Running head: OBESITY EPIDEMIC

The Widespread Obesity Epidemic

Caitlin Cox
University of Arizona
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Abstract

The purpose of this literature review is to analyze the current childhood obesity epidemic

through various factors including: knowledge deficit, nutrition impairment, and socioeconomic

status. The obesity epidemic among children has been trending upwards since the early 2000s

and has become a culture of the American society. If unaddressed the American population will

continue on the upward trend of obesity. Children must be educated at a young age what a

healthy diet consists of in order to ensure healthy eating patterns. This literature analysis will

review research on the different factors that have been largely known to increase childhood

obesity or this risk for it.

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Introduction

Statement of Purpose

The purpose of this literature review is to examine research articles regarding childhood

obesity and the factors influencing this epidemic. The journals later reviewed in this analysis

have been identified as key pieces of evidence relevant to this investigation. The current

epidemic and historical background regarding childhood obesity will be discussed throughout the

remainder of this analysis, as well as the significance of this health problem.

Historical Background

Childhood obesity has become a world wide public nursing issue. In America,

approximately 32% of children are obese, becoming the leading nation in obesity. There has been

a steady inclination of this statistic over the last 50 years. The rise of obesity slowly began

between 1960-1970 and taken a substantial increase since. A variety of environmental factors

influence obesity at a microscopic level, whereas obesity at the macroscopic level is centered on

the chronic imbalance of energy intake versus energy expenditure. The relationship between

energy intake and expenditure includes factors such as: easy access to energy dense food,

increased portion size, lack of physical activity, and increase in sedentary activities. Childhood

obesity stemmed from adult obesity. As adult obesity grew at an alarming rate in the 1990s to

early 2000s, child obesity quickly followed. Studies revealed that adults facing obesity began

having children facing the same weight issues, as the home environment was made up of

unhealthy foods. (Gibbs & Forste, 2014).

As current treatments have been studied over the 21st century, scientists have concluded

that lifestyle and diet modification is the most appropriate line of treatment. A second line of

treatment was discovered in 2007 through the use of pharmacotherapy. This form of treatment is
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recommended after lifestyle changes have been made and the child is still above the 95th

percentile in body mass index (BMI). In more recent years, scientists have also concluded that

bariatric surgery is not of highest recommendation and should be used very rarely, if at all (Gibbs

& Forste, 2014).

Significance of Problem

Childhood obesity is a critical problem in the large amount of health risks associated as

well as the potential psychological risks. According to the Center for Disease Control and

Prevention (CDC) obesity during childhood can have many taxing effects on the body. Children

faced with childhood obesity are more likely to experience high blood pressure and high

cholesterol, increasing their risk for cardiovascular disease. These children have an increased risk

for impaired glucose tolerance and insulin resistance, which potential may lead to the onset of

type 2 diabetes mellitus. Breathing problems such as asthma or sleep apnea, as well as joint

problems, fatty liver disease, and heartburn are all additional risk factors associated with

childhood obesity. Facing obesity during childhood can lead to several psychological problems

such as anxiety, depression, low self-esteem, and social problems like bullying. Facing

psychological challenges at such a young age has been found to increase likeliness for adult

psychological challenges. (CDC, 2017).

The psychosocial consequences have become increasingly alarming. In an observational

study, 233 adolescents were surveyed regarding physical comfort, social life, body esteem, and

family relations (Bass & Eneli, 2015). The results displayed that increasing BMI was a negative

quality of life factor. Adolescents felt victimized in social settings, uncomfortable in their bodies,

and low self esteem with even moderate obesity (2015). Facing psychological challenges at such

an early age can lead to unhealthy coping patterns, which in many cases with adolescents is
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comfort eating. Comfort eating to bury emotions or self-esteem issues results in increase of

obesity over time. This can often fall into a continuous cycle of unhealthy patterns. Ultimately,

this issue is very prevalent in current health promotion to ensure the upcoming generation is

engaging in healthy eating patterns and reducing the risk for health issues.
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Literature Review
Introduction
This literature review thoroughly addresses the current epidemic of childhood obesity and

the associated influencing factors. In order to acquire research in this area, a variety of search

engines were utilized including EBSCO, Pubmed, Google Scholar, and CINAHL. Childhood

obesity was the consistent keyword used with subheadings varying from influencing factors

parental knowledge education and socioeconomic status. This search revealed a total of

twelve articles that were further reviewed. The articles were published between 2013-2017 and

included systematic reviews, randomized control trials, qualitative studies, quantitative studies,

and organizational studies. These articles are clearly summarized and outline in the table of

evidence following the literature review.

