Nursing is a professional work which can focus on helping individuals, families and community in achieving, regain and maintain

the optimal health and the quality of work. It is focused in science and art to promote the health and quality of life.

Contemporary issues which is defined as currents being present and the existing occurs or within the same period. There are many current issues in related to the healthcare in nursing practice, such as obesity among children.

I have selected this topic because childhood obesity is a related issue in the public health nursing practice. I am as a Public Health Nurse in Healthcare Clinic with a large population in a city, and since I worked in this clinic, I always deal with these obesity cases among children.

Obesity is defined as the health impairment loses due to excess of body fat. According to Sorof & Daniels (2002), obesity is the most commonly nutritional problems happen among children in the developed countries. This case is growing

rapidly around the world, especially in the countries in where children are taking unhealthy foods, snacks or beverages every day. Childhood obesity is a global health issues recognized by World Health Organization (WHO).

In my country, there are no known of national research conducted with a specific purpose to determine prevalence overweight and is obesity among children. However, a smaller scale research has been reported and determining prevalence more increasingly. A prevalence of 8% overweight among school children was reported by Bong and Safurah (1996). There was also prevalence of 6.6% was detected among children between 7 years old and 13.8% among 10 years old by Ismail and Tan (1998). There were 5995 children around 7 to 10 years old used as materials in studying the prevalence by Tee et al (2002) whereby excess weight prevalence of 9.7% are boys and 7.1% are girls in Kuala Lumpur. A survey conducted by Ismail & Tan (1998) obesity among children between 7 to 10 years old is higher among boys than girls is 12.5% compared to 5%.

Since 1960s, naturally childhood obesity age 6 to 11years has risen more than double; WHO (2003). A national survey has been conducted at USA starting from

1988 until 1994 founded that more than 20% of children aged 12 to 17 years overweight and with 10% between 6 to 12 years old children been overweight by Segal & Sanchez (2001). Statistic from the latest studies in UK extremely shows that 25% of boys and 33% of girls between the ages of 2 to 19 years old suffer from obese.

Lots of reasons exist why obesity happen among children include genetics factor and environmental factors. First, usually obesity occurs because of the amount of input and output of energy in their body. Imbalance in energy input versus output is one of the factors that caused obesity. It started when the positive energy required for obese to be developed is to small which the person did not realized consuming it. Second, generally a person can identify their weight problem by determine the genetics factor. A correlation has been found between parents and children may be common factors of obesity. Moreover, genetics is the cause of a lot disease happened in obesity such as Laurence Moon Bardet Bieldl syndrome, Prader Willi syndrome, Trisomy 21, Wiedemman Beckwith syndrome which already have been found to be in patients. Fuentes et al. (2002) confirmed that the risk of obesity in their children will continue and increases three-fold as they got it from their parents. This is because parents usually transmit the disease into their heirs without their notice about it. Other than that, usually, children who have the highest body mass

index (BMI) and higher percentage of body fat; less active are children who frequently watching television. This is because children will more likely to spend their time watching television rather than doing physical activities involve body movement which can help in decrease their weight. Children are more interested in food advertisement that have been broadcasted by the TV programmes such as in California; whereby studies have been carried out and resulting for about 385 students in sixth and seventh grade concluded that obesity has linked with the time spent for watching television.

Another main contributor of obesity is fast food consumption. It is undeniable fast food contains a lot of chemical substances including saturated and Trans fats, glysaemic index, and large portion size. About 2200 calories was inside the fast food while sweetened drinks contribute to the total caloric intake which has been reported by Giammattei et al (2003). The condition in home is also one of the factors of obesity based on what Sherina and Rozali (2004). This is because guardian or parents are more likely to give their children any types of food they are interested which are usually high in caloric and poor nutritional value. There is possibilities whereby parents or guardians are more concentrated in placating wards rather than a long-term health. In the meantime, parents that busy with their work serve high calories or fast food because they usually dont have enough time

to prepare food in the house. About 50% of children get breakfast and lunch from their school while 10% get both of the meal based on a survey done in the USA. Thus, it shows that children's diet is influenced by the food supply in the school. What the school serves for the children is important because children may have the access to a wide variety of snack foods and drinks through vending machines and school stores. Maternal smoking during pregnancy can cause child obesity according to a study by Von Kries et al (2002).

The increased risks of obesity have linked with high weight gain. Moreover, children who rarely get breastfeeding from their mother will have the high risk of obesity. Breast milk contains bioactive that regulate the growth factor and tumors factor which two of the factors of obesity. Besides, children should have a good quality of sleep. A research has been done on the relationship between sleep in children and overweight. However, a study found that children aged 6 months to 2 years with sleep duration of fewer than 12 hours per day had twice the odds of being overweight at 3 years of age compared with children sleeping at least 12 hours per day. Thus, children who have the good quality of sleep may be prevented from get obesity.

