Running Head: CHILDHOOD OBESITY

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Childhood Obesity in America

Helen McDonald
Nursing Research Methods NUR5680
May 6, 2015
State University of New York Polytechnic Institute Utica Rome

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Abstract

There is a plethora of information about the rising epidemic of childhood obesity. Early
life obesity sets an individual up for lifelong complications related to the disease. So the question
is asked; with all this information and with childhood obesity being studied so well, why is it still
a problem of epidemic proportion in America? Multiple links have been associated with
childhood obesity. These links need to be compiled together because there is no singular cause
for this problem but rather a snowball effect of multiple factors. The purpose of this research is
to discover what causes obesity in America by discerning the social, political, economic,
biophysical, psychological and cognitive explanations that contribute to obesity using historical
research methodology.

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Childhood Obesity in America
Introduction

Background and Significance

Childhood obesity is an epidemic that has grown out of control in the United States.
Obesity can lead to numerous health problems including; hypertension, cardiovascular disease,
myocardial infarction (MI), stroke, and diabetes. Tragically, adult onset diabetes is increasing in
children as well as stroke and MI (Couric, David & Soechtig, 2014). Currently one third of
children are overweight and 17 percent of United States (US) children are clinically obese
(Gollust, Kite, Benning et al., 2015; Rutkow, Vernick, Edwards et al., 2015). In 1970, the obesity
rate in children ages 2 to 19 was 5 percent. In the 1980s childhood obesity rates doubled and in
2008, obesity rates soared to 16.9 percent (Gollust, Kite, Benning et al., 2015). Today, it is one of
the most frequent chronic health conditions in children with serious life and financial
consequences (Gollust, Kite, Benning et al., 2015).
The most commonly blamed reason for obesity is poor diet and lack of exercise coupled
with a sedentary lifestyle (Gollust, Kite, Benning et al., 2015). In 1977, a government dietary
committee formulated the first dietary guideline called Dietary Goals for the United States or
The McGovern report. The food industry fought the report and requested it to be rewritten
because it suggested their consumer should eat less (Couric, David & Soechtig, 2014). Later, the
World Health Organization (WHO) recommended no more than 10% daily calorie allowance
from sugar (Couric, David & Soechtig, 2014). The sugar industry fought this recommendation
and withheld a 4.6 million dollar donation from the WHO until the percent daily recommended
allowance of sugar was removed from food labels (Couric, David & Soechtig, 2014).

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Government health policy and food industries have had multiple encounters such as these where
the food industry has won over, placing our youth at greater risk for lifetime problems.
Food industries target children by enticing them with incentives to buy their products.
Incentives include cartoon characters on candy and jungle gyms at fast food restaurants (Couric,
David & Soechtig, 2014). Food is marketed toward children with commercials during childrens
television programing. A study where gold fish crackers were placed near children while
watching television showed that children were more likely to eat the crackers when commercial
ads were shown with food products (Couric, David & Soechtig, 2014). Children are targeted in
stores by placing it at their eye level in store (Couric, David & Soechtig, 2014).
Nurture versus nature has been examined in all areas of development, childhood obesity
is no different. Genetics and parenting have been identified as contributing factors to childhood
obesity. Ethnic and cultural backgrounds are non-modifiable risk factors that need to be
considered. Maternal health practices are detrimental to the health and wellbeing of neonates and
cause lasting effects in life. A childs family social activities and relationships have also been
shown to correlate with the disease.
Socioeconomic status (SES) contributes to the familys ability to afford and obtain
medical treatment, fresh produce, education and physical exercise. These are key factors when
evaluating causes for obesity. Government policy makers and food industries need to work
together to make these resources affordable to decrease the prevalence of childhood obesity.
Statement of Problem
What are the causes for obesity and what combination of risk factors place children at
higher risks? What changes in the legislative policy and nutritional recommendations may have