Literature Review Results
Incidence of Childhood Obesity
The purpose of this article is to observe the incidence of obesity among elementary aged

children, aged 5-14 years old. Researchers Cunningham, Kramer, and Narayan (2014)

investigated Early Childhood Longitudinal Study of the 1998-1999-kindergarten class by

enrolling 21,260 children beginning kindergarten in the fall of 1998. Of these students, 9,358

students were followed until eighth grade in 2007. Over this time, the researchers examined

several variables affecting obesity- height, weight, sex, age, race or ethnic group, socioeconomic

status, and birth weight. After data evaluation, the researchers used the Center of Disease Control

and Prevention (CDC) growth charts to calculate each childs appropriate BMI related to their

sex and age. (2014).

The findings from this study concluded that of the children entering kindergarten at the

mean age of 5.6 years 14.9% were overweight and 12.4% obese (2014). As the researchers then

followed these specific groups of children, by eighth grade at the mean age of 14.1 years, 20.8%

of children were obese (2014). After observing varying demographics it was found that the
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prevalence of obesity was higher among Hispanic children rather than non-Hispanic white

children. Non-Hispanic black children also displayed significantly higher obesity prevalence

with the greatest increase during first and third grade. This increased at a rapid rate of 13%-

18.6% in two short years. Throughout the measured timeline of kindergarten to eighth grade the

prevalence of obesity increased by 65% among non-Hispanic white children, 50% among

Hispanic children, 120% among non-Hispanic black children, and 40% among children of other

races. Additionally, the statistical data displayed children from the top 20% of wealthy families

had the lowest prevalence of obesity beginning in kindergarten at only 7.4%. These incidence

rates increased slightly throughout the measured span, but still remained significantly lower than

the other populations mentioned. It was concluded that children of a higher birth rate had a

significantly higher prevalence of obesity at all ages among all groups of children. (2014).
This study presented several strengths and limitations. In order to maintain a sample size

the researchers clumped Asian, Pacific Islander, Native America, and multiracial children into

one category of other races (2014). These races all experience vastly different eating patterns

causing the data in this category to be less representative of the weight variation in these

children. Secondly, the researchers did not have access to the weight of the children from birth

to kindergarten or past eighth grade preventing the display of the full weight trajectory during

childhood (2014). While the 1998-1999 kindergarten cohort is extremely applicable to the

obesity epidemic due to the fact that obesity increased significantly during the 1990s-2000s, the

researchers limited their study by only studying one cohort. Lastly, the researchers claimed that it

was beyond their scope to study factors influencing obesity, as that would have created a

completely separate study (2014). Overall the results of this study are consistent with national

data and provided significant data in the burden of childhood obesity.

The More the Heavier? Family Size and Childhood Obesity in the U.S.
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The purpose of this research article is to closely analyze the varying sizes of families and

the corresponding prevalence of childhood obesity. Researcher Ashlesha Datar examined how

family size is related to childrens body weight and obesity by conducting a multistage

probability sample design. Datar conducted her study by partnering with the National Center for

Education to collect data in the fall of incoming kindergarteners and spring of first, third, fifth,

and eighth graders. The data collected focused on childrens cognitive, health and developmental

outcomes, and contextual data on their families (2017). Fifth graders became the primary focus

on this research as BMI, physical activity, and dietary behaviors were further analyzed. The

sample includes 10,080 fifth graders in the 2004 class of United States children. Family size,

BMI and obesity, dietary behaviors, physical activity, and sedentary behavior in individual

children were observed (2017).

The finding from the study displayed the prevalence of obesity was significantly higher

among families of less number of siblings. Children with one, two, or three or more siblings have

3.9, 2.9, and 3.9% lower points in BMI compared to children with no siblings. Datar concluded

that obesity prevalence among children with no siblings was 25% higher. Additionally, her data

displayed that children with no siblings are more likely to be from single parent households, low

socioeconomic status or black. This evidence further supports Datars claim that disadvantaged

families show higher rates of obesity (2017).

There are several limitations and strengths to this study. One limitation to Datars study is

that the data is representative to the United States and does not represent other countries (2017).

