Effects of Food, Nutrition & Obesity on Global Health Care Sweta Christian Global Health Issues PHT 716 Professor Jennifer Enjem DPT.

PURPOSE To describe the causative factor of childhood obesity and different metabolic diseases caused by childhood obesity. To diagnose obesity based upon the DSM-IV substance abuse criteria by American Psychological Association. To describe the various eating habits causing obesity and issues related with it (psychological issues). To illustrate prevention strategies of obesity not only by promoting healthy lifestyle but preventing obesity right from the pregnancy.

OBJECTIVE To determine the causative factor of childhood obesity. To describe the types of obesity induced eating habits. To diagnose obesity based upon the DSM-IV substance abuse scale developed by the American Psychological Association. To evaluate the various risk factors associated with childhood obesity and improper nutrition . To describe and elaborate the effort to control, treat and prevent childhood obesity. To elaborate the effects of childhood obesity and its impact on global health care system.

OBESITY Obesity is the major health problem in United States, with over 67% adults classified as overweight (Montoye et al., 2013). Prevalence of childhood obesity comprises of 36% between the age group of 6-11 years old (Montoye et al., 2013). Montoye et al. (2013) states that 43% of Hispanics and 38% of American children between the age of 6-11 years old are overweight or obese. It has also been noted that children who consume large amount of sugar-sweetened beverages shows increased in the risk of obesity (Grimes, Ridell, Campbell & Nowson, 2013). Study conducted by Yang et al. (2012) sodium intake is positively associated with SBP and risk for pre-HBP/HPB among US children and adolescents, and this association may be stronger among those who are overweight/obese.

Causes of Childhood obesity Montoye et al. (2013) , states that Academic of Nutrition and Dietetics narrates the cause of childhood obesity based upon the following reasons, 1) Low nutrition density 2) High Energy Dense dietary patterns and 3) Increased used of computer games, video games and television. Pocock et al (2010 ) conducted a systemic review for understanding childhood obesity in pre-schooled children. According to Pocock et al. (2010) parents are unable to prioritize the factors of addressing childhood obesity which can also be the main factor for the epidemic spread of childhood obesity as seen in the 20th century. Oddy (2012), states that artificial feeding is also one of the biggest factor leading to childhood obesity. Artificial feeding stimulates a higher post-natal growth velocity with the adipose tissue rebound occurring earlier in those children who have greater fatness later, whereas breast feeding has been reported to show slower growth (Oddy, 2012). The adverse long term effect of accelerated growth velocity later results in childhood obesity and overweight problems. (Oddy, 2012). Oddy (2012) also states that the artificial feeding contains high amount of proteins which leads to increased in the post-natal growth velocity causing obesity, whereas on the other hand breast feeding has a protective effect on child overweight and obesity by inducing lower plasma insulin levels, thereby decreasing the fat storage and preventing excessive adipocyte development (Oddy, 2012).

Causes of Childhood Obesity cont.. Childhood obesity is also caused due to food preferences, depending upon the availability of food, preservatives used, type of living life style, hereditary factors, moderate to heavy sedentary lifestyle and climatic condition.

Childhood Obesity & Socio-Economic Status. Stewart, Liu and Rodriguez (2011), states that childhood obesity is directly proportional to the socio-economic status of the family. Increased risk of childhood obesity is noted in the families where mother works more hours per week which is highly seen in high socio-economic status families (Stewart et al., 2011). On the contrary Stewart et al. (2011) also states that maternal unemployment also shows increased in the childhood Body Mass Index leading to overweight and obesity. For complete explanation please refer the notes. Stewart et al. (2011) , compares various stages of a socio-economic family status in assessing the prevalence of childhood obesity. The first point the author makes is increase in the childhood BMI in the families where mother works more hours. BMI shows increased and decreased depending upon the stress levels and the socio-economic conditions. The imbalance in the BMI is vastly seen in the adolescents who works more hours with non-standard schedules than the individual who works more hours on a standard schedule (Stewart et a., 2011). Furthermore, parental improper work schedule always shows negative/positive impacts on childhood health due to improper dinner/lunch timings, imbalance dietary habits and off-timed food consumptions. Stewart et al.(2011) also states that total maternal unemployment also results in negative self esteem, decrease in the income, psychotic symptoms and sometimes chronic illness. Furthermore, this causes changes in the children’s schedule, children may become more withdrawn, and this is associated with increases in child BMI. Another way in which maternal unemployment could affect child BMI is by changing the family dynamic. Impairment in family function has been associated with childhood obesity (Stewart et a., 2011).