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amplified the problem? There has been a great deal of literature and research on the topic of
obesity, each one examining another reason for the rise in obesity. A historical design will
examine this evidence and place it in chronological order. The purpose of this research is to
discover what causes obesity in America by discerning the social, political, economic,
biophysical, psychological and cognitive explanations that contribute to obesity using historical
research methodology.
Literature Review
Early-life risk factors for obesity have been identified as; maternal age, maternal obesity,
excessive gestational weight gain, low maternal education, smoking during pregnancy, low
maternal vitamin D levels, high or low birth weight, short breastfeeding duration or lack of
breastfeeding, maternal occupation, education, income, marital status, number of members in a
household, family experience and SES (Robinson, Crozier, Harvey et al., 2015; Huang, Lanza &
Anglin, 2014). These risk factors, when found in combination, can increase the chance for
childhood obesity dramatically (Robinson et al., 2015).
Political. Childhood obesity is a public health crisis requiring comprehensive, evidencebased policy changes (Gollust et al., 2015). National, state and local legislative and regulatory
proposals have been made, but they all fall short for the scope and urgency of this growing
problem (Gollust et al., 2015). Policies are often subject to lawmakerss fundamental concerns,
anecdotes, values and political pragmatism (Gollust et al., 2015). Researchers and policymakers
work against each other inadvertently. Evidence based research needs to be relevant to
policymakers. To accomplish this, policymakers require research application of evidence from
local areas in a timely manner, written in easy formats with implications for specific policy
changes (Gollust, Kite, Benning et al., 2015). Policy recommendations for childhood obesity

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necessitates context with attention to specific agenda; such as nutritional policy or physical
activity policty (Gollust et al., 2015). A study completed in Minnesota from 2007 to 2011 found
that only half of policy decisions were related to evidence-based research (Gollust et al., 2015).
This demonstrates an opportunity and need for evidence-based support for policy decisions
(Gollust et al., 2015).
It will be difficult to reverse obesity rates without early intervention, especially where
obesity rates have reached more than 35 percent (Dunn-Rankin, Rudoy & Brennan, 2015).
Childhood obesity and its comorbidities can extend into adulthood (Kahn & McKenzie, 2015).
Manifestations of adult diseases are being seen in children because of obesity including; stroke,
cancer, type two diabetes and metabolic syndrome (Kahn & McKenzie, 2015). Physical activity
is an accepted way to prevent and treat childhood obesity (Kahn & McKenzie, 2015). Moderate
and vigorous physical activity is recommended daily for youths in elementary, middle and high
school (Kahn & McKenzie, 2015). Despite the known health benefits and recommendations of
daily physical activity, only 19 states have policies requiring time for physical education in
schools; only three of which have requirements for both primary and secondary schools (Kahn &
McKenzie, 2015).
Biophysical and cognitive. Reinforcing values of food (RVF) are how hard an
individual will work to earn food compared with alternative reinforces (Faith & Pietrobelli,
2015). The RVF is noted to be greater in obese women. It can predict weight in non-obese
adolescents, shows significant parent-child correlation, and interacts with serotonin
polymorphisms in predicting adult BMI (Faith & Pietrobelli, 2015). According to Faith and
Pietrobelli (2015), Neuroimaging research suggests hypreactivation of the brain reward
region associated with motivation and reward in obese compared with healthy-weight youth

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(421). Study design, sample size, analysis? In a study comparing infant twins, it was found that
higher food responsiveness predicted greater standardized weight gain (Faith & Pietrobelli,
2015). Children are often rewarded with foods high in sugar and fat rather than vegetables;
setting patterns for life (Trueland, 2014).
Biophysical and political. It is well known that decreasing energy intake by ingesting
fewer calories can reduce childhood obesity (Rutkow, Vernick, Edwards et al., 2015). Food and
beverage manufacturers promote energy dense items to children with false health claims; such
as, the product is a good source of vitamins and minerals (Rutkow, Vernick, Edwards et al.,
2015). Laws prohibits deceptive claims of product health benefits. Claims that are deceptive
include misleading consumer messages tied to consumers purchasing decisions (Rutkow,
Vernick, Edwards et al., 2015). The US Food and Drug Administration (FDA) regulate food
labeling and health claims and the Federal Trade Commission (FTC) regulate food advertising
(Rutkow, Vernick, Edwards et al., 2015). Legal action against these deceptive health claims
towards children has been increasing. The use of president?precedent setting? lawsuits increases
the likelihood of future success by tailoring new claims to location and plaintiff populations
(Rutkow, Vernick, Edwards et al., 2015).
Biophysical and Economic. Studies have found that children living in low
socioeconomic statuses have higher prevalencess of obesity (Huang, Lanza & Anglin, 2014).
Socio-demographic factors contributing to obesity in kindergartens include; Latino and African
American race/ethnicity, lower parental education level, unmarried biological mother, poverty,
non-English primary language, and Medicaid insurance coverage (Flores & Hua, 2013).

