Childhood Obesity (14) - Government legislation

The government should encourage the academia to conduct more research projects on junk food addiction by providing more research funding. The results of these research projects can give solid foundation to the Legislature for enacting appropriate laws against junk food by mirroring what is currently being done on tobacco products, for example, taxing junk food, labeling junk food as hazardous to one’s health, and limiting children’s access to junk food.

Childhood Obesity (13) - Implement successful programs

The Ministry of Education should research and study programs that have been tried and became successful in other places. For example, the “TAKE 10!” program (Peregrin, 2001), launched in 2001, has been implemented by at least 16 states and 238 schools with amazing successful results. One successful example is that the city of Philadelphia, once labeled as “America’s fattest city”, after implementing the “TAKE 10!” program, has become one of the healthiest cities in the U.S.

Reference
Peregrin, T. (2001). TAKE 10! Classroom-Based Program Fights Obesity by Getting Kids Out of Their Seats. Journal of the American Dietetic Association, 101(12):1409-1411, 2001.

Childhood Obesity (12) - Health Education and Physical Education

Teaching healthy eating habits should itself be a subject in the Elementary Curriculum, independent of the current “Health and Physical Education” subject.

This is the joint responsibility of the Ministry of Education and Health Canada for both developing the contents of the subject as well as administering the subject. This will give the “Health” aspect and the “Physical Education” aspect more emphasis in terms of more allotted time for educating our children its importance to healthy living.

Childhood Obesity (11) - Update the curricula

The current curriculum was written in 1998. It’s time to update the curriculum so that it can reflect more closely to the current thoughts on and approaches of combating the prevalence of childhood obesity.

One obvious aspect in the curriculum to be updated is: The current stipulation by the Ministry of Education in the Elementary Curriculum that a minimum of 20 minutes each day is far from the recommended time of at least 60 minutes each day by the World Health Organization. This is the responsibility of the Ministry of Education, which should also place a closer monitoring on the implementation details, such as “each day” really is “each day”, not “each day on the average.”

The Ministry of Education should also update the curriculum for high school to make the subjects of “Physical Education” and “Healthy Living” mandatory throughout all grades in high school. The current curriculum allows students to drop out of “Health and Physical Education” starting grade 10. It is unacceptable because we need to convey the message to our children that physically active and eating healthy are life-long commitments.

Childhood Obesity (10) - Recommendations

As the President of Ontario Medical Association Dr. Greg Flynn puts it, “Our children are a precious resource – we must take action to ensure they can live long and healthy lives.” (OMA, 2005b). What can be done to fight the prevalence of childhood obesity epidemic? In a word: Education.

We have to start educating our children when they were young. We have to educate them in both being physically active and eating responsibly. In order to achieve them, both curricula as well as government legislations will have to be updated accordingly.

Reference
OMA (2005b). “Doctors Fear Ontario Children May Not Live as Long as their Parents”. Ontario Medical Association. http:www.oma.org/media/news/pr051005.asp

Childhood Obesity (9) - Tax on junk food

As we all know, smoking is hazardous to our health. People who smoke will very likely develop health problems that will put a burden on our medical resources. And that is why the government levies a heavy tax on tobacco products.

Food that is high in calories but low in nutrients is labeled as junk food, which, in fact, is hazardous to health. One can use a similar argument that junk food will very likely induce its consumers to become obese, which in turn will induce developing other health related problems such as diabetes, heart diseases, and breathing problems, among others. This will put a heavy load on our medical system. We should put a tax on junk food, just as we tax tobacco products. However, before we can put the teeth to the Legislature, the academics need to conduct more research because currently food addition research is inconclusive (IDDBA, 2004). Several states in the U.S. have introduced bills to add a tax of between 0.25% and 6% to snack foods, but most such bills have had a hard time receiving legislature passing (Tatge, 2004).

Reference
IDDBA (2004). “Obesity: A Growing Problem with Growing Solutions.” International Dairy Deli Bakery Association. http://www.iddba.org/
Tatge, M. (2004). “Get ready for the Twinkie Tax.” Forbes, February 16, 2004.

Childhood Obesity (8) - Healthy eating

Currently the curriculum-stipulated 20 minutes are for the subject of “Health and Physical Education,” which comprises of two distinct components, namely, physical activity and learning make healthy food choice. The Ministry of Education should seriously consider splitting the topics covered in this subject into two distinct subjects: One for physical education and the other for healthy eating. We should start educating our children when they are young how to make healthy food choices and nurture good eating habits. Eating Well with Canada’s Food Guide, released in 2007, provides guidance on the amount of food for adults, teens and children. The Guide also includes information on the quality of food choices for healthy eating such as the type of fat, the total energy content of foods (Bush et al., 2007).

Children tend to remember things they see and hear often. If they are bombarded by the same (and correct) message, hopefully they will remember it well for the rest of their lives. Thus, the emphasis on eating healthy should be repetitive across all grades.