Childhood obesity report The Center of Disease Control and Prevention (2013), presents a report of childhood obesity based upon the survey conducted in New York and Los Angelis from the year 2003-2011. The survey report states that Hispanics showed the highest prevalence of childhood obesity ( age 3 -4 years old). The percentage of childhood obesity in Hispanics was 44 %(NY) and 82 % (LA) in 2003 increasing to 47.9% (NY) and 85.6% (LA) in 2007 and 46.4% (NY) and 85.7% (LA) in 2010 resp. Following Hispanics the next were African- American with the percentage of 28% in the year 2003. The percentage shows gradual decrease from 28% in 2003 to 23.9% in 2011 respectively. The lowest percentage showing the prevalence of childhood obesity were Asians with 5.8 % (NY) and 4.1 % (LA) in 2003. However, the percentage increased in NY in 2011 showing 12.9% and 3.3% in LA resp. The above mention reports were presented by Center of Disease Control and Prevention in the year 2013.

Obesity and risk-factors Childhood growth and obesity causes Insulin resistant obesity (Ong et al., 2000). Cardiovascular diseases (Ericksson et al., 1999). Dyslipidemia, increased insulin concentration and increased insulin growth factor I (Forsen et al., 2000) Type 2 Diabetes (Oddy, 2012). Metabolic syndrome such as high cholesterol, high blood pressure and insulin resistance (Singhal & Lanigan, 2007).

Types of Eating and obesity Pretlow (2011), conducted a qualitative internet study to find out the cause of extreme eating and its relationship with obesity and the psychological attitudes. An internet cookie was installed on the computers in the chat room to find out the postings on bulletin boards, chat rooms and forum regarding excessive eating and the reason behind it. Some of the examples of the chat rooms are as follows: a) I am unable to ride the rides at the amusement parks (female age, 12, 5’9”, 235lbs) b) Clothing was hard to find: “Nothing fits me”, it sucks (Female, age, 15, 5’8”, 240lbs). c) I have got a new boyfriend, I think he will break up with me because of my flabs (Female, age 17, 5’2”, 200lbs). Cont….

Types of Eating and Obesity Struggles faced by the youth and the tendency causing increased eating, e.g as follows, a) Its like I couldn’t stop eating.. I don’t know why I get this feelings (female, age 17, 5’2”, 240 lbs) b) I have tried so hard to say no to food… but I just can’t stop for some reason (female, age 15, 5’4”, 200lbs). Furthermore, Pretlow (2011), states different kinds of eating noted in the individuals such as comfort eating, out of control eating, stress eating, boredom eating, mindless eating and vicious cycle. The examples of all the different kinds of eatings is provided in the next slide. Continue…

types of Eating & Obesity The different kinds of eating are described below with the examples. Out of Control Eating: Comfort eating: People turn to food when they are sad, nervous, stressed out, lonely, tired and bored ( Pretlow, 2011). Stress Eating; Stress eating shows that people eat excesively when they are under stress. The following examples explains the best. Boredom eating: Eating out of boredom. Participants eat excessively when they are bored and need something to nibble to spend their time. Mindless eating shows excessive eating and the participants are not conscious regarding their eating habits. Vicious cycle is explained below. 1) Out of control eating; example as below a) God I can’t stop eating, this is so retard ( female, age 16, 5’4”, 216lbs) b) Sweets, pop, anything junk food. I seem to get drawn to it like a fly to a light .It’s really hurting my self esteem. (female, age 15, 5’0”, 155 lbs) 2) Comfort Eating: examples as below a) evertime i think about my dead grandma i go to food for comfort. (female, age 13, 5’7”, 223 lbs) b) My mum and dad are divorced so I comfort eat. (male, age 12, 5’1”, 165 lbs) 3) Stress Eating: examples as below, a) I eat when i am stressed out or depressed . . . its soo hard for me. (female, age 14, 5’4”, 189 lbs) b) I was stressing out big time about my exams . . . i had the biggest binge ever. (female, age 16, 5’8”, 171 lbs) 4) Boredom Eating: examples as below, a) I eat junk whenever I’m bored. (female, age 14, 5’4”, 153 lbs) b) I eat when im bored to and im not even hungry. (female, age 17, 5’3”, 225 lbs) Mindless Eating: The participants responded that they mindlessly eat and later on they realized that they have eaten too much. Vicious cycle: Many of those who posted were trapped in a vicious cycle, where they ate to ease the pain and stress of being obese itself: a) I am unhappy because I eat I eat cause I am unhappy. (female, age 12, 5’3”, 145 lbs) b) Every time I’m stressed I eat and my weight is making me stressed. (female, age 14, 5’6”, 171 lbs)