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A study by Fradkin, Wallander, Elliott et al. (2015) associated socioeconomic status

(SES) and obesity in adolescents with various races and ethnicities. The study found that youth,
in 5th and 7th grades, growing up in higher SES had lower prevalence of obesity compared to
lower SES. African American youth have no association between SES and obesity (Fradkin,
Wallander, Elliott et al., 2015). Previous research has demonstrated that higher SES in white
ethnicity decreases obesity rates; whereas in African Americans and Hispanics with higher SES
may increase obesity rates (Fradkin, Wallander, Elliott et al., 2015). Its been shown that African
Americans and Hispanic youth have higher rates of obesity disproportionately compared to nonHispanic Whites. This is attributed to SES and educational differences in racial and ethnic
groups. Study, design, sample size, analysis so the reader can also analyze the study.
There are differences in activity levels and dietary intake patterns when comparing SES
levels (Fradkin, Wallander, Elliott et al., 2015). SES affects the knowledge and means of
providing families with healthier diets and engaging in physical activities (Fradkin, Wallander,
Elliott et al., 2015). When gender is considered, further complications to associate SES and
obesity arise; a higher SES is associated with lower obesity rates in white females and in African
Americans this proves to be opposite, or that SES has no effect in theseis groups (Fradkin,
Wallander, Elliott et al., 2015). Children residing in lower SES neighborhoods have a decrease
availability of fresh produce and safe outdoor exercise facilities. There is disparity in research
that examines parental adiposity, pubertal development, family structure, meal frequency, body
image and body size values (Fradkin, Wallander, Elliott et al., 2015). The US is a melting pot;
research needs to be directed toward different groups in the behavioral social and cultural
processes defining the population (Fradkin, Wallander, Elliott et al., 2015).

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Social. The long-term effects of maternal smoking in 7 to 33 year olds has shown an
increased obesity risk for females at age 11 and age 16 for males; and age 33 for both genders
(Huang, Lanza & Anglin, 2014). Study, design, sample size, analysis so the reader can also
analyze the study.Obesity risk doubles for children age two to four with mothers who smoked
during pregnancy (Huang, Lanza & Anglin, 2014). Maternal smoking has been shown to
decrease fetal growth and ultimately accelerated growth immediately after birth (Huang, Lanza
& Anglin, 2014). A longitudinal association was found in the KOALA Birth Cohort Study
between smoking during pregnancy and childhood obesity (Timmermans, Mommers, Gubbels et
al., 2014). Babies born of maternal smoking during pregnancy typically have lower birth weights
and have catch-up weight within the first year, exceeding the 85th percentile of BMI into children
(Timmermans, Mommers, Gubbels et al., 2014). Mothers who smoked during and after
pregnancy are less likely to engage in health-promoting behaviors such as eating nutritiously and
engaging in physical activity which increases adolescent obesity in their children (Huang, Lanza
& Anglin, 2014).
Social and cognitive. Family rules and parental engagement of the childs daily activities
lowered the chances of obesity (Huang, Lanza & Anglin, 2014). Excessive television viewing
increases obesity risk (Huang, Lanza & Anglin, 2014). Study, design, sample size, analysis so the
reader can also analyze the study.Children are better able to self-regulate daily activities with
impulse control if more family rules are present (Huang, Lanza & Anglin, 2014). Greater
parental involvement may mean closer parent-child relationships which may lead to an increase
in consumption of nutritious foods and development of healthy habits (Huang, Lanza & Anglin,
2014). Maternal education was only seen to effect children at age 10 (first year of adolescence)
but no associated with obesity risk changes from age 10 to 18 (Huang, Lanza & Anglin, 2014).

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Negative social and emotional consequences from childhood obesity include low
self-esteem and depression (Jackson & Cunningham, 2015). Victimization with teasing and
exclusion among children with obesity has been well documented (Jackson & Cunningham,
2015). Unhealthy behaviors are due to poor social competence by avoiding social situations with
negative feedback resulting in energy imbalances and weight gain from solitary, sedentary
activities and unhealthy eating (Jackson & Cunningham, 2015). Children who are not
engaged with peers may be less receptive to cues about ideal body type, perhaps because they
spend less tie among peers or may be less skilled at interpreting- or less motivated by- social
censure (Jackson & Cunningham, 2015, p. 157). Evidence was not found to support that obesity
leads to decreased social competence (Jackson & Cunningham, 2015). Study, design, sample
size, analysis so the reader can also analyze the study.
Consistent bedtimes and more sleep are associated with lower weight prevalence
in preschool and kindergarten ages (Flores & Hua, 2013). Infants should be feed when they are
hungry and not on a regular schedule (Flores & Hua, 2013). Toilet training before the age of one,
more television watching and home computer use in preschool years and smoking in the home
have been associated with childhood obesity (Flores & Hua, 2013). Eating dinner together as a
family during preschool and kindergarten ages reduces obesity (Flores & Hua, 2013). Playing
outside, walking and participation in organized athletics can reduce obesity (Flores & Hua,
2013). Higher percentages of obesity were found in children drinking water with meals or
drinking coffee or tea between meals or before bedtime at two years of age (Flores & Hua,
2013). Drinking soda, sports drinks or fruit drinks with sugar and other additives increases risks
(Flores & Hua, 2013). Lower percentages of obesity were observed in children who drank milk
compared to other beverages with meals (Flores & Hua, 2013). Parental rules about the kinds of