Obesity has its own effects either to children but also contribute to the hardness in nursing and healthcare area. According to Buiten & Metzger (2000), Crawford et al (2001) due to high risk that the obesity in children may lead to adult obesity and cardiovascular disease. Data from a study has shown that 60% of children overweight had cardiovascular risk factor included heart diseases, hypertension, high blood pressure and hyperlipidemia. The Centers for Disease Control and Prevention (CDC) calculated that in 2000s, about $33 billion was spent by the United States in order to treat weight loss. Children who have a moderate overweight usually carry a low-density lipoprotein, low cholesterol level and hypercholesterolemia. It is well-known that childhood obesity has negative impacts on their body which have similarities with adults by Reilly et al (2003). Hence, because of this, action should be taken as a prevention of this disease.

There are suggestions whereby the American Academy of Pediatrics (AAP) Expert Committee on childhood obesity proposes the children to have balanced food nutrition in their meal. The fruits amount should be taken increasingly so do the vegetables which play important role in humans body. Not to forget to take foods that rich in calcium and fiber. The breakfast frequency and doing physical activity must be increased. Avoidance has to be taken whereby children should decrease

the meals consumed from home, screen time, and consumption of sugar beverages.

School provides an ideal setting to improve dietary and physical activity which also could be a way to prevent obesity. Lots of programs in school were conducted as initiatives to curb the disease. The role of communities and family are also essential in this matter. This is because parents are the first step to Demonstrate healthy lifestyles for their children. Parental beliefs and practices shape the outlook for their children's beliefs and practices. Observation is important to children whereby parents must watch every amount and types of food that their children take. Excessive amount of time spent sitting in front of a television should not be encouraged. The eating habit of the children should be control by the parents. The parents must check what type of foods they have in their home and what foods are consumed outside of their place. Parental supervision of food consumption is also crucial for a child. If parents believe that their children are able to select and prepare healthy foods on their own, their lack of involvement will likely lead to poor outcomes for their childrens health. Moreover, childrens physical activity is also should be determined by their parents. Extracurricular activities, such as clubs and sports need to be encouraged by parents. It is important to have them involved in other activities as well. Allowing children to come home from school and sit in front

of a television until bed hour will create poor lifestyle habits. A simple way for the parents to prevent obesity among their children is by limiting the amount of television viewing time for them. Television is one of the contributors of childhood obesity because of its media that show various food advertisements whether good or not. Thus, by limiting the viewing time amount, automatically, parents can help them in prevent obesity.

A study in my country was done from March to June 1991 in a primary school upon obesity children from year one until year six to determine the prevalence of obesity among primary school children. The study subjects were chosen whereby three primary schools in a rural setting were selected comprising one National Primary School, one National Chinese Primary School, and one National Tamil Primary School. A class of standard with one child and a class of standard six children in each of the schools were selected randomly comprising 25 children were also chosen randomly from each class. The prevalence rate of obesity of 7.8% should serve as an early warning signal to health authorities of the seriousness of the problem in our young children. While it is not as high as that reported for Singapore children, it is still high enough to be a cause for concern. In a prevalence study of obesity in Singapore primary school children, reported a prevalence of obesity of 1.8% in 1976 which increased sharply to 5.33% in 1980. Ministry of Education

Singapore (1988) was reported that the prevalence of obesity among children in Primary one, Primary six and Secondary four combined was 14.4% for boys and 10.6% for girls. Comparison of prevalence rates between schools in urban and rural settings shows a higher proportion of obesity among school children in urban areas compared to those in the rural areas for all the 9 districts. Overall, the prevalence of 9.8% of obesity in the urban schools was significantly higher than the 6.1% found for rural schools.

Urbanization and increasing affluence appears to be accompanied with an increasing number of obese people. In all the districts, except Kuala Selangor, the prevalence of obesity was found higher among Standard 6 pupils than the year 1 children. Overall, there was a significant higher prevalence rate of obesity in Standard 6 pupils (11.1% versus 4.4%, p<0.000l). This increasing prevalence rate among older children is noteworthy and is similar to the Singapore studies. Thus, to assess and control childhood obesity, it is necessary to screen children school several times and not just at Standard 1. This is probably one of the larger studies on obesity among primary school children in Selangor. It should be an impetus for us to conduct similar studies every 3 or 5 years to find out if the pattern of childhood obesity is one of increasing prevalence over the years. It should also fuel our interest to find out if older school children tend to develop obesity as they grow

older or not. All these studies will therefore provide basic data which will be of great help for future preventive measures.

