Understanding Childhood Obesity Research Articles

Understanding childhood obesity in Pakistan: exploring the knowledge, attitudes, practices of mothers, and influential factors. A cross-sectional study.

Childhood obesity is a significant public health issue with far-reaching implications. The World Health Organization reported that in 2020, around 38 million children under five were overweight or obese globally, and in 2016, 340 million children and adolescents aged 5-19 were affected. In Pakistan, the situation is alarming; 66.9% of school-going children in Punjab were overweight, and 5.8% were obese in 2022. This study explores mothers' knowledge, attitudes, and practices regarding childhood obesity in Pakistan and identifies factors contributing to this epidemic. Maternal perspectives are crucial as they significantly influence children's dietary habits, physical activity, and attitudes toward food and body image. A cross-sectional study was conducted from November 2023 to January 2024 at four medical centers: Fazaia Ruth Pfau Medical College Hospitals Karachi, Baqai Medical University Karachi, and Nishtar Medical University Multan. The study included 191 mothers with children aged 5 to 15 years. Data were collected using a structured questionnaire on sociodemographic characteristics, knowledge, attitudes, practices, and perceptions of childhood obesity. IBM-SPSS version 26.0 was used for data analysis, employing statistical tests like Kruskal-Wallis, Mann-Whitney U, Spearman, or Kendall Tau correlation to examine associations. Among the 191 mothers, 48.7% had education beyond intermediate, and 86.9% were housewives. The children's BMI distribution showed that 27.7% were obese and 21.5% overweight. Mothers had moderate knowledge (60.5%) about childhood obesity; 75.4% recognized its long-term health risks, and 62.8% associated it with diabetes. Attitudes were generally positive, with a 78.5% average score. Most mothers (73.8%) believed obesity could be controlled and had healthy practices (70.1% average score). However, 96.9% reported witnessing stigmatization of obese children, and 79.6% felt pressured by relatives about their child's weight. The findings indicate that while Pakistani mothers have moderate knowledge and positive attitudes toward childhood obesity, their practices are influenced by educational and socioeconomic factors. Addressing these disparities, enhancing public health initiatives, and mitigating stigmatization could improve childhood obesity management in Pakistan.

Cardiometabolic Risks in Adolescent Obesity

Currently, childhood obesity is a major public health issue in the Western world. There has been evidence citing that although obesity is a major problem during adolescence, it could also be the beginning of more serious conditions during adulthood. Because of this, numerous studies have been conducted to understand childhood obesity, most of which rely on cardiometabolic risk factors to predict and determine the prevalence of childhood obesity. This study aims to correlate childhood obesity with cardiometabolic factors to generate insights on forthcoming studies on this subject matter. Methods: This study relies on research into the verified risks linked to childhood obesity. Reliance of secondary sources of data, which include journals and textbooks that are relevant to this study were also included. Database (PubMed, Medline, Google Scholar) searches including key terms such as “childhood obesity”, “cardiometabolic risks”, “childhood obesity risks” and “metabolic syndromes” were used. Strategically, articles were included as early as the 1970s to track the changes in diet and lifestyle, which could be implicated as risk factors. This study consists of different populations of children from various parts of the U.S., which in consequently explores the implications of socioeconomic differences. Results: It has been shown that childhood obesity is associated with numerous cardiometabolic risks that can affect both children and adults. Additionally, evidence shows that childhood obesity has a high morbidity and mortality. It also has been shown that childhood obesity has been found to lead to exacerbation cardiovascular risk factors during adulthood. The evidence generated on this subject is not on par with meta-analyses and randomized controlled trials as the majority of these studies were non-experimental. Conclusion: The study into the association between childhood obesity and cardiometabolic risk factors as well as adult cardiometabolic risk factors underlines the requisite for more research on this subject matter. Suggested studies should include the restructuring of the general management of childhood obesity as well as associated risks for current and future generations. Although there is considerable information available on childhood obesity and related cardiometabolic risk factors, the validity as well as reliability that more assertive studies such as Random Controlled Trials (RCTs) and metaanalyses have been yet to be included.

