Childhood Obesity and Overweight in Australia: Prevalence and Control

1. Introduction

Background

Obesity and overweight are among the leading health problems in the world today. Various authorities including the World Health organization predict that the prevalence rates globally will only go higher owing to the upsurge of unhealthy lifestyles in the contemporary age. The population of obese and overweight people globally has doubled since 1980 with an estimated 1.9 billion people over their recommended Basal Metabolic Rate (BMI) (Olds et al., 2010). Both obesity and overweight are defined as the accumulation of excessive or abnormal quantity of fats in the body with increased risk of cardiovascular disorders, type 2 diabetes, musculoskeletal disorders and some types of cancer. Obesity and overweight not only increases the risk of the above health problems but also reduces the responsiveness to treatment for various disorders. Being overweight refers to having a BMI greater than or equal to 25 while obesity is generally identified as having a BMI greater than or equal to 30 (Gill et al., 2010). On the other hand, the BMI is a simple weight-for-height index that is universally accepted across healthcare professions for the determination of obesity and overweight. It is mathematically defined as an individual’s weight in kilograms divided by the square of his height in meters (kg/m²).

Childhood obesity and overweight has emerged as a greater challenge in the question of obesity and being overweight. The increased cases of the health problem have led to predications of an ailing population in the future and intensified responses locally and globally. Sedentary behavior, increased intake of processed foods and attendant advertisements targeting young children has been blamed on rising cases of childhood obesity (Chen, Beydoun, & Wang, 2008). By 2014, an estimated 41 million children were overweight or obese worldwide, highlighting the widening scope of the problem. The patterns of childhood obesity have also changed, with a proportionate increase in cases among both developed and developing countries. Asia, Africa and other parts of the world where the problem was previously less prevalent have increasingly recorded both obesity and overweight. Australia is one of the countries with high prevalence rates of childhood obesity and overweight with 1 out of 4 children (25%) currently obese (Olds et al., 2010). Children in this case refer to those between the age of 2 and 17. There is no significant sex difference in cases of childhood obesity in Australia with prevalence rates appearing to reach a plateau phase in recent times. The negative health effects of childhood obesity and overweight include increased risks of obesity in adulthood, disability and premature death. Additionally, obese children risk hypertension, fractures, insulin resistance and psychological harm.

Problem Statement

Australia has one of the highest rates of childhood obesity in the world at 25%. These children risk an array of health problems currently and in the future ranging from cardiovascular and musculoskeletal disorders to psychological harm. If unabated, this may transform into a huge disease burden in the future with negative implications on the health budget. Since the obesity rates increased from 21% in 1997 to 25% in 2005, there has been a seemingly constant rate since 2011 at 26% (Pulgarón, 2013). While this may seem to be a positive connotation in that the rates have not gone exponentially higher as earlier predicted, but is unsatisfactory to the extent that there has been no reduction either. There is need to reduce cases of childhood obesity from the current level to much lower given that the health problem is preventable. This calls for not only strategies of mitigation but also more refined statistics to understand the entire contours of the health problem.  

Research Questions

1. What are some of the strategies that can be used to reduce childhood obesity and overweight in Australia?

Aim: To identify ways through which the prevalence rates of childhood obesity and overweight can be moved from the current 26% to much lower rates. 

Philosophy: Interpretivism

Design: Content Analysis

2. What percentage of children between 0-5 years suffer from childhood obesity and overweight in Australia?

Aim: To generate further statistical insights into the scope of childhood obesity and overweight in Australia. 

Philosophy: Positivist

Design: Survey

2. Literature Review

Search

A search was initiated on three libraries, the Cochrane, Pubmed and medline repositories. These are reputable libraries in the area of medical research and are capable of providing relevant, updated and peer reviewed articles on the subject matter. In the first instance, the words “obesity” and “overweight” were searched for independently in all the three libraries. This strategy proved inefficient as a wide array of articles came up out of which a large number (356747 in Pubmed) was barely directly associated to the topic. They were geographically distributed across Latin America, Asia, US and the UK among other countries in the world besides falling outside the aspect of prevalence and control. Upon the introduction of the Boolean operator “and”, the search results were still barely specific. The search was narrowed by introducing Australia and childhood into the search terms from which the number of articles drastically reduced. They were now relevant, specific and appeared to address the topic (Table 1 below). However, there was still a mixture of old and new research and thus a 10 year time limit was introduced. This led to more specific and relevant results. 

