The effects of technology used for entertainment on childhood obesity
Statement of the problem
The enormous changes which have occurred in the United States for the past 50 years have been inexplicably tied to the advancement of technology and its integration into our society. Modern culture has evolved with it creating a society where such conveniences are no longer luxuries but rather necessities. And the demographic that has been most affected by these choices are children.
Children have been the main target of consumerism for so many years now that it has become an industry in and of itself. According to the FTC advertising towards children now profits manufacturers upwards of 200 billion dollars annually. Whether it be snacks, or toys or video games advertising towards children has now become a science which is exploited everyday in our society.
As with anything the use of this technology has its own medical, social and religious drawbacks. However one of the most chronic problems facing American society today is one of childhood obesity. The impact of this problem is far reaching and opens up children to several psychological and medical issues which can have far reaching consequences even into adulthood. This proposal will attempt to show the link between these two factors and how health care providers can aid and prevent such issues from occurring.
In simplest terms the cause of obesity is an imbalance in the caloric intake and expenditure. The true measure of obesity in a child is done by taking the child’s Body Mass Index. The Body Mass Index is a measure of the weight to height ratio. The scale reads an index of 18.5-24.5 as average while overweight ranges from 25-29.5. Anything above 29 is characterized as obese according to the average percentile of children in that age group. However in medicine the terms obesity and overweight are interchangeable in the case of children.
A standardized method has been recently created to catalogue and classify children who are overweight and obese based on the body mass index. This allowed the prevalence rates of obesity in children to be studied around the world. They found that obesity was associated with poverty in developing countries and that in adults it is associated with early morbidity (PT, 2004).
In study of nine million children over 6 years of age the Institute of Medicine of national academies found that the obesity rate had doubled in preschool and adolescents and more than tripled for children 6-11 years of age (Institue of Medicine of The National Academies, 2004).
These figures show how childhood obesity has reached epidemic levels within the U.S. Similarly other industrialized nations are also experiencing similar public health problems. Child obesity in Canada has been estimated to be at 30%. Children exposed to obesity at a young age go through several psychological and physical problems. The physical problems can manifest themselves as hypertension, respiratory problems, menstrual problems, hypercholesterolemia, sleep irregularities and several more. Often these problems follow them well into adulthood increasing the risk heart disease, diabetes and various cancers to name a few (Fitzgerald, 2005).
Obese children and adolescents are more likely to stay obese as adults. According to an article published by the CDC if a child is overweight at or before 8 years of age, obesity in adulthood is likely to be more severe (Centers for Disease Control and Prevention, 2009).
Because overweight children often become overweight adults, they are at a rising number of risks and conditions in addition to cardiovascular disease, Type 2 Diabetes and Osteoarthritis. In retrospect this epidemic is not only responsible for a decrease in the individual’s quality of life, but also accounts for a decrease in life expectancy.
When talking about the psychological problems associated with obesity it is important to note the views of society on this condition. Obesity has a negative stigma in society. Obese people are often the subject of ridicule in both the media and in real life. These facts often translate into increased problems faced by children during their pre-teens and adolescence. The Psychological problems stem from the individuals self image of them. Often times they will blame themselves for their condition and become depressed. This depression can be exacerbated by the social conditioning of other children to view obesity in a negative connotation. They will often bully or make fun of them and discriminate against them causing social problems later on in their life. Approximately 60 percent of Obese children between the ages of 6-10 have at least one cardiovascular risk fact while 25 percent have two or more such as elevated cholesterol, high blood pressure or insulin resistance (Institue of Medicine of The National Academies, 2004). Obese children are five times more likely to avoid participating in school physical activities and have lower social, emotional and academic prowess. Additionally when compared with children of normal weight, obese children are far more likely to be overweight when they become adults.
Many social and environmental factors are responsible for this sudden increase. Genetics, though always being cited as an important factor does not fully explain the sudden increase in obesity among ethnic communities. According to the centre for disease control the numbers of children in the 6-11 year range who are overweight are 25.6% for Mexican boys and 16.6% for Mexican girls. From the 12-19 year range it includes 20% and 17.1% of Mexican boys and girls respectively. Caucasian and African American statistics all number around 15% percent (Centre for Disease Control, 2007).
The Journal of Clinical Endocrinology and metabolism cites that the percentage of obese children in the United States based on the greater than 95th percentile showed 21.5% for African-Americans, 21.8% for Hispanics, and 12.3% for non-Hispanic whites. They also said that overweight children in all racial groups were heavier than they have been in the past. However African Americans and Mexican American were in the majority in this case. African American women aged 6-19 years showed the most increase with a prevalence of 26.6% (Slyper, 2004).