Slim choices: young people’s experiences of individual responsibility for childhood obesity

ABSTRACT When trying to understand childhood obesity, policymakers and healthcare professionals most often make use of behavioural sciences and biomedical perspectives. This approach assumes that fatness is unhealthy and caused by people making ‘bad choices’ about their diet and physical activity. Increasingly not only parents, but also children, are considered to be individually responsible for their weight, their health, and through that, for the ‘obesity epidemic’. Drawing on critical obesity/weight studies and practice theory, this paper challenges the individualistic and weight-based view of health, and the heuristic of ‘individual food choice’, and through that such a framing of childhood obesity. It does so by focusing on the experiences of young people medically identified as overweight, who are trying to lose weight. Looking at two domains of children’s lives, their family and peers, the paper demonstrates how young people experience and negotiate the individualized health advice, and what sort of consequences this has for their daily lives, and their mental and physical wellbeing. The article is based on observations of interactions between families and healthcare professionals, conversations with children and parents, as well as participant observation at youth summer weight loss camps, which were part of a larger ethnographic research project conducted in 2018–2019 in Poland. The paper concludes by proposing to reframe how we think about childhood obesity, and consider young people’s knowledge and lived experiences when re-designing policy interventions and wellbeing promotion programmes, that is, to work with, and not on, children.

Reframing the early childhood obesity prevention narrative through an equitable nurturing approach.

High‐quality mother–child interactions during the first 2,000 days, from conception to age 5 years, are considered crucial for preventing obesity development during early life stages. However, mother–child dyads interact within and are influenced by broader socio‐ecological contexts involved in shaping child development outcomes, including nutrition. Hence, the coexistence of both undernutrition and obesity has been noted in inequitable social conditions, with drivers of undernutrition and overnutrition in children sharing common elements, such as poverty and food insecurity. To date, a holistic life‐course approach to childhood obesity prevention that includes an equitable developmental perspective has not emerged. The World Health Organization (WHO) Nurturing Care Framework provides the foundation for reframing the narrative to understand childhood obesity through the lens of an equitable nurturing care approach to child development from a life‐course perspective. In this perspective, we outline our rationale for reframing the childhood narrative by integrating an equitable nurturing care approach to childhood obesity prevention. Four key elements of reframing the narrative include: (a) extending the focus from the current 1,000 to 2,000 days (conception to 5 years); (b) highlighting the importance of nurturing mutually responsive child‐caregiver connections to age 5; (c) recognition of racism and related stressors, not solely race/ethnicity, as part of adverse child experiences and social determinants of obesity; and (d) addressing equity by codesigning interventions with socially marginalized families and communities. An equitable, asset‐based engagement of families and communities could drive the transformation of policies, systems and social conditions to prevent childhood obesity.

Understanding childhood obesity in the US: the NIH environmental influences on child health outcomes (ECHO) program.

Few resources exist for prospective, longitudinal analysis of the relationships between early life environment and later obesity in large diverse samples of children in the United States (US). In 2016, the National Institutes of Health launched the Environmental influences on Child Health Outcomes (ECHO) program to investigate influences of environmental exposures on child health and development. We describe demographics and overweight and obesity prevalence in ECHO, and ECHO's potential as a resource for understanding how early life environmental factors affect obesity risk. In this cross-sectional study of 70 extant US and Puerto Rico cohorts, 2003-2017, we examined age, race/ethnicity, and sex in children with body mass index (BMI) data, including 28,507 full-term post-birth to <2 years and 38,332 aged 2-18 years. Main outcomes included high BMI for age <2 years, and at 2-18 years overweight (BMI 85th to <95th percentile), obesity (BMI ≥ 95th percentile), and severe obesity (BMI ≥ 120% of 95th percentile). The study population had diverse race/ethnicity and maternal demographics. Each outcome was more common with increasing age and varied with race/ethnicity. High BMI prevalence (95% CI) was 4.7% (3.5, 6.0) <1 year, and 10.6% (7.4, 13.7) for 1 to <2 years; overweight prevalence increased from 13.9% (12.4, 15.9) at 2-3 years to 19.9% (11.7, 28.2) at 12 to <18 years. ECHO has the statistical power to detect relative risks for 'high' BMI ranging from 1.2 to 2.2 for a wide range of exposure prevalences (1-50%) within each age group. ECHO is a powerful resource for understanding influences of chemical, biological, social, natural, and built environments on onset and trajectories of obesity in US children. The large sample size of ECHO cohorts adopting a standardized protocol for new data collection of varied exposures along with longitudinal assessments will allow refined analyses to identify drivers of childhood obesity.

