STUDENT PSYCHOLOGY JOURNAL VOLUME I
CHILDHOOD OBESITY: CONTRIBUTIONS OF
DEVELOPMENTAL RESEARCH TO INTERVENTIONS
Bridget Finnegan
Graduate 2010, Psychology
finnegb@tcd.ie
ABSTRACT
Childhood obesity is a rising issue entailing both health and economic
consequences. This paper looks to explore developmental research into
childhood obesity with reference to risk factors, protective factors, and the
social implications of overweight. Interventions that draw upon these
factors are discussed limitations in the research are explored.
Interventions that draw upon these factors are critically evaluated.
INTRODUCTION
The prevalence of childhood obesity has doubled over the past few decades
(Davison & Birch, 2001), with 15% of children overweight and 25% at risk
of overweight (Patrick & Nicklas, 2005). Consequences of obesity include
heart disease, sleep apnoea, hypertension, type 2 diabetes, cancer, and
endocrine disorders, the treatment for which could be lifelong and costly
(Lobstein, Baur, & Uauy, 2004). As estimated by the National Taskforce
on Obesity (2005) the subsequent health expenses are €30million annually.
Developmental research can inform policy and practice around obesity.
Factors influencing childhood obesity and suggested interventions
targeting these factors are discussed.
RISK FACTORS AND PROTECTIVE FACTORS
Research has made important contributions to our understanding of the
factors associated with obesity. The ecological model, as described by
Davison & Birch (2001), suggests that child risk factors for obesity include
dietary intake, physical activity and sedentary behaviour. The impact of
such risk factors is moderated by factors such as age, gender. Family
characteristics - parenting style, parents’ lifestyles - also play a role.
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Environmental factors such as school policies, demographics, and parents’
work-related demands further influence eating and activity behaviours.
Patrick and Nicklas’ (2005) review of the literature investigates
factors behind poor diet and offers numerous insights into how parental
factors may impact on obesity in children. They note that children learn
by modelling parents’ and peers’ preferences, intake and willingness to try
new foods. Availability of, and repeated exposure to, healthy foods is key
to developing preferences and can overcome dislike of foods. Mealtime
structure is important with evidence suggesting that families who eat
together consume more healthy foods. Furthermore, eating out or
watching TV while eating is associated with a higher intake of fat.
Parental feeding style is also significant (Birch & Fisher, 1998). The
author’s found that that authoritative feeding (determining which foods
are offered, allowing the child to choose, and providing rationale for
healthy options) is associated with positive cognitions about healthy foods
and healthier intake. Interestingly authoritarian restriction of “junkfood” is associated with increased desire for unhealthy food and higher
weight.
Government and social policies could also potentially promote
healthy behaviour. Research indicates taste, followed by hunger and
price, is the most important factor in adolescents snack choices (Story et
al., 2002). Other studies demonstrate that adolescents associate junk food
with pleasure, independence, and convenience whereas liking healthy food
is considered odd (Chapman & Maclean, 1993). This suggests investment is
required in changing meanings of food, and social perceptions of eating
behaviour. As proposed by the National Taskforce on Obesity (2005),
fiscal policies such as taxing unhealthy options, providing incentives for
the distribution of inexpensive healthy food and investing in convenient
recreational facilities or the aesthetic quality of neighbourhoods can
enhance healthy eating and physical activity.
Another factor which contributes to obesity levels is sedentary
behaviour, such as TV viewing. TV viewing can also impact children in
terms of media effects. Story et al. (2002) discuss research which indicates
the number of hours children spend watching TV correlates with their
consumption of the most advertised goods, including sweetened cereals,
sweets, sweetened beverages, and salty snacks. Despite difficulties in
empirically assessing the media impact, other research discussed
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emphasises that advertising effects should not be underestimated. Media
effects have been found for adolescent aggression and smoking and
formation of unrealistic body ideals. Regulation of marketing for
unhealthy foods is recommended, as is media advocacy to promote
healthy eating.
SOCIAL IMPLICATIONS OF OVERWEIGHT
Overweight may carry negative social implications which interventions
could target in order to improve the lives of those with obesity. In one
study, overweight adolescents received significantly fewer friendship
nominations from peers, and sometimes even received no friendship
nominations (Strauss, Harold, & Pollack, 2009). This is worrying as the
importance of friendship for the promotion of mental health is well
documented (Strauss et al. 2009). Another study (Janssen et al., 2004)
found overweight youths were more likely to be bullied. Additionally,
overweight boys and girls aged 15-16 years were more likely to bully
others. The authors suggest that one reason for these findings may be
that children are heavily influenced by stereotypes associated with
physical cues. “Anti- fat” stereotypes were particularly evident in a study
by Musher-Eizenman et al. (2004) which found even very young children
hold negative attitudes towards overweight peers, particularly when they
consider weight to be within one’s control.