Society plays a large role in contributing to this problem. Reasons such as an increase in violent behavior in urban neighborhoods and decreased real estate for physical activity along with pressures related to education have created a habitual decrease in the amount of exercise and proper eating behaviors among children in the United States. The time spent by children using and watching electronic media such as television and video games have increased. Studies have also shown that watching television lowers the children’s metabolic rates below what they would be even if they were sleeping.
The lack of physical activity is another potential factor in the obesity epidemic. The practice of walking and cycling once one of the best and simplest known ways to exercise has now been set aside. Reasons given are the loss of public spaces where such activities can be practiced and loss of safety on public roads (P M Hardus, 2004).
Schools have all but eliminated physical activity from their curriculum in favor of concentrating on proficiency tests. In 2005 only 45% of ninth grade and 22% of 12th grade attended physical education classes (Centers For Disease Control and Prevention, 2008). In 2004 a study compared the blood flow of obese children to that of school children who attended physical classes and found that the blow flow in obese children was drastically reduce. This blood flow improved after only three weeks of physical activity (Watts K, 2004).
Additionally the cross promotion between the media and the food industry has perpetuated a culture of eating fatty foods with very low nutritional value often in front of the television. Children spend an average of 5 hours a day watching various media and are exposed to an food commercial every 5.5 minutes. That equates to around 40,000 commercials a year. Most of those are for snacks, candy, fatty foods, soft drinks, cereals and fast food outlets and all are specifically marketed towards children.
Fast food companies have also created partnerships with schools. Absence of federal funds has dimmed interest within the schools to focus on promoting proper nutrition in children. Soda can dispensers and marketed are now sold in many school cafeterias across the United States in deference to the nutritional foods of yesteryear.
The American Academy of Pediatrics states that the dietary recommendation for those children of two years or older should be primarily fruits and vegetables, whole grains and non-fat dairy products. They also emphasize the low intake of any saturated and trans-fats along with sugars and salt (Samuel S. Gidding, 2006). However with Schools no longer having the budget to concentrate on feeding children they simply cannot feed these children the healthy foods necessary for their growth and development. And thus must defer to the menus set by their sponsors.
According the Clare Miller, a nutrition consultant and member of the American Dietetic Association School Nutrition Dietetic Practice Group, the School Nutritional Diet Study found that few schools met the Dietary Guidelines for fiber and sodium set in 2005. She also said that the students in schools generally purchased low nutrient, high calorie foods such as candy bars and cola beverages in deference to healthy foods (Elsevier, 2009).
The importance of teaching about food in primary schools thus becomes even more important. Teaching children about making balanced food choices is integral to the basis of their future health. It was suggested that the ‘tilted plate’ model, adapted to use foods that children frequently eat and enjoy, could be the basis of such teaching. Such a model could also be used to help caterers plan menus and as the basis of co-operation between nutrition educators and caterers.
A study in the international journal of obesity followed a group of 100 school children from the time when they were enrolled in preschool to early adolescence. The study was published in 2003 and the author found that “television watching was an independent predictor of change in the child’s BMI” and other measures of obesity. They concluded that “television watching is a risk factor for change in body fat, not simply reflective of more obese children tending to watch more television as a consequence of their obesity” (Proctor, 2003).
While a more recent analysis also came to the same conclusion in a study of 2,800 children aged 12 and under. This study also found a non-linear relationship between weight and children playing video games. The playtime in children in the higher weight range was found to be moderate while those in the lower weight range were found to play very little or a lot (Vandewater. E, 2004).
Another article from the Australian Journal of Early Childhood found that pre-teens play computer based video-games on an average of three hours per day. This was an hour more than teens that played for 2 hours per day and young adults who played for an hour a day (Clayton, 2003).
As you can see from all the examples stated above, no matter what economic, environmental or social forces come into play to influence the behavior and culture of children. No matter what actions are taken by health officers and medical workers to stave of this epidemic. The impending problem that is Childhood obesity is already here. And if left unchecked it will a newer generation of our children without any recourse but to live shorter and less healthy lives than their parents.
Methods, design, and procedures
The main objective of the study would be to assess the prevalence of obesity in children according to sex from different socioeconomic backgrounds in the United States. The study will include the amount of exposure to electronic media. Media such as television and video games will be the main focal point with all other media given secondary consideration. General information such as social conditions, lifestyle, diet, exercise will be collected to identify those groups who have characteristics known to be associated with Obesity risk factors. The study will be conducted on a large scale but will involve a small number of overseers in order to keep a limited budget and achieve maximum results.
The Target population of this study will consist of children 2-18 years of age from different socioeconomic backgrounds within the United States. This age group was chosen because the effect of growing up in a media centric environment requires to be explored especially when considered against the pressures of performing in school. Research has shown the obesity can be a product of genetics, upbringing or simply due to social pressure. This age range will allow the study to follow and identify the social and medical factors associated with these children becoming obese. It will also show the various differences in weight across social backgrounds and can explore the means through which obesity can be dealt with.