Childhood obesity in Mexico: A critical analysis of the environmental factors, behaviours and discourses contributing to the epidemic

Mexico has the highest prevalence globally for children who are overweight. We conducted a qualitative study to understand childhood obesity in Mexico and the complex factors at play. Data were collected at three elementary schools in a low socio-economic area in Mexico City. Semi-structured interviews were conducted with 60 children, 24 parents and 28 teachers. The children interviewed were between the ages of 8 and 12 years old. Interview texts were analysed using NVivo 9 and 10 and thematic discourse analysis was used. Findings revealed how children’s choices around nutrition and physical activity were constrained by their environment and discursive constructions.

Risk and Protective Factors for Child Overweight/Obesity Among Low Socio-Economic Populations in Israel: A Cross Sectional Study.

Background and Aims: Scientific evidence regarding protective factors that contribute to healthy weight in childhood is limited and is particularly scarce in lower socio-economic populations in different ethnic groups. This study aimed to assess the prevalence of biological, behavioral and psychosocial factors for child overweight/obesity in Jewish and Arab population groups in Israel, and to compare their associations with child overweight/obesity in the two groups.Methods: Children aged 5–6 years were randomly selected from 20 Mother and Child Health clinics in towns and villages of lowest socio-economic ranking in Northern Israel. Children and mothers were invited for a special “One Stop Shop–Preparation for School” visit which included growth measurements. Questionnaires were distributed to mothers for self-report on biological, SES, psychological and lifestyle factors. Perinatal and early nutritional data were retrieved from clinic records. Multivariate analyses using logistic regression models predicting child overweight/obesity were conducted separately for Jewish (N = 371) and Arab (N = 575) children.Results: Overweight/obesity (BMI ≥85th centile) rates were higher in Jewish (25%) than Arab (19%) children. In both Jewish and Arab groups, respectively, maternal BMI (OR = 1.10 [95%CI = 1.04, 1.17]; OR = 1.08 [95%CI = 1.04, 1.13]), and child birthweight (OR = 1.33 [95%CI = 1.04, 1.71]; OR = 1.39 [95%CI = 1.11, 1.73]) were significant risk factors for overweight/obesity, and maternal self-efficacy regarding child's lifestyle was significantly protective (OR = 0.49 [95%CI = 0.28, 0.85]; OR = 0.54 [95%CI = 0.34, 0.85]). Additionally, four other maternal psychological and child behaviors were significantly associated with overweight/obesity in the Jewish group and two child lifestyle behavior factors in the Arab group. Moreover, significant interactions indicating moderation effects were found only in the Jewish group: maternal education and maternal age moderated the effect of maternal BMI on child overweight/obesity. No other moderation of risk factors was found.Discussion: In this study of children from low SES families, protective factors contributed to healthy child weight alongside risk factors for overweight/obesity. They differed between the population groups, and fewer variables explained overweight/obesity in Arab children. Although further expansion of these findings is required they point at the relevance of protective factors, maternal self-efficacy in particular, for understanding childhood obesity in specific ethnic contexts and for planning culturally adapted prevention programs in disadvantaged populations.

Noncommunicable disease modeling and simulation as means of understanding childhood obesity and intervention effectiveness

Lifestyle and dietary changes have led to rise in noncommunicable diseases such as diabetes, obesity, and cardiovascular disorders, accounting for increased mortality and morbidity in many parts of the world including developing countries. Obesity has doubled since 1980s and continues to be a growing problem of our times. Public health policies to address obesity are evolving in connection with dynamically changing human behaviors and complex interactions with the environment. However, designing and testing of new interventions are expensive and time-consuming. Computational simulations to model interventions offer useful tools to compare the effectiveness of potential interventions. In this article, we discuss a popular computational approach, agent-based modeling (ABM), to address the global challenge of childhood obesity through modeling of different interventions as described in the literature.

Fathers are critical to understanding childhood obesity

Fathers are critical to understanding childhood obesity

Exploring primary school headteachers' perspectives on the barriers and facilitators of preventing childhood obesity.