My country has become one of the developed countries in the world in terms of technologies, education, media, economic and job. The westernization that created from other countries has diffused into our country and it affects a lot in terms of technology, society, culture and habit. In my country, obesity has increased from 1% in 1990 to 6% in 1997 among 13 to 17 year olds by Ismail & Zulkifli (1996), The westernization of global eating habits has also brought about an increase in the number of fast-food outlets in my country during the last decade. This is where the Ministry of Health in my country started to form various plan in order to have vision into a healthy lifestyle. Healthy lifestyle is including healthy eating habits and maintaining a desirable dietary pattern, Tee (1999).

In consequence of the issue of increasing diseases in my country, the Health government has launched campaigns for the health lifestyles such as the School Health Program and the School Canteen Guideline. It is aimed to protect and maintain excellent health of students and school personnel, advocate healthy

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school living and establish enticing knowledge, attitudes and practices relate to health. The Healthy Lifestyle Campaign was launched in my country as a constant reminder to the public about the importance of a healthy lifestyle in national development. The objective of the campaign is basically to increase the awareness and knowledge of the public about diseases that arise as a result of unhealthy lifestyles as well as to motivate the public to adopt health-promoting practices and lifestyle. Another series of activities was implemented with the theme Healthy Eating by the Ministry of Health and completed under second phase of the campaign. Different organizations were recognized by the Health Ministry for collaboration such as Radio and Television, the Education Ministry and more due to propagate the Healthy Eating messages.

A study of food and nutrition among the various target groups was carried out to obtain baseline data (Tee, 1999). There were a lot of challenges during the process of implementation of the healthy lifestyle campaigns where nutritionists are trained to accomplish this activity together with other intervention programs. The numbers of nutritionists need to be increased to ensure the good achievement of the programs. Need to be adequately addressed is also the continuing education of existing by Tee (1999).

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Management of childhood obesity has recommended in a clinical practice guidelines which were arranged by the Ministry of Health and Academy of Medicine in my country. The recommendations were included the reduction of energy intake by dietary modification, increased energy expansion through external activities that grows and family members participation in the process of changes. On the other hand, the government also thinks the good manner to influence the convention is to avoid it. Hence, parents should play its role towards the prevention of obesity including observation on their children such as observe and limiting the amount of high calorie foods that stored at home, do not currently offer candies in exchange for meals spent, and others.

Childhood obesity related to health effects and enormous cost to society. Immediate action is needed to slow or reverse the worrying trend by Zhang & Wang (2004). The program addressed to the treatment of children with obesity, pay more attention should be given to prevention strategies. Nurses working in health and the community environment that provides many opportunities for the health promotion and prevention of obesity. They have an important role in working with other healthcare provider, society and governments to deal with the serious public health problems. The proposal for nursing intervention, as the ecology of framework, to assist the nurse population, school family and the individual level of practice. The role of nurses in this management also important because nurses

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can provide healthcare education to pregnant mothers during the clinic visit as advised them to supply of good nutrition, prenatal care, avoid excessive maternal weight. After childbirth, nurses have to help mother to lose weight and offers

nutrition education and suggest them on the benefits of breast feeding. For infants promote to mothers of exclusive breast feeding up to 6 months, and maintain breast feeding until 2 years WHO (2003). To encourage initial introduction of solid foods, supplement to feed have to start essentially by 6 months. Promote healthy eating and physical activity. Nurses evaluate the physical growth and child development which includes: discussing or documenting basic dietary patterns, identify risk factors among individuals and families on children who obese, measure and record the height and weight; calculate the BMI for children who are two years of age and observe for important variations.

In conclusion, all communities and organizations should together prevent obesity among human especially among children. Healthy lifestyle including healthy behavior such as physical activities should be encouraged since they were young. The relevant ministries must take part in this issue and so did the nurses must have a lot advice to pregnant mother and to those in need. The role of parents and families are important for those children. The parents cannot despise the overbalance risk among children. They should understand the importance of physical activity with encouraging them for active outdoor or indoor play. Apart

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from performing enabled environmental, parents also have to performing a healthy nutrition environments such as a healthy diet that is rich in fruit, vegetables, and cereals. School also must play its role in this matter. It is a necessity for school agency to provide physical and social that allows children to participate in outdoor activities which are safe and enjoyable. Physical education timeline should not be ignored that seeks to revise.

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