Secondly, some aspects of this study were estimated based off of varying family styles and

because this was an observational study. Ultimately, the results are significant enough to suggest

that smaller families in the U.S are at higher risk of obesity most likely due to convenience of

fast food for one child and lack of physical activity between siblings.
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Relationship Between Food Insecurity, Child Weight Status, and Parent-Reported Child

Eating and Snacking Behaviors

Researchers Kral, Chittmans, and Moore performed a cross sectional study analysis

aimed as observing the relationship between childhood obesity and food-insecurity. This study

was conducted by asking fifty mothers of 8-10 year old children to complete questionnaires

regarding the U.S. Household Food Security, height, and weight. The survey included the

following topics: household food security, parent feeding style, child feeding style, child eating

in absence of hunger, and child and maternal height and weight.

The findings in this study revealed that it is five times more likely for children from food-

insecure households to face obesity compared to children from food secure homes (2016). After

observing eating patterns in these children, researchers found that most children are consuming

the recommended three meals a day. The varying factor in eating patterns was amount of

snacking between meals. Children from insecure homes averaged 5 or more snacks a day, while

children from food secure households averaged 3. In addition, children from food insecure

homes ate past satiation and in the absence of hunger (2016). Researchers gathered that the

children sometimes lived in fear of not being able to get food at other times; therefore taking

advantage of the food they see. Additionally, the food insecure families generally received an

abundance of food at the beginning of the month and faced caloric restriction by the end (2016).
The key limitation of this study was the lack of observance on family household size,

which limited the ability to analyze families under the poverty line. Additionally, household

income was not observed, which plays a large factor into poverty and food assistance program.

The findings from this study contribute to nursing practice by providing further support in the

relationship of childhood obesity and family food insecurity. Nurses can incorporate this research

into practice when caring for children by further inquiring about eating patterns and parent

feeding practices, as well as educating families about increase risk for childhood obesity (2016).
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Features of the Built Environment Related to Physical Activity Friendliness and Childrens

Obesity and Other Risk Factors

The goal of this qualitative research study is to identify modifiable environmental

attributes that can lead to the creation of intervention and programs to prevent childhood obesity.

Researchers, Taylor et al. (2014), used a cross-sectional design to investigate the association

between environmental factors of physical activity friendliness, socioeconomic status, and

likelihood of obesity. The sample consisted of 911 kindergarteners through sixth graders from

three different elementary schools coming from urban school districts in the southeastern United

States. The participants were asked a serious of questions in a randomized method about their

current health practices (2014).

The findings were divided among the following categories: accessibility, safety, comfort,

and pleasure. Accessibility was the most significantly correlated to the risk of obesity, as

families that live in lower income areas didnt have resource to provide after school programs to

their children or encourage them to live an active lifestyle. Safety was also a high risk factor as

parents explained dislike for their kids to be playing outside when the neighborhood isnt safe

(2014). This resulted in children watching increased hours of television and engaging in screen

time. Additionally, the researchers found that comfort features in an environment encouraged

physical activity among the participants. This leads into the limitations of the study, as the

researchers did not examine specific physical activities enjoyed or found comfortable by

participants (2014). The study also was limited to the method of research conducted; the

questions asked to the participants were broad and allowed for a large variation of results,

allowing for possible inconsistencies. Although there were several limitations, this study also

included numerous strengths. Nursing students were the personnel walking around

neighborhoods collecting data and they were able to evaluate the neighborhoods and determine
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possible physical activity interventions in playgrounds or parks (2014). Additionally, the sample

size was large with a wide range in diversity among races and age. Overall, this study accurately

displayed the significant effects that the environment has on physical activity and risk for

obesity.
Prevalence and Prediction of Overweight and Obesity Among Elementary School Students
Nursing researchers, Moreno, Shelton, and Boles (2013), used this quantitative study to

identify factors that affect the distribution of overweight and obese children within school

districts. This study gathered the heights and weights of 2317 elementary school children from

kindergarten through fifth grade in one Oregon school district. The researchers collected data for

six possible predicting factors of obesity: gender, ethnicity, number of siblings, free and reduced

lunch, school English as a second language (ESL) status, and grade level (2013). The data was

collected through a screening process where children were weighed and measured individually.

The information was then transmitted to a database to calculate the BMI for each student.

Additionally, with parental permission, the schools released the listings of students that qualified

for free and reduced school lunches based on their familys economic status. The findings

displayed that four of the six predictors for risk of being overweight or obese were significant.