Search attempt	Strategy	Pubmed	Medline	Cochrane
1	Use of “obese” and “Overweight” independently	356747	506543	345234
2	Addition of the Boolean operator “and”	181983	345621	109765
3	Addition of “Childhood” and “Australia” to the search terms.	6230	8945	2183
4	Introduction of 10 year time limit	679	987	569

The results indicated that childhood overweight and obesity has been on the increase since the turn of the new millennium but has remained constant in recent times. Most of the studies indicate rates between 25-26% of childhood obesity and overweight in the last 5 years with no significant changes. This is not only true for Australia but also various countries around the world. However, the trend is hardly satisfactory as the prevalence rates are significant enough as a health problem. Childhood overweight and obesity can be addressed through community level and school based interventions as well as addressing social factors and public policy. 

Research Summary

Author and year	Aim	Methodology	Data Analysis	Key findings
Olds et al (2010)	To examine trends in childhood obesity and overweight in Australia since 1985.	Systematic review of studies between 1985-2008	Secondary data collected from published articles, content analysis performed.	There has been a plateau since 1998 with little if any increment in the cases of child obesity and overweight.
O’dea (2008)	Explore associations between obesity and weight perceptions with class, ethnicity and gender amongst Australian children	Sample of both high school and primary schools was used. A survey design was adopted.	Data collection through questionnaire. Descriptive statistics such as percentages, mean and standard deviation used in analysis.	Students from pacific islands were more obese than others. Anglo Caucasian/ Asian females were mostly obese. More high school males than females were obese.
Gill et al (2009)	To identify whether the claims of increasing childhood obesity in Australia are real or sensationalized.	Critical reviewSample: Statistics on childhood obesity and overweight between 1985 and 2004.	Content analysis	The current prevalence of childhood obesity and overweight in Australia is significant enough to warrant a structured response.
De Silva-Sanigorski (2010)	To determine the effectiveness of the Romp and Chomp intervention in reducing obesity amongst children of 0-5 years.	Cross sectional and quasi-experimental design with a comparison sample.	Quantitative analysis with descriptive statistics.	Community wide and multi-strategy interventions can be effective in reducing childhood obesity and overweight.
Chen, Beydoun, & Wang (2008)	To determine whether sleep duration has a relationship with Childhood obesity	Systematic review and Meta- Analysis	Relative risk/ hazard ratio, regression Analysis	Reduced sleep duration is associated increased childhood obesity and overweight.
Olds et al (2011)	To determine whether the rates of childhood obesity and overweight have really plateaued in 9 countries (Australia, China, England, France, Netherlands, New Zealand, Sweden, Switzerland and USA) (pg. 342).	Systematic review	Descriptive analysis	Though the prevalence of childhood obesity appears to have become constant in all reviewed countries, the rates remain high and thus a significant health problem.
Pulgarón (2013).	To highlight comorbidities associated with childhood obesity locally and internationally.	Systematic Review	Content analysis	Internalizing disorders, metabolic risk factors, and attention-deficit hyperactivity disorder are some of the cormobidities that had strong support in literature.
Gonzalez-Suarez et al (2009)	To investigate the effectiveness of school based programs in the management and prevention of childhood obesity	Meta-analysis	Descriptive analysis.	School based interventions were only effective on the short term in reducing childhood obesity and overweight.
Freeman et al (2012).	To investigate obese parental effect on child weight status and whether sex matters	Longitudinal study (prospective)	Correlational analysis (regression)	There were apparent relationships between child and parent BMI. Additionally, having an obese father and a healthy weight mother still increased chances of obesity.
Ben‐Sefer, Ben‐Natan, & Ehrenfeld (2009)	To discuss current literature on childhood obesity and overweight and provide useful insights for interventions by health stakeholders.	Critical review	Content analysis	Cultural and social factors, advertising, exercise and public policy all cause obesity. There is need for partnerships in public policy in dealing with obesity.
Han, Lawlor, & Kimm (2010).	To discuss current issues in childhood obesity and overweight	Critical review	Content analysis	Activity recommendations and calorie intake for children need reassessment due to increasingly sedentary lifestyles of children. Though the prevalence of childhood obesity seems to be constant at the moment, there is need for more efforts to continue or improve the exciting pattern.