The experiences resulting from the social implications of obesity
have serious consequences. Eisenberg, Newmark-Stainer and Story (2003)
revealed that teasing about weight is associated with low bodysatisfaction, low self-esteem, and suicidal tendencies. It is consequently
vital that research contributes to practical and effective interventions to
target the negative social implications of obesity.
INTERVENTIONS
Taking aforementioned research into account, several interventions have
been developed to prevent and deal with issues arising from childhood
obesity. Successful interventions generally highlight the importance of a
multi-disciplinary approach. For example, Nemet et al.’s (2005)
intervention suggested dietary changes, nutritional education, physical
activity, behavioural modifications and parental involvement produced
significant changes in weight, cholesterol levels and fitness after 3 months.
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Impressively, these changes persisted at the 1-year follow up. More
recently Gentile et al. (2009) evaluated the Switch program, targeting
reduced TV viewing, increased fruit and vegetable consumption and
increased physical activity at home, school and community levels. Again
the importance of targeting multiple levels of influence was evident. At
the 6-month follow up, there were significant changes in TV viewing and
consumption of fruit and vegetables, although no effect on physical
activity or BMI. The authors emphasise that these results are not trivial;
obesity is a multifactorial condition, and small changes can have large
long-term benefits. Results also underline the importance of family
involvement in interventions.
Social consequences for overweight individuals may be improved
through participation in sports or extracurricular activities (Strauss, et al.,
2009). Since sports activities may appear intimidating to overweight
youths, provision of alternative activities could be advisable. Eisenberg et
al. (2003) suggest investment in support and skills training for overweight
children who experience teasing. According to Janssen et al. (2004), school
interventions involving awareness of bullying, increased supervision, and
victim support can reduce bullying by 30–50%. Musher-Eizenman et al.
(2004) advise educating children about diversity of body-size. Similarly,
research should investigate ways to influence internal attributions for
weight by discussing low-responsibility conditions, e.g. genetic disorders
(Musher-Eizenman, et al., 2004). While this research offers valuable
insight, several limitations are apparent. Salient sources of teasing have
yet to be identified (Eisenberg et al., 2003). Future research must assess
the reliability and validity of friendship selection measures as well as
compare children’s attitudes with actual friendship behaviour (MuscherEizenman et al., 2004). Qualitative research may be useful in clarifying
why negative stereotypes are associated with overweight individuals.
LIMITATIONS OF RESEARCH
While research indicates numerous methods for preventing obesity,
critical evaluation has drawn attention to the lack of investigation of
predictive factors across multiple levels of influence- home, school, etc.
(Story, Neumark-Stainzer & French, 2002). Further research is required to
identify factors which are most influential and amenable to change.
Longitudinal studies, improved psychometric properties in measurements,
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and more direct observation of dietary behaviour are recommended to
enhance the contribution of research to interventions (Story et al. 2002).
Although informative, much of the research on intervention
strategies is flawed. The distinction between statistical and clinical
significance constitutes one issue requiring examination. Many studies fail
to track the extent to which children, parents and teachers utilise advised
strategies (Nemet et al., 2009). A review by Flodmark, Marcus & Britton
(2006) revealed 41% of prevention interventions investigated produced
positive effect indicating prevention of childhood obesity is possible.
However this finding is of little practical benefit since characteristics of
effective studies were not identified. Some frequent methodological
limitations of unsuccessful studies include inadequate sampling,
inappropriate analysis, poor monitoring of “dose” received by
participants, and an acute lack of theoretical basis for intervention
(Thomas, 2006). The question of statistical versus clinical significance is
also raised.
CONCLUSION
In conclusion, the research in this area is relatively beneficial in guiding
practice. Based on the research discussed, key challenges facing clinicians
include improving criteria for measuring overweight, development of
interventions which alleviate negative social consequences of obesity,
educating children, parents and teachers about consequences of unhealthy
lifestyles, and how overweight can be avoided, revision of advertising
standards, and further investigation of characteristics associated with
successful interventions. An exploration of individual differences might
also illuminate our understanding of childhood obesity. It is probable that
interventions could benefit from research involving individual, emotional,
and personality factors which may predispose young people toward
overweight and obesity.
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