Term Paper on "Childhood Obesity & Nutrition Evaluation of Contemporary"

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Introduction

Childhood obesity, particularly in the United States, is at an all time high and the problem is one that appears to be only growing. This work will evaluate the available medical treatments of child obesity and clarify the pros and cons of the most prevalent treatments for child obesity by today's medical professionals.

Review of Literature

The work of Rebecca Moran, M.D. states that the prevalence of childhood obesity "in the United States has risen dramatically in the past several decades." (1999) While 35 to 30% of children are affected by childhood obesity, "this condition is underdiagnosed and undertreated." (Moran, 1999) Generally, factors such as hormonal or genetic factors are very rarely, what causes childhood obesity. It is extremely important that obesity in childhood be evaluated including prevention in order that children are able to avoid the long-term implications relating to their success and overall happiness. (Moran, 1999) the National Institute for Health Care Management Foundation states that maintenance of a balance "between energy intake and energy expenditure is a critical factor in regulating body weight. The majority of obesity-related academic research, government funding, media attention and parental concern has focused on nutrition and dietary contribution to child and adolescent overweight." (NIHCM, 2003) According to the NIHCM Foundation the advantages of prevention of childhood obesity include: (1) the ability to maintain optimal metabolic physiology; (2) Applying prevention strategies at the populations level; (3) early counseling or behavior modification therapy in addressing the root cause(s) of eating and activity behaviors; and (4) secondary beneficial effects such as general disease risk reduction and preventative behaviors have limited or not hard to a child or adolescent." (NIHCM, 2003) the NIHCM Foundation states that requirements in prevention and treatment of child obesity include the introduction of healthy behaviors, the modeling of healthy behaviors and the reinforcement of healthy behaviors in early childhood. It has been demonstrated by medical researchers that "prevention of obesity is easier than treatment..." (NIHCM, 2003) of the problem of childhood obesity. Preventions and interventions in the "healthcare, school and community settings" have been shown to be effective in the prevention of childhood obesity. It is stated that current prevention efforts "should focus primarily on anticipatory guidance with parents and children addressing knowledge, attitudes, and beliefs about eating and activity behavior." (NIHCM, 2003) the NIHCM Foundation states: "the influence of hereditary factors in managing weight may also be a challenge and requires HCPs and parents to focus on building self-esteem and addressing the psychosocial issues." (NIHCM, 2003) Several different methods have been studied in the prevention and treatment of childhood obesity. First reported is that "several studies have examined the contributions of breastfeeding to prevention of childhood obesity." (NIHCM, 2003) Studies have indicated that infants who are bottle-fed are at more risk of become obese later in life. In a review of 11 studies, which examined the prevalence of obesity in children, eight studies reported a lower risk of obesity in children who had been breastfed as opposed to being bottle-fed. Bergmann et al. made an examination of the "role of breastfeeding as a protective measure" against obesity in childhood. "BMIs in the breast-fed and bottle-fed infants were very similar at birth. However, bottle-fed infants had significantly higher BMIs and thicker skinfolds at three months and six months than breast-fed children. And at six years, obesity prevalence in the bottle-fed children nearly tripled." (Ibid) This study conducted logistic regression analysis and found the "bottle-feeding, maternal overweight, maternal smoking during pregnancy, and low SES were risk factors for overweight and adiposity at six years of age." (NIHCM, 2003)

The Stanford Adolescent Heart Health Program study had as its focus the improvement of health behaviors in 1,500 10th graders from four high schools that were ethnically diverse. The target interventions in the study were aerobic physical activity, physical fitness, dietary fat, body fatness, and smoking. Stated is: "Delivered in the classroom over 20 sessions, boys and girls in the experimental schools reported becoming regular aerobic exercisers and increasing their selection of low-fat, high fiber foods. Improvements in physical fitness and body fatness substantiated the reported behaviors. The treatment group students also had decreases in BMI and skinfold thickness." (NIHCM, 2003) Another program created by Stanford researchers is the "Obesity Prevention for Pre-Adolescents" program (OPPrA). This program was reported to be funded by the NHLBI, and included 1,000 diverse children who attended 13 public elementary schools. In a three-year intervention which started in the third grade until the fifth grade was an attempt to alter the preferences of children a to their food choices, aimed at reduction of television viewing and presented health advocacy activities and the provision of an intensive treatment program for those who were already overweight and the families of the overweight children. The intervention was inclusive of: (1) a 5-a-Day nutrition information; (2) parent newsletters; (3) a new PE program; (4) taste tests during lunch time, (5) television viewing reduction curriculum; (6) summer programs; (7) reduction fast-food and junk food; and (8) an optional weight control program for overweight children." (NIHCM, 2003) the following figure illustrates the "Recommended Overweight Screening Procedures."

Recommended Overweight Screening Procedures

Source: Childhood Obesity - Advancing Effective Prevention and Treatment: An Overview for Health Professionals (2003)

The following figure illustrates the "Childhood Obesity: Diagnostic Algorithm"

Childhood Obesity: Diagnostic Algorithm

Source: Childhood Obesity - Advancing Effective Prevention and Treatment: An Overview for Health Professionals (2003)

Behavioral Treatment of Childhood Obesity

Treatments of childhood obesity include Behavioral Treatment which "can be implemented at several different levels: (1) individual; (2) interpersonal; (3) organizational; and (4) societal." (Ibid) the NIHCM Foundation states that "Research has shown success in intensive group programs, however, this approach is not easily translated into an office visit. According to the NIHCM Foundation, the work of "Robinson and others" suggests that "the most effective behavioral treatment programs have certain components that result in successful, long-term weight loss..." (Ibid) Those identified components are: (1) parent involvement including parent education about critical behavior areas; (2) frequent meetings or sessions; (3) sustained treatment duration; (4) group format with individual behavior counseling; (5) a simple diet that produces a calorie deficit; and (6) physical activity intervention that allows for personal choice;) Emphasis on reducing sedentary behavior; (8) Home and family environmental change that increase cues for physical activity and reduces cues for calorie intake and inactivity; (9) Self-monitoring, goal setting, and behavior contracts; and (10) Education regarding skills for behavior maintenance and relapse prevention." (NIHCM, 2003)

Recommendations Actions in the Evaluation and Treatment of Obesity in Children

According to the NIHCM Foundation report, there are designated actions required in the evaluation and treatment of obesity in children according to recommendations of the expert committee. These designated actions are listed in Figure 3: Obesity Evaluation and Treatment: Expert Committee Recommendations. The first of the actions listed is 'Identify', which includes calculation of the BMI or body-mass index, and those with a BMI in the 95th percentile should undergo a medical assessment. The second listed action is "Assess" at which time genetic or endocrinologic causes are assessed as well as any possible medical complications, the degree the child is overweight and finally make a determination if the child should be referred to a specialist in this area. Third is the 'Evaluation' as to the 'readiness to change' of the obese child; the child's history of physical activity; and the child's diet history. (Ibid; paraphrased) the fourth action is stated to be that of: "Setting Goals" in relation to behavioral, medical and weight focused goals. The final two steps have to do with therapy both family and individual.… READ MORE