HW

Introduction

Obesity has been an increasingly worldwide epidemic, that has brought many researchers to look at many factors that contribute to obesity and diabetes. What is obesity? Obesity is a condition of chronic nutrient overload. Many health problems such as diabetes are known to be linked to obesity. Obesity is affecting individuals worldwide and it is very crucial to bring forth awareness when trying to address such an issue. It is stated by the National Institutes of health that 1 in 6 American children between the ages of 2-19 are diagnosed as obese (National Institutes of Health, 2012). Aside from genetic factors, which an individual does not have so much control over, there are many lifestyle changes an individual can make to reduce their risk of becoming obese. One of the most important lifestyle changes that we do have control over is physical activity. Children need to be educated on the  importance of daily physical activity at a young age in order to be able to understand how the body reacts when there is a lack of physical activity and its long term effect.

Another important factor that contributes to obesity is the amount of sugar that the body consumes. This has brought many researcher interest in determining how much of an influence it has on obesity. It is sometimes difficult for an individual to keep track of their daily sugar consumption. There are food regulations that are put into place whether it is in schools or on the market,  to help and guide individuals into choosing the healthier choice of meals, however, these regulations do not always have a positive impact.

As a strategic planning committee we researched the factors contributing to obesity and its long term effects on students ages 9-17 and we will be making a recommendation on a  position Health Maintenance Organizations should be taking due to our findings.

Research Question

What are the factors contributing to obesity of students ages 9-17 and its long term effect?

Methods

Resources Used

        Our peer reviewed articles were found by using Google Scholar, PsycINFO and Csun OneSearch. In addition to the peer reviewed articles, we also used the National Institute of Health to further our research findings. We used these search engines to the best of our knowledge and by taking the course HSCI 391 it helped in the search for narrowing down to our main focus.The main focus was to locate articles that would suggest the factors contributing to obesity and its long term effect on preadolescent and adolescent children. The following keywords were used, “ obesity”, “sugar intake”, “regulations”, “physical activity”, “adolescence” and “long-term”. Our first method was going into Csun’s very own OneSearch tool to start our research process. One of the things we had trouble with was narrowing down the articles that had the full text available to us instead of just an abstract page. Another issue we encountered was when we searched “ long-term effects of obesity” in OneSearch, we did not see the results we were hoping to find. Once we read through the article we felt like it did not fully answer our research question. We were able to retrieve at least four articles from the experience. Using google scholar, we were able to find articles that would answer our research question. As we all agreed, Google Scholar was one of the most useful resource when it came to finding statistics on the amount of sugar that is consumed by students ages 9-17. In order to not get such outdated articles, we had to customize the year of the articles between 2008-2015.

        We initially tried to look for articles that gave us some statistic on how much sugar is being provided to  children during their breakfast and lunch meals in school. One article that seemed to be what we were looking for, unfortunately, we did not have access to it unless we purchased the research study. From there on we started looking into articles that gave us statistics on how much sugar does an average individual intake compared to what health experts say is the reasonable amount. We did not only limit ourselves to research obesity in the United States being that obesity is a worldwide issue, we allowed our research to expand to places such as Taiwan and Saudi Arabia. We were able to find these articles through Google Scholar as well. When it came to finding information for obesity and physical activity it was fairly easy and the information was relevant to our research question. PsycINFO gave us better results to work with when we  narrowed our search down by using keywords such as obesity and lack of physical activity. And to make sure we used peer reviewed articles, we marked peer reviewed section to find our articles. Lastly, we had a great experience with using National Institute of Health. One of many things we liked about this website was that once we searched about a specific topic it automatically gave us a section of “related topics”  on the right hand side to further our search and find answers to our research question.

Analysis Strategy

We organized and  analyzed our data by using the matrix table and identifying the authors, the year the article was published, sample characteristics, study design, main findings, and finally conclusions/comments. As each group member contributed 3-4 articles to the table, this strategy was useful because once the information was put into the matrix table, we were able to understand how much of our findings agreed or disagreed with each other.

Results

We had a total of 12 peer reviewed articles, one governmental website (NIH)  and excluded 3 articles because one focused more on the obesity prevalence among adults rather than childhood obesity, excluded an article because the title did not fit our research criteria, and excluded another because of access. The articles that our group found consisted of the average age group range between 8-17 years old. The articles also included a sample size bigger than 300 participants. Although we had two articles that looked at childhood obesity outside of the United States, most of the studies conducted and information gathered for our research articles mainly focused on children and adolescents in the United States and the District of Columbia.