These predictors included: ethnicity, grade level, free and reduced lunches, and number of

siblings (2013). As the students increased in grade level, the number of obese and overweight

students increased. Additionally, the students found eligible for free and reduced lunches were

1.24 more times likely to be obese or overweight as compared to students that did not. The

findings displayed that children without siblings in the same elementary school had a higher risk

of becoming overweight. Lastly, evidence showed the highest predictor was ethnicity, with

Hispanic children being 1.81 times more likely to suffer from being overweight or obese (2013).

Overall, this study succeeded in identifying the main identifiable risk factors for childhood
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obesity. The researchers plan to present this information to school boards in hopes of

implementing policies to decrease risks of this health concern.

This study was limited in various ways including, the use of only one school district in

Oregon, the lack of family history for high BMI or obesity, and the lack of attention to physical

activity occurring during the school day. In order to create policies for school boards to

implement the researchers should have noted the amount of physical activity currently occurring

during the school day and the possibility of being able to increase it. This study also included

several strengths. The researchers gathered data first handedly rather than referring to previous

chart history for heights and weight, they utilized the database from the school on all other

demographic information rather than asking parents or children who may have the possibility of

answering incorrectly due to embarrassment or other factors (2013). Overall, this nursing journal

is consistent with similar articles and provides statistically and clinically significant data in this

field of research.
Exploring the Relationship Between Parental Concern and the Management of Childhood

Obesity
Nursing researchers, Moore, Harris, and Bradlyn (2013), conducted a multi-stage study

using a random sample of 1,500 parents of students in kindergarten, 2nd, 4th, 5th, 7th, and 9th

grade. The parents were interviewed and asked questions regarding demographics, parent

perceptions, child physical activity, child/family diet, obesity knowledge, interactions with health

care providers, and perceptions of the schools role in childhood obesity prevention. The parent

interview was approximately 20 minutes long and conducted via telephone. The findings showed

that parents who expressed concern in their childs weight were more likely to limit screen time

activity and more willing to implement an exercise regimen in their childs routine. It was also

concluded that parents with greater concern for their childs health had already implemented a

more health conscious diet. Parents of females were the most likely to participate in this study
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and express greater concern for their childs health (2013). Overall, the evidence from this study

found that the more involved parents are in their childs life and health behaviors, the lower risk

for childhood obesity.

The limiting factors of this study consist of participants being from a rural state with

limited ethical diversity resulting in a larger portion of the participants coming from white

families (2013). Additionally, actual height and weight calculations were not collected on the

individual children; rather it was based off of the parental interview. The strengths from this

study include the implementation of nursing interventions for parents that are concerned and

willing to create a healthier lifestyle with their children and the large randomized sample size of

number of parents participating in the study (2013). This study is considered to be significant in

determining the concern parents play in their childs health and the correlation to childhood

obesity. It can be concluded that child gender, BMI, and parental perception are all key attributes

to the level of concern that a parent displays in their childs health.

Economic Differences in Risk Factors for Obesity Among Overweight and Obese Children
A total of 407 overweight and obese children participated in this cross-sectional

descriptive study design. Nursing researchers Kim, Ham, Jang, Yun, & Park, (2014) conducted a

study to identify the difference in familial, physiological, psychological, and lifestyle

characteristic related to childhood obesity in various income level homes. A convenience sample

was collected in South Korea consisting of overweight and obese children ranging from ages 6-

12 (2014). Parents of the student participants completed survey questionnaires and physiological

measurements for the study. Some of the measurements collected included BMI, muscular

strength, fitness, blood pressure, family history, self esteem, depression, eating habits, exercise

regimen, and television/computer use. The researchers found that physiological, psychological

(self esteem and depression), and lifestyle characteristics (eating and television habits) of

overweight and obese children coming from households of varying incomes were significantly
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different (2014). The evidence found from the research conducted supported the researchers

original hypothesis that low-income families have a higher rate of obesity due to eating a high fat

diet because it is more cost effective and parents being consumed by work causing the children

to watch countless hours of television (2014).

