Childhood Obesity: A Review of Risk Factors, Effects, and What We Can Do About It

Childhood obesity is a serious global issue that merits the attention of interdisciplinary professionals. Between 2009 and 2011, 19.8% of Canadian children between the ages of 5 and 17 were overweight and an additional 11.3% were obese, which was calculated using World Health Organization cut-offs (Roberts, Shields, de Groh, Aziz, & Gilbert, 2012, p. 5). In comparison, 14.9 % of children ages 2 to 17 years in the United States were overweight while an additional 17.3% were obese between 2011 and 2012 (Skinner & Skelton, 2014, p. 565). These statistics were calculated using the Centers for Disease Control and Prevention (CDC) body mass index (BMI) guidelines which define childhood overweight as weight greater than or equal to the 85^th percentile but less than the 95^th percentile, and childhood obesity as weight greater than or equal to the 95^th percentile (Skinner & Skelton, 2014, p. 562; CDC, 2016, para. 1). Childhood obesity has many biopsychosocial consequences that are of concern to the child’s short-term and long-term health. Physical complications of obesity include hypertension, high cholesterol, glucose intolerance, insulin resistance, type 2 diabetes, asthma, sleep apnea, menstrual abnormalities, joint problems, musculoskeletal discomfort, fatty liver disease, cholelithiasis, and gastro-esophageal reflux (CDC, 2016, para. 7; Sahoo et al., 2015, p. 190). While many of these health conditions were previously thought only to appear in adulthood, they are becoming increasingly prevalent among obese children (Sahoo et al., 2015, p. 190). Furthermore, obese children are likely to remain obese into adulthood (Sahoo et al., 2015, p. 187), therefore increasing their risk for or exacerbating obesity-related diseases. This is significant, since an estimated $215 billion is spent annually in the U.S. on direct and indirect obesity-related expenses in the child and adult populations, emphasizing an urgent need to reduce rates of obesity and its complications (Hammond, & Levine, 2010, p. 294). From the psychosocial standpoint, obese children are at an increased risk for anxiety, depression, low-self-esteem, low self-reported quality of life, body dissatisfaction, stigmatization, bullying, social marginalization, and eating disorders (CDC, 2016, para. 8; Sahoo et al., 2015, p. 190). Overweight and obese children are also more likely to have problems at school in comparison to normal weight children, which can impact academic success (Sahoo et al., 2015, pp. 190-191).

Risk factors for childhood obesity can be classified into 6 main categories: unhealthy diet, eating habits, sedentary lifestyle, social influence, genetics (Sahoo et al., 2015, pp. 188-190); and insufficient sleep (Ruan, Xun, Cai, He, & Tang, 2015, p. 12). However, these factors cannot be fully explored without considering some social determinants of health, including: low socioeconomic status, low educational level, and food insecurity (Mikkonen, & Raphael, 2010). We must also consider the impact of child marketing, accessibility, and mental health.

Interventions can be divided into two levels: individual & family-centered interventions and societal interventions. On the individual & family level, one can prevent or reverse childhood overweight and obesity by implementing a healthy diet and adequate physical activity, limiting TV and electronics usage, increasing quality time with the family, living in safe neighborhoods with fewer fast food options, having adults act as healthy role models (Sahoo et al., 2015, pp. 188-189); breastfeeding in infancy (American Academy of Pediatrics, 2012, p. e830); and increasing hours of sleep (Ruan et al., 2015, p. 12). On the societal level we must look to build partnerships with the interdisciplinary team, including dietitians, physicians, and other nurses; as well as school boards, principals and teachers; and government affiliates in the health, education, and marketing sectors. Proposed changes in the school system involve increasing health education taught by nurses and dietitians, increasing the number or length of physical education classes, increasing opportunities for and accessibility to active extracurricular activities, improving the quality and affordability of cafeteria food, incorporating school gardens, integrating cooking classes into the curriculum, cultivating an enriched play environment and limiting screen-time during school hours. Corporate interventions are directed mostly at marketing and accessibility. A major recommendation is to reduce the amount of child-directed marketing for unhealthy foods (Sahoo et al., 2015, p. 189) and entertainment products that promote sedentary lifestyles, such as video games and TV shows. Increasing the amount of grocery stores that are easily accessible by public transport, increasing the amount of locally produced merchandise, and selling blemished produce at a lower cost are other interventions that may promote healthier eating and thus reduce rates of childhood overweight and obesity. It is important also to advocate for smaller portion sizes in the fast food and restaurant industries to discourage overconsumption (Sahoo et al., 2015, p. 189). Within neighborhoods, increasing the number of community gardens and farmers markets may also have a positive impact on the accessibility of healthy food options.

If these individual/family and societal interventions can be incorporated as the new norm, it is likely that rates of childhood overweight and obesity will decline. Not only would this be hugely beneficial to the health of the individual, reduced prevalence of childhood obesity implies reduced healthcare costs on obesity-related comorbidities and complications. I recommend that these spared resources be reallocated towards an upstream approach to promote the sustainability of childhood obesity prevention. Nurses, having strong relationships with patients and families, extensive knowledge about health, strong communication skills, and leadership experience are in a prime position to initiate a childhood obesity movement. On the individual & family-centered level, nurses can make change by engaging in high quality patient & family teaching; seeking opportunities to teach in schools and in the community; participating in nursing research and implementing best practices related to childhood obesity prevention and reversal; and being a positive role model for patients, families, peers, and other nurses. On the societal level, nurses must be able to advocate for change, participate in research, build partnerships with other sectors, and inspire others to take a stand against childhood obesity.