After putting together our findings, there were a couple different common factors between the articles we used. We learned that there is not just one contributing factor to obesity, but rather there are many factors that lead to obesity. The two main factors that were most frequently discussed in our articles were: lack of physical activity and dietary choices, which included sugar intake. Throughout our search for information, it was mentioned in several articles that the lack of physical activity, the higher the rate of obesity in children. Each of the articles found tended to agree with one another and we noticed a pattern to the information; the data we incorporated into answering our research question all agreed and emphasized the importance of limiting sugar intake, eating healthier foods and participating in consistent physical activity. Although sugar intake and physical activity are the primary causes to the obesity and diabetes epidemic, we have discussed our other findings and results and separated them in the themes as follows:

Theme 1: Physical Activity

        The articles that were found for physical activity and obesity all included a common feature that showed children who are obese are less likely to participate in a 60-minute daily physical activity ( Hulst, A. et. al., 2015) The lack of physical activity plays a major role, and is impacted to cause type 2 diabetes in youth. (Kriska, A. et. al., 2013). Furthermore, it was discussed that boys spent more time playing seated video games, greater total sedentary screen time, and greater caloric intake and percentage of caloric intake in carbohydrates compared to girls (Goldfield, G. et.al., 2012) Indicating that more time that is spent indoors results in less time spent participating in outdoor activities.  These articles have shown that without physical activity the rise of obesity will just continue and that there needs to be physical activity incorporated in the children’s daily lifestyle.

Theme 2: Sugar Consumption

When it came to  researching on sugar consumption, two of the articles indicated  males consumed more sugar drink than females (Ogden, C. et al, 2011). These sugar drinks include fruit drinks, sodas, energy drinks, sports drinks, etc. What was interesting to find was that more than one-half of sugar-drink are consumed in the home (Ogden, C. et al, 2011). Males ages 12-19 showed to consume 273 Kilocalories from sugar drinks on any given day, while females within the same age consumed 171 kilocalories on any given day (Ogden, C. et al, 2011).  These articles showed that boys having a higher obesity rate than girls and was positively correlated with sugar-sweetened carbonated beverage (SSCB) intake in boys only (Collison, K. et al, 2010). This also resulted in both boys and girls showing less frequency of exercise. In addition, one of the articles did find  that when  nutrition education intervention where available in schools, children increased the intake of fruits as substitutes for the purchase of sugar-sweetened beverages (Liou, Y. et al, 2015) This article did not state if this decreased obesity rates in that particular school. It was clear to say that all three articles concluded that teenagers and young adults consume more sugar than other age groups.

Theme 3: Long-Term Effects of Obesity

Many health problems are known to be linked to obesity and are not limited to, type 2 diabetes, cardiovascular disease, blood pressure and overall quality of life. One of the articles stated that not only can obesity cause health problems, it can social and psychological problems later in life ( Waters, E. et al, 2011).  The importance of intervention and prevention of obesity can be seen in a number of studies. In particular, a 5 year study conducted research to see if 1- year of lifestyle intervention in obese children had any long-term outcomes. The results indicated that younger age children, after participating in the intervention, had the best long term outcome with a decrease in BMI (Reinehr, T. et al, 2010). Another article that had similar results showing that children who were at risk of being obese, received intervention at an early age had a lower BMI at age 4 and improved health behavior as they approached adolescence (Brotman, L. et al, 2012).  This shows how important it is to educate children at a young age and programs and interventions do make a difference.

Theme 4: Implementation of Food Regulations

Since the rise in prevalence of obesity and diabetes, there have been a variety of different initiatives and research conducted to not only identify what the cause of this epidemic is but to find a way to decrease its prevalence. According to BioMed Central Public Health, “associations between dietary intake and obesity have been examined in numerous studies. Intake of sugar sweetened beverages and high fructose corn syrup may be contributors to the obesity epidemic, as the increases in consumption show a pattern consistent with the rise in obesity” (Benjamin, et al, 2008). A study done by the American School Health Association found that, “most states (58%) and the majority of school districts (61%) permit the sale of competitive foods and beverages, which are neither regulated by federal nutrition guidelines nor likely to conform to nutrient intake recommendations.” (Bevans, et al, 2010). In this time and age, children are more prone to desiring these “calorie-dense and nutrient deprived foods” and by making them accessible in schools leads to a much higher potential to develop obesity or diabetes (Sharma, Teret, Brownell, 2010). There needed to be some sort of intervention of the widespread of this disease and it would not being taken lightly.