The population used in this study limited the results by gathering participants from only

one city within South Korea, this sampling allowed for the possibility of bias to enter the study,

as the population should have been more diverse. Additionally the study only examined

overweight and obese children without having a normal weight control group of children the

same age and demographic. Because this was one of the first studies to analyze childhood

obesity in this manner, there are very few studies to compare results too. The study was

strengthened by its well-rounded approach to look at the children in a holistic manner, rather that

just physiologically (2014). Additionally, nurses implementing various interventions to alleviate

the childhood obesity epidemic strengthened this study. The nurses educated on healthy eating

patterns, strategies to cope with psychological issues, and a plan to increase the role school

nurses play in the lives of students to help them achieve a healthier lifestyle (2014).
Relationship Between Media Viewing and Obesity in School-Aged Children in Taipei,

Taiwan
In this case-control study by Huanh, Chien, Yeh, Lee, & Chang (2013), the researchers

studied the relationship between the viewing of television after school and obesity in school-aged

children. This research was conducted in one of the worlds largest cities, Taipei, Taiwan, using a

case-control study consisting of a total of 550 participants. Convenience samples of fourth grade

school children were recruited across twenty-nine different elementary schools in the city of

Taipei. For each obese child selected, a child of normal weight with the same gender and age was

selected for the control group. The researchers gathered baseline data at the beginning of the

school year, including: BMI, height, and weight. The researchers measured their data by
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investigating media viewing using a 3-day self reported physical activity log and the daily

sedentary activity component of the National Health Interview Survey in Taiwan. After school

media viewing was reported based upon total time spent watching television, playing computer

games, and reading. The findings showed that children spending more than two hours per day

utilizing media had a much higher chance of being at risk for childhood obesity (2013). The

children from the obese group as a whole were already spending over two hours a day viewing

media.
The researchers noted that decreasing media viewing is not the only facet to this obesity

epidemic among children. Various other factors were monitored including family dynamics,

socioeconomic status, and parent involvement. For example, families with lower socioeconomic

status trended to have higher rates of childhood obesity because resource to healthier foods is

limited significantly more than a middle or high-class family. The limitations of this study

focused on the population being limited to only the Taipei city (2013). This is an urban city and

obesity rates may differ in rural areas, therefore future studies should gather participants from

both spectrums. Additionally, this study used self-reported log, which allowed for a wide

variation of feedback from the children. In the future, to decrease chance for any inconsistencies

a standard terminology should be created for children to select in their activity log. The strength

of this study is the comparable statistical findings with research done in this area; the results are

consistent to what has previously been found (2013).

Correlates of Total Sedentary Time and Screen Time in 9-11 Year Old Children Around the

World: The International Study of Childhood Obesity, Lifestyle, and the Environment
The purpose of this study was to closely analyze the relationship between screen time

(ST) and sedentary time (SED) with childhood obesity around the globe. Researchers LeBlanc,

Katzmarzyk, Barreira, Broyles, Chaput, Church, et al. conducted a cross sectional study taking

place in 12 different sites across the world: Australia, Brazil, Canada, China, Colombia, Finland,
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India, Kenya, Portugal, South Africa, United Kingdom, and United States. The sample included

5,844 children between the ages of 9-11 years old. Data was obtained through parent and child

reported behavioral, household, and neighborhood characteristics. There were 21 potential

correlates between SED and ST. (2015).

The findings in this study revealed children averaging 8.6 hours of daily SED, with

54.2% failing to follow ST guidelines. All studies displayed boys with higher ST leading to

higher BMI scores than girls (2015). In 9 of the 12 sites girls scored higher in SED time. The

most common correlates between higher SED and ST included poor weight status, low physical

activity, and having a TV or computer in the childs bedroom (2015). Researchers obtained

anthropometric variables regarding height and weight based on sex. These variables were cross-

examined with reported behaviors and appropriate BMI for the individual child. Ultimately, data

significantly supported higher ST and SED with increased risk for childhood obesity. The

number one correlate was found to be a TV in a childs bedroom (2015).

This journal presented several strengths and limitations. The age group was restricted to

just 9-11 years old, which limits data results as a childs TV viewing behavior changes with age

(2015). Additionally data was collected through parental reporting which allows room for errors

in data to be inaccurate in areas. The major strength of this article is the vast diversity among

cultures. The researchers were able to obtain information across 12 countries and use

accelerometers for tools of measurement to provide accurate results. Overall, the data

significantly supports to researchers claim that high SED and ST correlate directly with an

increase in BMI (2015).

