Childhood Obesity Introduction Obesity is caused by various unhealthy lifestyle habits, such as poor dieting and lack of physical activity, but obesity in children is a social problem because the behaviors of children are influenced by their social settings, including families, schools, and communities. Obesity needs to be prevented because it is associated with both immediate negative effects (e.g. risk factors for cardiovascular disorders, prediabetes, joint disorders, and social stigmatization) and long-term negative health effects (e.g. type 2 diabetes, stroke, cancer, osteoarthritis, heart disease, etc.) (Centers for Disease Control and Prevention, 2014). Childhood obesity is relevant to the sociology of health and illness because it discusses the relation of health issues to institutions such as family and school, which are the key influences on the behavioral development of children. According to the concept of social imagination, each social activity or problem can be observed through multiple dimensions. In the context of childhood obesity, the analysis of the problem can consider the impact of the family, community, and school on the development of unhealthy lifestyle behaviors and obesity. However, it is difficult to isolate a single dimension of the problem because all of those institutions simultaneously affect the children’s behavioral development. Therefore, the research question is, “How do schools, neighborhood environments, and parents contribute to childhood obesity and how influencing those factors could contribute to obesity management?” Literature Review The community environment can determine childhood obesity by shaping the dieting habits of the local population. Li, Harmer, Cardinal, Bosworth, and Johnson-Shelton (2009) found that 38.2% of the participants (n = 1,221) who lived in areas with high fast food restaurant density were obese. Furthermore, 24% of the residents reported visiting fast food restaurants at least once per week while 72% of them reported eating fried foods up to 23 times per week (Li et al., 2009). Overall, residents living in communities that have a high density of fast food restaurants have higher obesity rates than residents who live in areas with a low density of fast food restaurants (Li et al., 2009). Although the population of the study by Li et al. (2009) included adults between 50 and 70 years of age, adults are the main providers for children, and their eating habits will eventually be adopted by their children. Schools can contribute to childhood obesity if they do not offer adequate food programs, a physical activity curriculum, or health education to their students (Veugelers & Fitzgerald, 2005). An example of an environmental influence on obesity found in the school system is the presence of vending machines that distribute artificially-sweetened beverages, which have been associated with increases in body mass index (BMI), even though the children reported up to 2 hours of moderate or rigorous activity (Ludwig, Peterson, & Gortmaker, 2001). A school-based intervention program that educated children about the health benefits of choosing water over artificially-sweetened beverages showed that educating children about health can prevent weight gain by encouraging students to make better lifestyle choices (James, Thomas, Cavan, & Kerr, 2004). Other factors within schools that can determine childhood obesity if not properly regulated and provided to the students include health education, health services, school food services, physical education, and health promotion (Story, 1999). Parents can have a significant impact on childhood obesity because they are the children’s providers and behavioral role models. Several factors can determine the eating habits of the family, but two factors have been identified as the most important ones. First, low socioeconomic status was also reported as a potential predictor for the family’s eating habits because families with low income and without continuing education were more likely to eat at buffets and shop at convenience stores, which may encourage overeating (Casey et al., 2008). Second, poor parenting strategies can result in childhood obesity while parenting strategies that reinforce healthy behaviors and set examples of healthy behaviors for the children can improve weight management in children and reduce the prevalence of obesity (West, Sanders, Cleghorn, & Davies, 2010). Research on the topic of childhood obesity appears to be consistent, and there are few contradictions within the literature exploring the impact of the community, family, and school on childhood obesity. All three sources of influence can increase the chances for obesity if they do not promote the development of positive, healthy behaviors. Although there is still room for improving obesity prevention programs, all studies reported positive effects on obesity reduction when children were exposed to health education, better nutrition, and positive parenting strategies. Data and Methods The importance of creating school-based programs (e.g. health education and nutritional programs) to minimize the obesity rates among children has been supported by several researchers (Story, 1999; James et al., 2004; Veugelers & Fitzgerald, 2005). The meta-review by Story (1999) analyzed 12 studies and found that 11 of those studies reported reduced obesity rates among students. A significant emphasis needs to be placed on reducing artificiallysweetened beverage intake because the energy intake exceeds the amount of output (Ludwig et al., 2001; James et al., 2004). However, data collection strategies are a significant limitation in the studies on obesity because behaviors need to