DSM-IV Substance Dependence .CRITERIA. Pretlow (2011), uses the DSM-IV scale of addiction criteria by the American Psychological Association, 1994. The criteria are as follows: a) Large amount of substance consumed over a large period b) unsuccessful efforts to cut down. c) continued use despite adverse consequences,. d) tolerance. e) withdrawal and f) neglecting aspects of life in pursuit of the substance. Pretlow (2011), states that the majority of the chat room talk exhibited the point a) large amount of substance consumed over a large period, b) unsuccessful efforts to cut down and c) continued use despite adverse consequences.

Efforts to minimize obesity. O’Connor (2011), proposes some important points in order to promote health eating habits and active lifestyle. 1) Identify the key nutrients that are important to support the growth and development of children. 2) Describe the food groups that make up a healthy, balanced diet. 3)Demonstrate an understanding of the importance of diet and physical activity in maintaining a healthy weight, and the factors involved in the development of childhood obesity. 4) Understand the role of diet in oral health and advise schoolchildren on ways to prevent dental caries O’Connor (2011) also proposes a chart based upon the nutritional guidelines and the amount of calories need for the school going children. The key factor of the chart is to first estimate the amount and requirements needed (O’Connor, 2011). O’ Connor (2011) also states that children should be required to intake health food, balanced diet which consist of fresh fruits and vegetables and some protein rich food and dairy fats. However, the author also emphasizes that low fat version food such as skimmed mild should be recommended).

Techniques to reduce childhood Obesity Wojcicki and Heyman (2012), states that childhood obesity can be reduced by decreasing the consumption of 100% fruit juice. Wojcicki and Heyman (2012) states that according to the National Examination survey data from 1994-2004 shows that preschool children between the age of 2-5 years old consume 10 ounces or more daily on and average. Wojcicki and Hey man (2012) also states that 100% fruit juice is not a complete fruit juice as it contains 0 gram of fibre, 13 grams of sugar for 60 calories. Similarly 100% grape juice contains 20 grams of sugar per fluid ounces. We all have duly noted this when we check the calorie list listed on the fruit juices while purchasing it from the market store.

Treating Obesity right from Pregnancy Baker (2011), states that by developing pathways of care right from the pregnancy level can help to minimize the risk of childhood obesity. Baker (2011) state suggest several stages that should be incorporated during pregnancy. The stages are Pregnancy phase Post-natal phase I Post-natal phase II and Toddler obesity prevention strategies. Please refer to the next slides for the strategic planning for each stages as stated by Baker (2011).

Cont.. Pregnancy Phase: a) Reduce weight gain b) Promote breast feeding c) Promote Healthy lifestyle d) Promote Healthy start. Post-natal Phase I a) Post-natal weight reduction b) Breast-feeding support. c) Preparation for weaning Phases continue….

Cont.. Post-natal Phase 2: a) Weaning b) Active Play c) Parenting skills d) Parental role e) Signposting f) Promote Healthy lifestyle Toddler Obesity Prevention Services a) Services such as early years settings and promoting healthy exercise nutrition for the really young also known as Henry.