Examining the Association Between School Vending Machines and Childrens Body Mass

Index by Socioeconomic Status

This journal of nutrition education and behavior, by OHara and Maslow (2015),

displayed the research conducted involving 2,263 students ranging from the fifth to the eighth
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grade in a randomized and controlled quantitative study design. The purpose of this study was to

analyze to relationship between vending machine accessibility in schools and body mass index

(BMI) amongst various groups of children based on gender, race/ethnicity, and socioeconomic

status (2015). The researchers of this study measured their data by utilizing a dataset that had

previous statistics on an individual childs BMI, height, weight, demographics, physical activity,

and dietary habits. This information was utilized when asking the student participants to take a

survey about their vending machine habits. In addition to the student participants, parents and

teachers were asked to take the survey about vending machine accessibility. The researchers then

used a first difference equation to calculate accurate results of BMI changes over the years from

fifth to eighth grade and compared to the original baseline results from the database. After

factoring in the appropriate increase expected for a childs growth, the findings showed that with

greater access to vending machines in schools, children have higher chances of being at risk for

childhood obesity (2015). Additionally, the researchers took a brief look out other independent

variables that may be affecting this epidemic. The researchers noted that race and socioeconomic

status also played a vital role, as the statistics display low income Hispanic students were the

main users of vending machines as they did not have resources to purchase lunches or bring

lunches from home. Students from a Hispanic household often suffered from improper dietary

education due to a language barrier, therefore this demographic as a whole showed the highest

rate in childhood obesity. Results also found that television watching was promoting a sedentary

lifestyle for this age group and prohibiting the children from physical activity (2015). Overall,

vending machine availability had a positive correlation to BMI, as well as television watching

and low socioeconomic status for Hispanic households.

A limitations of this study included the contents of the vending machines not fully being

discussed, the researchers mentioned sugary snacks, but did not discuss possible healthy options
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offered. The study also analyzed various other independent factors affecting childhood obesity

but did not discuss at what extent these variables are being abused to lead to risk of obesity. The

large population size from a very diverse population strengthened the results of this study, as

well as the extensive categories of demographics being looked at over the course of several years

(2015).
Maternal Underestimation of Child's Weight Status and Health Behaviors as Risk Factors

for Overweight in Children

The primary focus of this cross sectional study, by Vallejo, Cortes-Rodrguez, and Colin-

Ramirez (2015), was to analyze the maternal perceptions of their childs current weight ranking

and their aim to modify family health patterns among mothers of both normal-weight and

overweight children. The study also examined the relationship between a childs risk for being

overweight and the mothers knowledge deficit of healthy weight and behaviors. A convenience

sample 140 mother-child dyads (children ages 2-6) were collected with 65 in the normal-weight

children group and 75 in the overweight children group (2015. The mothers completed a short

questionnaire about their childs current health conditions and any futuristic plans for

implementations of health behaviors. The findings of this study showed maternal

underestimation in both the normal-weight and overweight categories, yet the underestimations

were higher in the overweight category. It was reported that 62.4% of mothers with overweight

children classified their child as being normal weight and 41.5% of mothers with normal-weight

children underestimated their childs current weight status (2015). After discussion with the

mothers, the researchers concluded that mothers were more concerned about having a child

underweight rather than overweight. This misconception showed the nursing researchers the lack

of education present among mothers of fairly young children. The nurses conducting the research

also found that mothers with nutrition deficit were also allowing their children to watch over 8
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hours of television a week. Majority of these children are already overweight and at a high risk

for obesity. The nurses educated the mothers on proper nutrition habits and the importance of

physical activity for children ages 2-3.

There are three main limitations to this study: the cross sectional nature of the study, the

relatively small sample size, and the current number of media viewing hours in each child was

not analyzed. While this study had limiting factors, the study was strengthened by the statistics

being congruent to similar nursing journals analyzing the same topic. Additionally, the authors

had no conflicts of interest or bias when conducting this research. (2015).

Why Do Parents Enroll in a Childhood Obesity Management Program? A Qualitative

Study with Parents of Overweight and Obese Children

Davidson and Vidgen conducted a qualitative study to examine parental perspective on

factors that influence their decisions to address their childs weight (2017). This study was

performed by obtaining a sample of 154 parents of overweight children. Parents that were apart

of the Parenting, Eating and Activity for Child Health (PEACH) program were emailed about

participation in this study. A total of 154 replied, with 13 enrolling. Secondly, researchers made

telephone calls to enrollees that did not respond and had a total of 21 consent to participate in the

study. Data was collected through telephone interviews with the parents regarding child behavior,

beliefs, attitude towards childs weight, intention to address childs weight, and attitude toward

enrolling in a weight management program. (2017).

