Over the past few decades, the burden of non-communicable diseases seems to have been increasing year-by-year. Childhood obesity serves as an outstanding example of non-communicable conditions whose consequences seem to have reached catastrophic levels. Evidence indicates that obesity and overweight trends have been increasing at alarming rates, especially over the past three decades . This implies that the trends of obesity related health conditions are going to reflect upward changes in the future. According to Parsons, Power, Logan and Summerbell reaffirm that 70% of obese adults became obese during their childhood ages . In retrospect, this phenomenon is believed to be attributable to the greater social inequality in developed countries as compared to developing countries . Nevertheless, primary prevention strategies are required to reverse the diseases’ trends across the world. Epidemiological rationale for the emphasis on primary prevention of childhood obesity is based on the fact that the condition is difficult to reverse with secondary interventions . Therefore, this report is intended to inform the Federal Health Minister the scope of childhood obesity and the appropriate interventions which can address its impact.
Epidemiology of Childhood Obesity
Overall, epidemiological data from the World Health Organization indicate that over 40 million children aged below five years were obese or overweight by 2011 . In Australia, it is reported that 25% of children are obese or overweight, whereas the adult population accounts for 60%. As such, the overall burden of obesity in Australia is estimated to be 7.5% . Elsewhere in the United Kingdom, approximately 22.6% of children of preschool age are obese or overweight . Similar trends have been reported in New Zealand where the population of obese children accounts for 31% of the total children population. A recent epidemiological survey indicated that the prevalence of childhood obesity had increased to 10% by 2012 from the rate of 8% recorded in 2006 . Despite these differences in epidemiological trends of childhood obesity, it is apparent that its determinants are relatively the same in developed and developing countries.
Determinants of Childhood Obesity
The key determinants are physical inactivity, excess caloric intake, socio-economic status, socio-cultural factors, built environment, age, and gender. Of all these determinants, reduced physical activity and unhealthy dietary habits are considered be the main culprits for the raising prevalence trends of childhood obesity, worldwide . As such, it is apparent that modifying these risk factors may reverse the prevalence of childhood obesity among the global population.
Proposed Approaches for the Prevention of Childhood Obesity
In this context, primary prevention approaches are deemed necessary for increasing physical activity, as well as adopting healthy dietary habits, rather than forcing obese individuals to lose weight . Controlling weight gain for obese children, as well as secondary prevention of childhood obesity is also required to prevent the onset of obesity related conditions which reduce an individual’s life expectancy and quality of life. In retrospect, it is apparent that there is no single preventive approach that has proven to reverse the prevalence of childhood obesity. However, some of the preventive approaches are known to be more effective than others. This implies that an integrated approach that combines several interventions may achieve appreciable success in combating the impact of childhood obesity across the globe. Therefore, this report recommends the adoption either or both of the proposed prevention strategies. The two main interventions which have been proven to reduce the prevalence of childhood obesity are school-based interventions and community-based interventions.
School-based Childhood Obesity Prevention Approach
In the past two decades, school-based interventions against childhood obesity have gained popularity. Different school-based preventive programs have been developed in different countries to prevent the increase of childhood obesity. Therefore, it is apparent that such approaches can help in addressing obesity epidemic in the country. In this context, a school-based obesity prevention approach should focus on reforming the curriculum to incorporate physical activity and integration of parents and teachers in obesity prevention programs.
The adoption of a structured learning curriculum which does not involve movement of children seems to be contributing to the increase of childhood obesity. According to Gardner, movement experiences are considered as some the main components of children’s learning . This is why the Institute of Medicine [IOM] observes that the pragmatic shift from movement-based learning to structured learning that focuses more on academic skills than physical activity may be contributing to the increasing prevalence of childhood obesity, especially in the United States, as well as other countries with a similar curriculum . These concerns have been reaffirmed by Gehris, Gooze and Whitaker who investigated teachers’ perception towards the role of movement in early childhood education programs. This qualitative survey indicated that movement experiences play integral roles in children’s learning. For instance, this study revealed that movement is an innate need for children. Movement experiences were also found to augment children’s success in school and life. Moreover, it was found out that movement experiences are essential in preparing children for learning. This is why teachers in this survey observed that a structured learning curriculum that excludes movement experiences as contradictory to the children’s needs . Therefore, the curriculum requires reforms to incorporate physical activity and nutritional education as the key elements of learning and obesity prevention among children.
In practice, engaging children in physical activity combined with healthier eating have proven to be an effective approach to prevent childhood obesity. The scientific rationale for integrating physical activity in childhood education is provided by two prospective studies which concluded that prudent diet and physical activity improves obesity related outcomes. Stone, McKenzie, Welk and Booth reviewed the impact of physical activity-oriented educational programs and concluded that a curriculum-based intervention is effective in improving children’s health outcomes, especially with regard to obesity . In another prospective study that involved school-based strategies including participation in physical education and sports, as well as healthier eating, the prevalence of obesity among 6th, 7th and 8th graders was found to decrease within two years. As a result, investigators in this study suggested policy-based changes at the education sector and school levels to promote physical activity through physical education and sports .
Moreover, the outcomes of two school-based programs; the Energize and APPLE (A Pilot Program for Lifestyle and Exercise) in New Zealand show how a curriculum-based approach can address the prevalence of childhood obesity epidemic in the country. The APPLE project focused on engaging children in non-curricular activities outside the classroom, as well as incorporating bursts of physical activity during classroom sessions. It also focused on promoting healthier dietary habits. Overall, the outcome of this intervention showed significant improvement of the key indicators of obesity. For instance, the mean BMI among the intervention group decreased by 0.26 points, whereas systolic blood pressure decreased by 4.8mmHg compared to the control group . Similar outcomes were achieved in the Project Energize in which children in the participating schools recorded an average BMI reduction of 3% compared to that of the control children population .
However, the success of these programs showed that an effective school-based obesity prevention approach requires the integration of the key stakeholders, primarily parents and teachers. Middleton, Evans, Keegan, Bishop and Evans  describe teachers and parents as ‘social agents’ who play integral roles in enhancing the success of school-based healthy eating programs that are aimed at improving children’s wellbeing including the prevention of childhood obesity.
Overall, the greatest strength of school-based obesity prevention programs is that the program can be designed to the targeted population. However, it is worth noting that parental influence serves as the key limitation .
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