Critique

Olds et al (2010) presents useful insights on the trends of childhood obesity and overweight in Australia. The study addresses the research question on prevalence rates among children 0-5 years of age but does not address the question on the strategies that can be used to get rid of the plateau phase. Nevertheless, the article is relevant to the study due to its statistical insight which is one of the main outcomes desired.

O’dea (2008) is an important article to the paper in that it presents evidence on the possible causes/risk factors of childhood obesity and overweight. This can be useful in addressing the mitigation strategies, though does not offer any statistical knowledge on prevalence rates. It is reliable due to its rigorous methodology involving a large sample and descriptive analysis.

Gill et al (2009) addresses the question of prevalence rates from a general viewpoint but makes the all-important finding that prevalence rates are still high and constitute a health problem. Though the methodology may be affected by bias from pre-collected data, the article is highly relevant as it also addresses the question of controlling the health problem to a considerable extent. The only weakness is that it does not address itself wholly to either of the research questions or at least with significant specificity.

De Silva-Sanigorski (2010) comprehensively addresses the research question on controlling childhood obesity and overweight. The article is also rigorous on methodology, combining quasi-experimental design with cross sectional design with a comparison sample. However, it is totally detached from the research question on prevalence rates as the focus is fully on the effectiveness of community based projects. 

Chen, Beydoun, & Wang (2008) is relevant in that it looks at one of the causes of childhood obesity and overweight- sleep duration. Despite not addressing prevalence rates between children of 0-5 years, the article presents findings that can inform prevention and control of childhood obesity and therefore remains relevant. Its methodology is also highly reliable, including both systematic review and meta-analysis. 

Olds et al (2011) reviews statistics from several countries including Australia to establish whether there has indeed been a plateau on the prevalence rates of childhood obesity and overweight. By confirming the above assumption, the study addresses the research question on prevalence rates but does not engage the other on control measures. The article uses a fairly large sample and makes useful comparison among 9 countries which makes the quality of its evidence strong. Further, it is an important article in that its sample covers the desired geographical scope, Australia. 

Pulgarón (2013) on their part investigates the cormobidities associated with childhood obesity and overweight. Though the study is relevant in that it remains within the larger subject of childhood obesity and overweight, it does not directly address any of the research questions or at least fully do so. There are brief overviews on statistics that help to address prevalence rates but not to a significant extent.

Gonzalez-Suarez et al (2009) looks at the effectiveness of school based programs in addressing obesity and overweight. The article is relevant due to its association with control mechanisms suitable to the health problem but falls short of addressing prevalence rates amongst children 0-5 years. It however employs a large sample in meta-analysis that allows for the generation of reliable results. 

Freeman et al (2012) investigates the effects of having obese parents on childhood overweight and obesity. Though this does not directly address the question on prevalence rates, it is quite comprehensive on the causes of the health problem. The paper has strength in methodology in that it employed a longitudinal design which is suitable in generating reliable data in clinical questions.

Ben‐Sefer, Ben‐Natan, & Ehrenfeld (2009) draw its relevance from discussing multiple causative factors of childhood obesity and overweight. This is important in the design of control and preventive measures which are of interest in one of the research questions. Though it does not address prevalence rates, the article is significantly valuable to the study. 

Han, Lawlor, & Kimm (2010) addresses the question on control of childhood obesity and overweight but does not offer any insights on prevalence of the health problem. However, the paper is important to the study as a whole as it revisits current research on the matter. It is helpful in the design of mitigation measures to the health problem and is quite detailed to that extent.

3. Methodologies and Design

The non-positivist research philosophy in question was interpretivism. This approach has several assumptions including the ontological one that there are multiple realities normally socially constructed by individuals. There is no single idea that can be termed as reality as a result as it is majorly a construction of individuals (Creswell, 2012). Epistemologically, knowledge is gained through understanding the subjective opinions, experiences and understandings of people. This is important in addressing the possible causes of obesity and overweight as they are largely pegged on lifestyle. Thereby, understanding how to control the health problem requires a close examination of people’s experiences, attitudes and subjectivity. The research approach also takes the axiological assumption that the biases of the researcher are important in interpreting the data alongside their values and intuition (Creswell, 2012). In this case, the researcher may make interpretations based on their interactions with obese people or their own weight status. Methodologically, it is assumed that the best methods for use in such approaches are qualitative, as such types give insight into the subjective feelings, opinions and experiences of the participants. No wonder, content analysis, a qualitative research design was recommended with respect to the question on strategies of dealing with overweight and obesity. The method allows for a review of literature and drawing interpretations from other studies that have already explored the problem. 