The findings from this study revealed three themes. The first theme discovered was the

motivation to enroll in a health management program. The two other themes noted were the

influence of a support network to enroll in a weight management program and the parents

perceived control over their childs weight issue (2017). Overall, the parents motivation to enroll

was centered on support from surrounding people and health professionals. Additionally, parents

tended to be aware of their childs weight status and had attempted to address it but were not
OBESITY EPIDEMIC 20

successful. Lastly, the parental behavior was dependent on the childs emotional state, in that the

parents did not want to hurt or offend their child during the process (2017). The limitations in

this study included the small sample size and parental discretion during interviews. Additionally,

the design of the study set a framework of obtaining results based on parental intention to

change, rather than the actual behavior patterns to address change in their childs weight status

(2017).
Summary
The journals reviewed above consistently display the clear risks for childhood obesity.
The most common risk factors for childhood obesity seen throughout the twelve journals include
parental knowledge deficit, endless hours of media viewing from children, low socioeconomic

status, poor dietary options in schools, and parental attitude toward change. Several of the

journals discussed various interventions that can be implemented in the children to decrease their

chance for becoming obese. If parents become more involved and set the standard at home for

what a healthy lifestyle embodies, their children will have a higher chance of maintaining a

recommended weight. It is known that educating parents, improving school lunches, decreasing

screen time, and increasing physical activity will help decrease risks of childhood obesity. This

information is applicable to nursing, as this field works heavily with parents to educate what a

healthy weight status is for their child and communicate clear healthy eating patterns. Although

factors influencing childhood obesity can be adjusted, parent and child motivation to change is

the main drive for lifestyle modification. Cultures as a whole have traditions that are causing

childhood obesity and research still needs to be conducted to determine how to solve this issue.

Future studies will hopefully have answers to these issues, as the epidemic of childhood obesity

remains a global issue.

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Bass, R., Eneli, I. (2015) Severe childhood obesity: an under-recognized and growing health

problem. Postgraduate Medical Journal.91:639-645.

Center for Disease Control. Childhood Obesity Causes & Consequences. (2016). Retrieved from:

https://www.cdc.gov/obesity/childhood/causes.html
Cunningham, S. A., Kramer, M. R., & Narayan, K. M. V. (2014). Incidence of childhood obesity

in the United States. N England J Med, 370(5), 403-411. Doi:10.1056/NEJMoa1309753

Davidson, K. A., & Vidgen, H. (2017). Why do parents enroll in a childhood obesity

management program?: A qualitative study with parents of overweight and obese children

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Appendix

Questions,
Author(s) and variables Design, Findings
Date Objectives, sample, setting
hypothesis
Davidson & Childhood Qualitative 1. Parents tended to be aware of
Vidgen, 2017 obesity, obesity study childs weight status
management 2. Parents were influenced by peers
program 21 parents of and health professionals to enroll
obese children child in program
3. Parental attitude toward weight
Australia management program was
dependent on childs emotional
OBESITY EPIDEMIC 23

status

Datar, 2017 Childhood Multistage 1. Children with no siblings have

obesity, family probability higher prevalence of obesity than
size, USA sample design children with 1, 2, or 3 or more
siblings
10,080 5th 2. Children with one, two, or three
graders or more siblings have 3.9, 2.9,
and 3.9 lower percentile points in
United States BMI compared to children with
no siblings
3. Obesity prevalence among
children with no siblings was
25% higher

Kral, Chittams Food Cross-sectional 1. Children from food-insecure

& Moore, insecurity, analysis homes are five times more likely
2016 child eating to be obese than children from
patterns 50 children food secure homes
ages 8-10 years 2. Children from food insecure
old and their homes snack 1-2 times more/day
biological than others in fear of being
mothers without food
3. Nurses can educate families and
Philadelphia, patients about risk for obesity
United States
O'Hara & Vending Randomized, 1. Vending machine availability had
Haynes- machine controlled a positive correlation (P < .10)
Maslow, 2015 accessibility, quantitative with BMI
children BMI, 2. Television watching had positive
socioeconomic 2,263 5th-8th correlation (P < .05) with BMI
status grade students 3. Low socioeconomic status
increased risk of childhood
United States obesity
4. Hispanic households.
OBESITY EPIDEMIC 24