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food the child are at preschool and kindergarten ages, whole-milk consumption in kindergarten,
and no consumption of fast foods in the past seven days also were associated with a lower
overweight prevalence (Flores & Hua, 2013, p. 1181). Study, design, sample size, analysis so
the reader can also analyze the study.

Hypothesis and Research Question

The research question is; what are the biophysical, psychological, social and cognitive
explanations for childhood obesity in America. It is hypothesized that there are multifaceted
problems for obesity. Obesity is not caused by any one problem but rather intricate combinations
of different complications found throughout history.
Methods and Procedures
Description of Research Design
The historical research methodology will be used as the research design. Historical
research requires a question to identify, inventory and evaluate sources (Grove, Burns & Gray,
2013). A historical narrative is written with a clear, concise statement of topic (Grove, Burns &
Gray, 2013). The time period being studied has to be identified. Knowledge of the social,
political and economic factors that would have an impact on the topic needs to be understood to
determine the time period (Grove, Burns & Gray, 2013).
Description of Setting

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The major settings that will be used are primary and secondary schools in the United
States. Other settings used would will include hospitals, doctors offices and dieticians offices.
The childs primary household will be identified as a setting as well. Household factors and
parental SES and parenting styles will be examined. The neighborhoods in which children live
need to be considered for access to nutrition and availability of recreational activities.

Sample Procedure and Characteristics

This is a historical design and therefore literature five years and older should be
examined; the requirement for this paper is within five years. Online databases, CINAHL and
MedlinePlus are searched. Key words include; obesity, obesity in America, pediatric obesity,
obesity in children, obesity in adolescents, obesity in school aged children, obesity prevention,
obesity risk factors, obesity epidemic, obesity legislation, McGovern report, nutritional
guidelines, food industry and obesity, American agriculture guidelines, obesity causes, obesity
health associated problems. Historical research is also gained from; local and national television
news, documentaries, political and government documents. The Food and Drug Administration
(FDA), Centers for Disease Control and Prevention (CDC) and National Institutes of health
(NIH), World Health Organization (WHO), American Heart Association (AHA), and United
States Department of Agriculture are excellent sources for this research. Social media is a source
of information from parents and older children to gain insight into the problems from their
perspectives. Interviews from children and their families who suffer from obesity can be
conducted. Primary sources are children and families that are involved in the situation. Evidence

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iswill be gathered from their personal experience but this lacks critical analysis. Secondary
sources arewill be written about the situation from an outside perspective (Grove, Burns & Gray,
2013). These are literature sources of writing about children with obesity (Grove, Burns & Gray,
2013). Secondary sources validate primary sources and add additional information and opinions
(Grove, Burns & Gray, 2013). It is essential that external and internal criticisms establish
authenticity and determine if information is consistent with what is already known (Grove, Burns
& Gray, 2013). Sampling and eligibility criteria will have inclusion and/or exclusion sampling
criteria (Grove, Burns & Gray, 2013).
Ethical Consideration
Ethical considerations are covered in the Belmont Report (1979) and United States
Department of Health and Human Services (HHS) Regulations for the Protection of Human
Subjects (Protecting Human, n.d.). The Belmont Report identifies respect for persons,
beneficence and justice as essential components of ethical conduct of research with humans
(Protecting Human, n.d.). Because the research subjects studied are persons with diminished
autonomy, in this case children, they need to be taught to their comprehension and respect their
right to choose to participate based on capacity (Protecting Human, n.d.). The parent or legal
guardian must grant participation permission (Protecting Human, n.d.). Participants need to
comprehend risks and benefits associated with participation (Protecting Human, n.d.).
Participants cannot be coerced or compensated for participation (Protecting Human, n.d.).
Beneficence is to do no harm, maximize benefits and minimize harm (Protecting Human, n.d.).
Children are a vulnerable population and subpart D offers addition protection for research
involving children (Protecting Human, n.d.). Any informed consent needed?? IRB approval is
needed!