The positivist methodology has several underlying assumptions. First, it assumes that there is a single defined reality that is observable, measurable and fixed. It is this assumption that entertains the idea that prevalence rates can be determined specifically for children between 0-5 years because they actually exist and are measurable. There is also an epistemological assumption that knowledge from science is objective and quantifiable (Creswell, 2012). This means that scientific methods can be used to generate valid and reliable insights into the problem of prevalence of childhood obesity and overweight without bias. Generally, it is assumed that science offers a credible framework for measuring and giving a true understanding of the health problem. Positivism also assumes that objectivity is a good thing and should be observed in any process of gaining knowledge. Subjectivity on its part is frowned upon as one that is misleading and not a reliable way of approaching a research problem. Methodological assumptions include the use of experiments and quasi-experimental, exploratory and analytical designs that not only requires objective measurement and data analysis approaches (Creswell, 2012). The methodology resulting in quantitative data was a survey which helps in collecting information through questionnaires, interviews and secondary sources for the sake of understanding a research problem. The quantitative research design assumes that phenomena can be adequately explained in statistical terms and measurement is a reliable way of understanding such. It does not prefer immeasurable characteristics as they do not give a concrete view of the problem.

References

Ben‐Sefer, E., Ben‐Natan, M., & Ehrenfeld, M. (2009). Childhood obesity: current literature, policy and implications for practice. International nursing review, 56(2), 166-173.

Chen, X., Beydoun, M. A., & Wang, Y. (2008). Is sleep duration associated with childhood obesity? A systematic review and meta‐analysis. Obesity, 16(2), 265-274.

Creswell, J. W. (2012). Qualitative inquiry and research design: Choosing among five approaches. Thousand Oaks, CA: Sage.

De Silva-Sanigorski, A. M., Bell, A. C., Kremer, P., Nichols, M., Crellin, M., Smith, M., … & Robertson, N. (2010). Reducing obesity in early childhood: results from Romp & Chomp, an Australian community-wide intervention program. The American journal of clinical nutrition, 91(4), 831-840.

Freeman, E., Fletcher, R., Collins, C. E., Morgan, P. J., Burrows, T., & Callister, R. (2012). Preventing and treating childhood obesity: time to target fathers. International Journal of Obesity, 36(1), 12.

Gill, T. P., Baur, L. A., Bauman, A. E., Steinbeck, K. S., Storlien, L. H., Fiatarone Singh, M. A., … & Caterson, I. D. (2009). Childhood obesity in Australia remains a widespread health concern that warrants population-wide prevention programs. Medical Journal of Australia, 190(3), 146.

Gonzalez-Suarez, C., Worley, A., Grimmer-Somers, K., & Dones, V. (2009). School-based interventions on childhood obesity: a meta-analysis. American journal of preventive medicine, 37(5), 418-427.

Han, J. C., Lawlor, D. A., & Kimm, S. Y. (2010). Childhood obesity. The Lancet, 375(9727), 1737-1748.

O’dea, J. A. (2008). Gender, ethnicity, culture and social class influences on childhood obesity among Australian schoolchildren: implications for treatment, prevention and community education. Health & social care in the community, 16(3), 282-290.

Olds, T. S., Tomkinson, G. R., Ferrar, K. E., & Maher, C. A. (2010). Trends in the prevalence of childhood overweight and obesity in Australia between 1985 and 2008. International journal of obesity, 34(1), 57.

Olds, T., Maher, C., Zumin, S., Péneau, S., Lioret, S., Castetbon, K., … & Sjöberg, A. (2011). Evidence that the prevalence of childhood overweight is plateauing: data from nine countries. Pediatric Obesity, 6(5‐6), 342-360.

Pulgarón, E. R. (2013). Childhood obesity: a review of increased risk for physical and psychological comorbidities. Clinical therapeutics, 35(1), A18-A32.