issue 5, 1 October 2001, Pages 1129–1136, https://doi.org/10.1093/ije/30.5.1129

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