The Obama Administration developed the Healthy, Hunger Free Kids Act (HHFKA) of 2010, which was publicly promoted by the first lady, herself, Michelle Obama. The purpose of the act was to implement healthier school meals K through 12th grade, that followed the standards set by the Food and Nutrition Service and United States Department of Agriculture, in cafeterias across the country and to encourage children to get active. However, the program received much criticism and comments towards the implementation of the plan and revising or delaying the efforts was suggested by commenters. The National Register of Nutrition Standards in the National School Lunch and School Breakfast Programs stated that, “a number of commenters suggested that USDA conduct additional research or pilot test the proposed changes before implementation” (National Archives and Records Administration, 2012). Concerns of the cost of the program, implementation time, student participation in meal plans, and potential food waste were all brought to light and revisions were made to the program. This program was a great way to address the issue at hand, the increasing occurrence of obesity and diabetes that is, but unfortunately was not as effective as originally projected. Establishing and mandating food regulation standards are a key factor in reducing the obesity prevalence rate and more awareness of the issue and education on the topic need to be shared with the public.

Discussion

Overview of main findings:

Of the information gathered from our peer reviewed articles, National Institutes of Health website, and the National Archives and Records Administration’s Federal Register on the Health, Hunger-Free Kids document we were able to sufficiently answer our research question. Obesity and diabetes are a growing threat to our nation’s and the world’s child and adolescent population, however, there are lifestyle changes and governmental regulation changes that can make a dramatic impact on decreasing their occurrence. Overall, our main findings concluded that without physical activity and limitation of sugar intake can lead to obesity thus also leading to health problems in the future with long term effects. In addition, the government should take initiative and implement an effective standard for food that will not only encourage children and adolescents to eat healthier foods but protect them from nutrient poor and sugar filled food products.

Research Gaps:

We did encounter a few research gaps while conducting our research and putting together our findings. For example, there was only one article that we found that related to sugar consumption in schools. This was initially the research we wanted to find. As well finding articles discussing the actual regulation standards of school lunches (ie. amount of fruits and vegetables recommended per meal). This was information that would have been very advantageous for our group to obtain because of our research topic. It would have been interesting to see the comparison of what is recommended and what is actually being served. In addition, another research gap that we encountered was not being able to find research that explains how lack of parents physical activity and nutrition lifestyle affects the child in the household. We were curious to know how the effects of obesity starts at home and what parents can change in order to prevent obesity. Lastly, one of the biggest obstacles in finding relevant articles for our research was definitely access. Many of the articles found that could have greatly contributed to answering our research question either needed to be purchased or needed a subscription to the journal or website the article was published in.

Conclusion

In conclusion, our group found the four factors that contribute to obesity, our results for this was lack of physical activity, excessive amount of sugar consumption and the lack programs that promote healthy eating and the lack of successful implementation of food regulations. Obesity is a worldwide growing epidemic that needs to be address. Based on our findings of lack of health promotion, HMO’s need to lend a helping hand and contribute to the prevention of obesity and promote healthy behaviors.  One strategy is by having intervention programs that include diet, nutrition and exercise programs for children and their families. This results in being more proactive than reactive when it comes to obesity or overall health.  

References

Goldfield, G.S., Suanders, T.J., Kenny, G.P., Hadjyannakis, S., Phillips, P., Alberga, A.S., Tremblay, M.S., Sigal, R.S., (2012). Screen viewing and diabetes risk factors in overweight and obese adolescents. American Journal of Preventative Medicine, 44, s364-s370.

Kriska, A., Delahanty, L., Edelstein, S., Amodei, N., Chadwick, J., Copeland, K., Galvin, B., El

ghormli, L., Haymond, M., Kelsey, M., Lassiter, C., Mayer-Davis, E., Milaszewski, K., Syme, A. (2013). Sedentary behavior and physical activity in youth with recent onset of type 2 diabetes. Official Journal of the American Academy of Pediatrics, 131. e850 –e856.

Van Hulst, A., Roy-Gagnon, M. Gauvin, L., Kestens, Y., Henderson, M., Barnnett, T.A. (2015).  Identifying risk profiles for childhood obesity using recursive partitioning based on individual, familial, and neighborhood environment factors. International Journal of Behavioral Nutrition and Physical Activity, 12.

Collison, S., Kate., Zaidi, Z.,  Marya, Subhani, N., Shazia., Al-Rubean, Khalid., Shoukri, Mohammed., & Al- Mohanna, A., Futwan. (2010). Sugar-sweetened carbonated beverage consumption correlates with BMI, waist circumference, and poor dietary choices in school children. BMC Public Health. doi:10.1186/1471-2458-10-234