Reference
Bush, M. A. A., et al. (2007). Eating Well with Canada’s Food Guide: “A Tool for the Times.” Canadian Journal of Dietetic Practice and Research, 68(2):92-96. 2007.

Childhood Obesity (7) - Physical activity

The World Health Organization recommends that “at least 60 minutes of regular, moderate- to vigorous-intensity each day” (WHO, 2008b). From the current Elementary Curriculum, a stipulation of “a minimum of twenty minutes each day of vigorous physical activity pales far below the World Health Organization’s recommendation. It is not seem enough, nor has it been followed coherently by school’s curricular administrators. The minimum time should be increased to 60 minutes, as recommended by the World Health Organization. In addition, the “each day” stipulation has not been adhered to constantly.
A study showed that children of low-income families face more obstacles than their peers of middle- and upper-income families even if they want to participate in more physical activities such as lack of transportation, cost of equipment and fees for certain sports (Evers et al., 2007). The government should consider providing more funding to schools in low-income communities so that such schools can purchase sports equipment, perhaps used ones, so that children can play sports after school. School boards should also schedule school buses that run later so that children can have a viable means to get home after finishing after-school physical activities.

Reference
WHO (2008b). “What can be done to fight the childhood obesity epidemic?” World Health Organization. http://www.who.int/dietphysicalactivity/childhood_what_can_be_done/en/.
Evers, S., et al. (2007). Persistence of Overweight among Young Children Living in Low Income Communities in Ontario. Journal of the American College of Nutrition, 26(3):219-224, 2007.

Childhood Obesity (6) - The Ontario curricula

The website of the Ontario Ministry of Education lists Health and Physical Education as one of its curricular subjects in both elementary and secondary curricula (Ministry of Education, 2008). It has been noted that the elementary curriculum was dated in 1998 whereas the secondary curriculum was dated in 1999.

Both the Elementary Curriculum and the Secondary Curriculum state that the goals of the subject of health and physical education are to help students develop
· an understanding of the importance of physical fitness, health, and well-being and the factors that contribute to them;
· a personal commitment to daily vigorous physical activity and positive healthy behaviours;
· the basic movement skills they require to participate in physical activities throughout their lives. (Ministry of Education, 1998, p.2; 1999, p.2).

The Elementary Curriculum of Health and Physical Education consists of three strands: physical activity, active living, and healthy living. And the Secondary Curriculum adds an additional strand: living skills.

However, the subject of Physical Education is only mandatory for grade 9 students, but is optional for students of grade 10 to 12. This is not enough, and this may send the wrong message to students that after grade 9, physical activity is an optional thing in life. We certainly do not want our students to get that impression. We need to convey the message that a physically active healthy living is a life-time commitment.

Reference
Ministry of Education (1998). The Ontario Curriculum Grades 1-8: Health and Physical Education. Toronto: Queen’s Printer for Ontario.
Ministry of Education (1999). The Ontario Curriculum Grades 9 and 10: Health and Physical Education. Toronto: Queen’s Printer for Ontario.

Childhood Obesity (5) - Causes of obesity

While some rare genetic conditions may cause obesity, obesity is generally caused by not making the correct choices in lifestyle. Obesity can occur when calories intake is greater than calories consumption, resulting a positive balance of calories retained in the body. Thus, the equation of obesity:
Retention of calories = Intake of calories – Consumption of calories

From the above equation, obesity is directly proportional to the amount of retention of calories in the body. Hence, it is easy to see that to reduce the chance of becoming obese is either to reduce the intake of calories, or to increase the consumption of calories, or both. To reduce the number of obese children, we need to start tweaking the above equation with children at schools.

We have to teach children at a young age to know the importance of reducing calories intake on the one hand, and the importance of physical exercises regularly on the other. However, Starky (2005) found that the availability of nutritional food choices in schools is of poor choices. A regular school day is usually of “low levels of physical activity, high participation in sedentary activities” (Hanning et al., 2007).

Reference
Starky, S. (2005). The Obesity Epidemic in Canada. Ottawa: Parliamentary Information and Research Services, Economics Division.
Hanning, R. M., et al. (2007). Nutrient Intakes and Food Consumption Pattern Among Ontario Students in Grades Six, Seven, and Eight. Canadian Journal of Public Health. 98(1):12-16. 2007.

Childhood Obesity (4) - Costs of obesity

Obesity can lead to serious health problems. Among other medical problems, the more commonly known ones are cardiovascular diseases, high blood pressure, type 2 diabetes, obstructive sleep apnea and other breathing problems. With more obese children turning into obese adults, they will more likely produce obese children. As a result of this vicious cycle, the economic burden on society increases at an alarming rate.