Effects on Global Health Childhood obesity, lack of nutrition and overweight greatly affect the health care system globally. We read in the above slides how childhood obesity can be associated with various systemic and metabolic disease. If childhood obesity issues remain to continue than the coming generation will be at a much greater risk. Improper food, improper nutrition and obesity results in wide endemic spread of various metabolic diseases and thereby increasing the mortality rates. The resultant cause of obesity leads to increased in the cost of health care, decrease in the economy, decrease in the life span and is really cost-effective.

Conclusion Childhood interventions and prevention of obesity is a very necessary factor which requires reformation on a global aspect. Obesity today is a leading factor of unstable economy and increased in the health care cost. Proper education regarding nutrition, promoting health lifestyles and knowledge regarding food should be propagated globally. Restrictions should be placed on mouth-watering junk food ads shown on the television which leads to increased in the consumption of this junk foods in teenage, childhood and adults. Promoting healthy lifestyle should be a global goal and should be promoted through workshops, onsite seminars, pre-natal educations, live media, school sites, brochures and by health care personals. Thank You.

REFERENCES Baker, J. (2011). Developing a care pathway for obese women in pregnancy and beyond. British Journal Of Midwifery, 19(10), 632-643. Eriksson, J.G., Forsen,T., Tuomilehto, J., Winter, P.D., Osmond, C., Barker, D.JP., (1999). Catch-up growth in childhood and death from coronary: longitudinal study, Brit Med J 318: 427-431 Forsen, T., Erikkson , J., Tuomilehto, J., Reunanen, A., Osmond, C., Barker, D.JP., (2000). The fetal and childhood growth of persons who develop type 2 diabetes. Ann Intern Med 133: 176–182. Grimes, C.A., Ridell, L.J., Campbell, K.J., & Nowson, C.A., (2013). Dietary Salt-Intake, Sugar-Sweetened Beverage Consumption, and Obesity Risk. Pediatrics, 131(1), 14-21.

REFERENCES Montoye, A. H., Pfeiffer, K. A., Alaimo, K., Hayes Betz, ,., Paek, H., Carlson, J. J., & Eisenmann, J. C. (2013). Junk Food Consumption and Screen Time: Association With Childhood Adiposity. American Journal Of Health Behavior, 37(3), 395-403. Ong, K.K., Ahmed, M.L., Emmett, P.M., Preece, M.A., Dunger, D.B., (2000). Association between postnatal catch-up growth and obesity in childhood: prospective cohort study. Brit Med J 320: 967-971. Obesity prevalence among low-income, preschool-aged children - new york city and los angeles county, 2003-2011. (2013). MMWR: Morbidity & Mortality Weekly Report, 6217-22.

REFERENCES Oddy, W. H. (2012). Infant feeding and obesity risk in the child. Breastfeeding Review, 20(2), 7-12. O'Connor, A. (2011). Promoting healthy eating and an active lifestyle in schoolchildren. Nursing Standard, 25(48), 48-56. Pretlow, R. A. (2011). Addiction to Highly Pleasurable Food as a Cause of the Childhood Obesity Epidemic: A Qualitative Internet Study. Eating Disorders, 19(4), 295-307. Pocock, M., Trivedi, D., Wills, W., Bunn, F., Magnusson, J. (2010). Parental perceptions regarding healthy behaviours for preventing overweight and obesity in young children: a systematic review of qualitative studies. Obes Rev, 11:338-353

REFERENCES Stewart, L., Liu, Y., & Rodriguez, E. (2012). Maternal unemployment and childhood overweight: is there a relationship?. Journal Of Epidemiology & Community Health, 66(7), 641-646. Singhal, A., Lanigan, J., (2007). Breastfeeding, early growth and later obesity. Obesity Rev 8: 51054. Wojcicki, J. M., & Heyman, M. B. (2012). Reducing Childhood Obesity by Eliminating 100% Fruit Juice. American Journal Of Public Health, 102(9), 1630-1633. Yang, Q., Zhang, Z., Kuklina, E.V., Fang, J., Ayala, C., Hong, Y., Loustalot, F., Dai, S., Gunn, J.P., Tian, N., Cogwell, M.E., & Merritt, R., (2012). Pediatrics, 130(4), 611-619.

GOOD LUCK TO ALL THE END.