The proposed design of the study consists of several separate longitudinal studies with a specific cross sectional study design. Each study will focus on children from different socioeconomic backgrounds with no regards to ethnicity. Probability samples of children and a cluster sampling technique will be used at first. And the children selected will be followed at 3 month intervals. The children themselves will keep diaries recording the amount of time spent on indulging in said media. At the end of every 3 months physicals can be taken to assess the health and diet of the children selected. A sample size of 2000 children will be taken with 1000 children of each sex. Socioeconomic backgrounds will be classified according to the income to the main wage earner of the family. The incomes will be divided as follows:
Below 25,000 Dollars
Between 25,000 and 50,000 Dollars
Above 50,000 Dollars
A list of schools in communities can be used to set up sampling sites. At the start a hundred children from each school can be used in each sample. The data of the number of children per school can be made available as well. Other data such the number of classes taken at the school, the amount of physical activity and the nutritional value of the food served in its cafeteria can also be received over a period of time. Personal interaction with the families of the children sampled will be required to gain the maximum benefit of this study. If necessary the aid of the school administration can also be taken in order to ease the parents of the children about the viability of the study. The samples taken will be observed to ensure that an equal number of children are present from all 3 socioeconomic backgrounds to assess the viability of the study. Samples will also be checked to ensure that the children are off the same age as of January of that year. The guardians of the children in question will be asked to keep a diary detailing their habits regarding the use of television, video games or computers. At the age of 7 children will be asked to take over such duties. Details such as their eating habits, their school performance, their psychological make-up, and their personal relationships can also be written. In accordance two procedures can be undertaken for this study. Procedure 1 is suitable for those parents and children who do not wish to keep a journal. In this case a physician and a worker can visit their home every 3 months and assess the health of the child, take his BMI and ask him questions about his habits related to electronic media. Procedure 2 is for those parents and children who have no objections to keeping a diary. In this case a health worker will visit the child at home or will examine him in at a location to be chosen, take the physical of the child and collect the diary. Division of results according to age groups 2-6, 7-10, 12-18 is suggested in this case.
The most relevant measurements related to obesity will be taken. The most feasible that can be taken on a large scale include weight and height for the calculation of Body Mass Index. The hip, thigh and waist circumferences can also be taken. This can be done by a nursing staff at a medical facility or by a physician who visits the home of the child every 3 months. The Dairy given to the family will have sections to record amount of time spent viewing television, playing video games, using a computer and amount of physical activity. The fields will have to fill in daily and accurately by the guardian or the child. A separate field will exist which will be optional this can be used to write any personal comments, dietary information or school performance. If a diary is not used a questionnaire can be provided to both the child and his family to answer. The questionnaire will be collected by the field worker at the end of the child’s physical examination. Each sample will have a different data collection centre to avoid bias.
The data collected will be computerized according to each socioeconomic background. At the end of every year the data collection center will send the cumulative data to a central location which will be responsible for analyzing it. The main analysis will consist of estimation by sex, age, background, media usage of the BMI distribution and the number of children with a BMI above the 90th percentile according to the common reference of that area’s population. An attempt will also be made to indentify the populations affected due to genetics based on the family history of the sample child.
Seasons will be taken into account and indicators such as the living conditions of the child and the changing curriculum of the schools attended will also be analyzed. An attempt will be made to account for the differences in the prevalence of obesity throughout the samples 16 year lifetime. This analysis may lead to new causative factors within the samples age group. Apart from this the local teams will be given freedom to follow-up at different intervals and to develop more local procedures better suited to their area. The data will be further divided according to relevant age groups and socio-economic income.
Existing data can also be used in the analysis if they are indicative of the representative samples from each area taken according to age. Samples of an adequate size can be considered such as 500 minimum for both sexes. The studies conducted would have to have been done within the past two years and include high quality measurements of sex, age, height, and weight (and hip, thigh, and waist circumferences and other measurements, if available). However such data will only be used to supplement the main data.
Supervision of the study can be undertaken by an administrator at each medical facility used for data collection or the supervisor at each data facility. Anonymity will be maintained between each facility to ensure accuracy of data. The focal point of the administration will be done by the central data processing point responsible for the tabulation of all data.
Significance of the study/contribution to the knowledge base
The study can be restarted within a 10 year time frame observing how changing trends in technology can affect the health of children aged 2-10. Two studies occurring concurrently can compare the effects of technology to children with the 2-10 year range and 11-18 year range. It can also be used to study the psychological effects of childhood obesity well into adulthood. If required the study can be restarted to include parameters aiding any form of medical science ranging from pediatrics to dermatology. The data collected can be used to initiate health reforms concerning the use of technology and make people aware of the dangers associated with them.
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