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Measurement Instruments
Measurement instruments are flexible with a qualitative, historical design (Grove, Burns
& Gray, 2013). Content analysis and literature review will be used to describe the circumstances
surrounding the chronological processes that have led to the epidemic problem of childhood
obesity. The historical design is a descriptive account of the past, tying pieces together with
flowing and revealing vibrance (Berg, 2001). It describes interesting and important past events,
people and developments by discovering records and accounts in the past that have helped
formed the present (Berg, 2001). Contemporary issues of health can be explored through
historical analysis of social knowledge, traditions and conditions (Berg, 2001). It provides a
broad understanding of human behavior compared to with static isolation of the present (Berg,
2001). Measurements are met when the answer to a question is found or relationships of events
in connection to the present (Berg, 2001).
Data Collection Strategies
Data collected will fulfill the criteria of the research problem and question. Data
collection sources are from confidential reports, public records, government documents,
newspaper editorials and stories, essays, songs, poetry, folklore, films, photos, artifacts
interviews and questionnaires. The data collection strategy will begain with identifying the topic
and research question followed by conducting a literature review. Research ideas will beere
refined ?and the historical research design method was chosen.? Primary and secondary data
sources arewill be identified; then authenticity and accuracy of sources arewill be identified.
Finally, the data is will be analyzed and developed into a narrative. Stay in future tense as the
study has not been done!!

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Analysis Plan
Historical analysis is used to gather and analyze data at the same time (Grove, Burns &
Gray, 2013). Documents are sampled to seek descriptions and contextual details as well as
analyze conflicting records (Grove, Burns & Gray, 2013). The researcher will become immersed
in data and develop a topic description based on findings (Grove, Burns & Gray, 2013). The
historic narrative uses extensive record analysis, some with more than one-hundred references
(Grove, Burns & Gray, 2013). Interpretation of documents, opinions and stories help to
understand or uncover the topic (Grove, Burns & Gray, 2013). Once redundancy is found,
research should stop: it can begin again if further questions or gaps in information are found
(Grove, Burns & Gray, 2013).
Data must be organized chronologically and could be completed in an outline becoming
the skeleton of the narrative or biography (Grove, Burns & Gray, 2013). A historical narrative or
literature review is produced with knowledge gained from research (Grove, Burns & Gray,
2013). The researchers motivation, such as curiosity, personal factors or professional reasons,
need to be explained with a clear, concise statement of topic (Grove, Burns & Gray, 2013). The
researcher must have broad knowledge of social, political and economic factors that have had an
impact on the research topic (Grove, Burns & Gray, 2013). Links are made by the historical
researcher from the past to the present (Grove, Burns & Gray, 2013). The focus of the historical
design is the final product which may be a documentary, essay or book.
Limitations
Limitations of the historical research are related to the quantity and quality of the
information found. Bias will occur if information is weeded down to the researchers preference

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of information found. The historical design is limited to the collection of information found and
the interpretation or analysis of data found (Berg, 2001). The researcher must avoid using
modern thought to understand past information; literal and latent meanings need to be analyzed
(Berg, 2001). Judgement about earlier cultural norms can cause limitation to understanding and
should not be drawn but rather seen for the progression of modern practice (Berg,
2001).Confusion may result in attempting to understand and assess the motives of resource
authors (Berg, 2001). The quantity of information collected may cause confusion and
disorganization (Berg, 2001). Data storage and retrieval methods need to be determined prior to
data collection to prevent confusion and loss of data.
Dissemination of Findings
Dissemination of findings will be discussed during nursing, research, public health,
school and student conferences. The findings can be presented to legislators and assist with new
policies to decrease the prevalence rates. The historical narrative of Childhood Obesity in
America will be published in nursing, dietary, research, political and news journals and
newspapers. There will be a great deal of data found on the topic and a book may need to be
written.
Conclusion
Childhood obesity is an epidemic in America. It has become a progressive problem with
seemingly no end in sight. A historical design will examine this evidence and place it in
chronological order. The purpose of this research is to discover what causes obesity in America
by discerning the social, political, economic, biophysical, psychological and cognitive

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explanations that contribute to obesity using historical research methodology. The results of this
research willth uncover the underlying problems surrounding this problem.

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