be reported by the participants. Even though the sample sizes of 5,200 children (Veugelers & Fitzgerald, 2005), 644 children (James et al., 2004), and 548 children (Ludwig et al., 2001) provide adequate power to the statistical analyses, the only objectively collected data was the BMI measure at baseline and follow-up. The data collected about the diet and physical activity habits was self-reported and subject to error, which means that those studies cannot be used to identify causal relationships. The role of parents in shaping their children’s healthy behaviors also needs to be addressed because parenting strategies (e.g. reinforcing healthy behaviors, setting examples through personal nutrition habits, etc.) can determine childhood obesity by affecting their behaviors (West et al., 2010). The study by West et al. (2010) contained 101 families, which is an adequate sample size, and the data collection strategies relied on standardized instruments (Lifestyle Behavior Checklist, Parenting Scale, and Session Content Checklists) with high test-retest reliability, which increases the internal validity of the study. Although there is a high correlation between fast food restaurant density and community-level obesity, the research designs used to investigate the issue do not allow the researchers to make conclusions about causal relationships. The study by Li et al. (2009) contained 1,221 participants, which is a significant sample size, but because of the cross-sectional nature of the study, they were unable to establish causal relationship between fast food availability in the community and obesity rates. The study by Casey et al. (2008) was a large, multisite study that included 1,258 participants from 12 rural areas, but despite the large sample size, the crosssectional design cannot be used to for causal inferences. However, both studies pointed out that community environments (e.g. fast food availability, lack of supportive resources for physical activity, etc.), which means that those influences warrant further longitudinal studies. Theory Functionalism is the best theory that can be used to explain childhood obesity because it considers that social problems occur when a part of society is dysfunctional. Therefore, the problem of childhood obesity occurs because institutions that influence the behavioral development of the children do not support healthy lifestyles. Symbolic interactionism cannot be used to explain the problem of childhood obesity because it focuses more on personal reasons and triggers behind actions than on the process of learning behaviors that lead to obesity. Conflict theory could potentially explain the development of childhood obesity because communities with higher levels of poverty could have less access to schools with good obesity prevention programs and physical activity centers, but that explanation would be incomplete because it would not account for the influence of parenting strategies on obesity development. Conclusion The impact of the community, family, and school on childhood obesity development has been extensively studied, and while it is impossible to isolate one of those factors as the major cause of obesity, they all contribute to the development of lifestyle behaviors that may result in obesity. However, more longitudinal studies are needed to observe the influences on healthy behaviors of children to determine the causal relationships between those influences and obesity. At the moment, various schools have implemented nutrition and health education programs to regulate obesity rats among children, but those programs also need to be combined with communitybased interventions (e.g. reducing the density of fast food outlets, providing physical activity recreation resources, primary healthcare interventions) to improve results. Finally, interventions aimed at resolving obesity in children also need to target parental behaviors and parenting strategies to improve outcomes and reduce childhood obesity. References Casey, A. A., Elliott, M., Glanz, K., Haire-Joshu, D., Lovegreen, S. L., Saelens, B. E., Sallis, J. F., & Brownson, R. C. (2008). Impact of the food environment and physical activity environment on behaviors and weight status in rural U.S. communities. Preventive Medicine, 47(6), 600-604. doi:10.1016/j.ypmed.2008.10.001 Centers for Disease Control and Prevention. (2014). Childhood obesity facts. Retrieved from http://www.cdc.gov/healthyyouth/obesity/facts.htm James, J., Thomas, P., Cavan, D., & Kerr, D. (2004). Preventing childhood obesity by reducing consumption of carbonated drinks: Cluster randomised controlled trial. British Medical Journal, 328(7450), 1237-1239. Li, F., Harmer, P., Cardinal, B. J., Bosworth, M., & Johnson-Shelton, D. (2009). Obesity and the built environment: does the density of neighborhood fast-food outlets matter? American Journal of Health Promotion, 23(3), 203-209. Ludwig, D. S., Peterson, K. E., & Gortmaker, S. L. (2001). Relation between consumption of sugar-sweetened drinks and childhood obesity: A prospective, observational analysis. The Lancet, 357(9255), 505-508. Story, M. (1999). School-based approaches for preventing and treating obesity. International Journal of Obesity & Related Metabolic Disorders, 23. Veugelers, P. J., & Fitzgerald, A. L. (2005). Effectiveness of school programs in preventing childhood obesity: A multilevel comparison. American Journal of Public Health, 95(3), 432-435. West, F., Sanders, M. R., Cleghorn, G. J., & Davies, P. S. (2010). Randomised clinical trial of a family-based lifestyle intervention for childhood obesity involving parents as the exclusive agents of change. Behaviour Research and Therapy, 48(12), 1170-1179.