The Ontario Medical Association report pointed out that studies have shown that there is a 50% chance that the children will also be obese if only one parent is obese, and the chance increase to 80% when both parents are obese, and the report assessed that in 1997, Canada spent more than $1.8 billion on fighting obesity (OMA, 2005a).

This figure just shows the direct costs, which are inputs of resources to fight the direct medical consequences of the problem. However, this problem also carries indirect costs, which are negative outputs, or lack of outputs. As a result, levels of economic productivity are negatively impacted due to poorer health, absenteeism, disability and premature mortality (Starky, 2005).

Reference
OMA (2005a). An Ounce of Prevention or a Ton of Trouble: Is there an epidemic of obesity in children? Ontario Medical Association.
Starky, S. (2005). The Obesity Epidemic in Canada. Ottawa: Parliamentary Information and Research Services, Economics Division.

Childhood Obesity (3) - Overweight and obese

Although it is not the main purpose of this paper to present how overweight and obesity is
determined in the health sciences, yet it will help to lay a better foundation for understanding the issue.

A commonly used metric to classify human body weight is body mass index, or BMI, which is calculated by using the following formula:


where W is the weight in kilograms and H in metres.

The cut-off points are 25 and 30. Adults with a BMI of between 25 and 29.9 are classified as overweight, and 30 and above as obese (CDC, 2008a). However, BMI is calculated differently for children and teens because the amount of body fat differs between boys and girls and changes with age. Hence, BMI for children and teens is often referred to as BMI-for-age. When the BMI-for-age falls within the 85th to less than the 95th percentile, the child is considered to be overweight. When the BMI-for-age is equal to or greater than the 95th percentile, the child is considered to be obese (CDC, 2008b).

Reference
CDC (2008a). Defining Overweight and Obesity. Centers for Disease Control and Prevention. http://www.cdc.gov/nccdphp/dnpa/obesity/defining.htm.
CDC (2008b). About BMI for Children and Teens. Centers for Disease Control and Prevention. http://www.cdc.gov/nccdphp/dnpa/healthyweight/assessing/bmi/childrens_BMI/about_childrens_BMI.htm

Childhood Obesity (2) - The stakeholders

Many people are affected by this problem directly or indirectly. They are all stakeholders. The following lists whom these people are and why they are:

· Students – Obesity affects their health.

· Parents – It’s their children’s health that they are concerned about.

· Teachers – It’s their responsibilities to teach students to live healthy lives.

· Educators – It’s their responsibilities to include the appropriate topics in the curriculum so that teachers can teach them to the students. These people are policy makers in the provincial Ministry of Education.

· School administrators – It’s their responsibilities to make sure that policies are adhered to and curricula are followed closely by school principals and teachers. These people are trustees in school boards.

Childhood Obesity (1) - The issue

The World Health Organization estimated that in 2005 there were approximately 1.6 billion adults were overweight, and at least 400 million adults were obese (WHO, 2006). In 2004, figures from Statistics Canada showed that over 11 million Canadians were overweight or obese (StatCan, 2004). Canada is not alone in facing this problem. Similar trends occur worldwide just like an epidemic. The World Health Organization even coined the term “globesity” to refer to this escalating global epidemic of obesity (WHO, 1997).

This “globesity” apparently has spread from adults to children. The World Health Organization sees that childhood obesity is one of the most serious public health challenges of the 21st century. The problem is not just limited to developed, industrialized countries; it is steadily affecting many low- and middle-income countries. It has become a global issue (WHO, 2008a). In a report issued by the Ontario Medical Association (OMA, 2005a), obesity in Canadian children has increased significantly from 1981 to 1996. During this period, overweight boys increased almost two-fold from 15% to about 29%, while overweight girls increased from 15% to about 24%. In addition, obese Canadian children during the same period increased more than two-fold from 5% to more than 11%.

The figures obtained during this period were usually through self-reported numbers. Subjects of research might tend to over-report or under-report certain anthropometrics, thus making the results less objective. A study (Shields, 2006) is based on measured heights and weights of subjects, which makes the results of the survey more reliable. From this study, 26% of children of age 2 to 17 are overweight or obese, and 8% of children are obese.

These figures are alarming, and even more so, it is on a rising trend. One may ask: Who are affected by the issue? Who are the stakeholders?

References
WHO (1997). Obesity: Preventing and Managing the Global Epidemic. World Health Organization.
WHO (2006). “Obesity and overweight”. World Health Organization. http://www.who.int/mediacentre/factsheets/fs311/en/
WHO (2008a). “Childhood overweight and obesity” World Health Organization, http://www.who.int/dietphysicalactivity/childhood/en/.
OMA (2005a). An Ounce of Prevention or a Ton of Trouble: Is there an epidemic of obesity in children? Ontario Medical Association.
Shields, M. (2006). “Overweight and obesity among children and youth” Health Reports, 17(3):27-42, 2006.
StatCan (2004). Canadian Community Health Survey. Ottawa: Statistics Canada.