LeBlanc AG, Sedentary Cross-sectional 1. Children averaged 8.6 hours of

Katzmarzyk time, screen study SED daily
PT, Barreira time, 2. Boys were more likely to engage
TV, Broyles childhood 5,844 children in ST, leading to higher BMI
ST, Chaput J-P, obestiy aged 9-11 years averages
Church TS, et old 3. The strongest modifiable
al. 2015. correlate is the removal of a TV
Australia, from the childs bedroom
Brazil, Canada,
China,
Colombia,
Finland, India,
Kenya,
Portugal, South
Africa, United
Kingdom, and
United States
Vallejo, Childrens risk Cross-sectional 1. Children whose weight status
Cortes- for obesity, study, was underestimated by their
Rodrguez, & maternal quantitative mothers were at greater risks of
Colin- underestimatio being overweight compared to
Ramirez, 2015 n of weight Convenience those whose weight status was
status, health sample= 140 correctly perceived
behaviors mother-child 2. Less television viewing time was
dyads associated with a 63% reduced
risk of being overweight
Mexico City
Cunningham, Incidence of Cohort study 1. Children entering kindergarten at
Kramer, & childhood the mean age of 5.6 years
Narayan, 2014 obesity, Multistage showed 14.9% being overweight
prevalence of probability and 12.4% obese
obesity sample= 9,358 2. Prevalence of obesity was
children highest among Hispanic children
followed from 3. Greatest increase in prevalence
kindergarten to of obesity was among first-third
eighth grade grade
4. Children from top 20% of
United States wealthiest household reported
lowest incidence rate of obesity
Kim, Ham, Economic Cross sectional, 1. Obesity rate was 69.0% in the
Jang, Yun & differences in descriptive low-income bracket
Park, 2014 familial, study 2. The children in the low-income
physiological, group were more prone to have
psychological, Convenience poor eating behavior and more
and lifestyle sample= 407 likely to spend more than 2 hr
characteristics, overweight and
OBESITY EPIDEMIC 25

overweight and obese children viewing television.

obese children 3. Also more likely to have lower
South Korea self-esteem and more depressive
symptoms.

Taylor et al. Environmental Cross- 1. Accessibility was the

2014 features of sectional, significantly correlated to the risk
physical correlational of obesity (P= <0.5)
activity study 2. Safety was also a risk factor as
friendliness, parents relayed they didnt like
socioeconomic 911 for their kids to be playing
indicators, and kindergarteners outside when the neighborhood
prevalence of - 6th graders wasnt safe
obesity (BMI 3. Children watching increased
status) United States hours of television.
4. Comfort features in an
environment encouraged physical
activity among the participants
Moreno, BMI Quantitative 1. Prevalenceof85thpercentile
Johnson, & prevalence, study washighestamongHispanic
Boles, 2013 overweight and children.
obesity 2317 2. Ethnicitywasthestrongest
predictors, elementary predictorofinclusioninthe
elementary schoolchildren 85thpercentilecategory
schoolchildren followedbygradeandfreeand
United States reducedluncheligibility
3. MostoftheBMIvariationis
accountedforbyethnicity,SES,
andgrade
4. Thegradeeffectandhigh
prevalenceofoverweight/obesity
providearationaleforBMI
screeningretentionattheschools

Huanh, Chien, Media viewing Case-control 1. Participants with total obesity

Yeh, Lee, & after school, study had significantly more television
Chang, 2013 childhood watching time (60.24 minutes vs.
obesity Convenience 43.50 minutes, p G .05) and total
sample= 275 media watching time (73.61
obese children, minutes vs. 52.67 minutes) than
275 normal normal-weight participants
weight children 2. Media watching durations greater
than 2 hours a day correlated
Taipei, Taiwan
OBESITY EPIDEMIC 26

significantly with obesity

Moore, Harris, Parental Qualitative 1. Parents were significantly more

& Bradlyn, concern, likely to report concern if their
2013 childhood Stratified child was female
obesity, BMI random sample 2. Concerned parents were
of 1,500 significantly more likely to limit
kindergarten, child screen time, take steps to
2nd, 4th, 5th, 7th, improve child diet, and increase
and 9th grade child physical activity than were
students parents who reported no concern
United States