Headteachers of primary schools in England are a crucial partner for childhood obesity prevention. Understanding how this works in practice is limited by their views being underrepresented or missing from the evidence base. The aim of this study was to explore primary school headteachers' perspectives on childhood obesity and the perceived barriers and facilitators of prevention. A qualitative study with a purposive sample of 14 primary school headteachers from the Yorkshire and Humber region of England was conducted. Semi-structured interviews were audio-taped, transcribed and analysed using an inductive thematic approach. An extensive range of barriers and facilitators emerged within four key themes; understanding childhood obesity, primary school setting, the role of parents and external partners. A lack of knowledge, awareness and skills to deal with the sensitivity and complexity of childhood obesity across all school stakeholders presents the most significant barrier to effective action. Headteachers recognize primary schools are a crucial setting for childhood obesity prevention; however their school's often do not have the capability, capacity and confidence to make a meaningful and sustainable impact. To increase headteachers' ability and desire to prevent childhood obesity, schools require specialist and tailored training, resources and support from external partners such as public health teams and school nursing services.

Linking electronic health records with community-level data to understand childhood obesity risk.

Environmental and socioeconomic factors should be considered along with individual characteristics when determining risk for childhood obesity. To assess relationships and interactions among the economic hardship index (EHI) and race/ethnicity, age and sex in regard to childhood obesity rates in Wisconsin children using an electronic health record dataset. Data were collected using the University of Wisconsin (UW) Public Health Information Exchange database, which links electronic health records with census-derived community-level data. Records from 53,775 children seen at UW clinics from 2007 to 2012 were included. Mixed-effects modelling was used to determine obesity rates and the interaction of EHI with covariates (race/ethnicity, age, sex). When significant interactions were determined, linear regression analyses were performed for each subgroup (e.g. by age groups). The overall obesity rate was 11.7% and significant racial/ethnic disparities were detected. Childhood obesity was significantly associated with EHI at the community level (r = 0.62, P < 0.0001). A significant interaction was determined between EHI and both race/ethnicity and age on obesity rates. Reducing economic disparities and improving environmental conditions may influence childhood obesity risk in some, but not all, races and ethnicities. Furthermore, the impact of EHI on obesity may be compounded over time. Our findings demonstrate the utility of linking electronic health information with census data to rapidly identify community-specific risk factors in a cost-effective manner.

The role of both parents' attachment pattern in understanding childhood obesity.

Within the research area on the determinants of childhood obesity, a relatively new approach is the use of attachment theory to explore the mechanisms underlying children’s obesity risk, especially considered as emotion regulation strategies in parent–child relationship. Few are the empirical researches that have addressed this issue. The empirical investigations have used self-report measures to assess adult attachment. In attachment studies, the use of interview methods and/or performance-based instruments is advised to evaluate the entire range of possible adult attachment patterns and comprehensively explain the emotional strategies, correlates, and consequences of individual differences in attachment system functioning. The aim of this study was to explore the extent to which both parents’ attachment patterns serve as self-regulative mechanisms related to childhood overweight/obesity by the Adult Attachment Projective Picture System (AAP) in a sample of 44 mothers and fathers of children referred for obesity. Insecure attachment was found as a risk factor both for mothers and fathers. Also unresolved/disorganization was found to play a significant role in childhood obesity. The role of father’s attachment was explored and findings suggested considering it in etiology and treatment of childhood obesity.

Family mealtimes: A contextual approach to understanding childhood obesity

There has been a growing interest in the role that shared family mealtimes may play in promoting the health and well-being of children. Families that regularly eat their main meal together four or more times a week are more likely to have children who do better in school, are of average weight, less likely to use drugs and alcohol at an early age, and consume more fruits and vegetables. The mere fact that families eat together does not address the process by which shared family mealtimes may protect children from unhealthy weight gain. Just as there is no simple explanation for the rising rates of obesity, the link between shared family mealtimes and childhood obesity is a complex one including socioeconomic and cultural context. In this paper, we provide an overview of how shared family mealtimes are embedded in a socio-cultural context that may either support or derail healthy eating patterns for children and youth. Evidence from an observational study of 200 family mealtimes demonstrates the complex interplay between socio-economic factors, family mealtime behaviors, and child obesity status. Families who had a child of healthy weight spent more time engaged with each other during the meal, expressed more positive communication, and considered mealtimes more important and meaningful than families who had a child who was overweight or obese. Using a cumulative risk model, it was found that the combination of family level and neighborhood risk factors predicted child overweight status. Recommendations are made for future research directions and policies directed toward families living in diverse economic circumstances.

Understanding childhood obesity in America: Linkages between household income, community resources, and children's behaviors

Understanding childhood obesity's root causes is critical to the creation of strategies to improve our children's health. We sought to define the association between childhood obesity and household income and how household income and childhood behaviors promote childhood obesity. We assessed body mass index in 109,634 Massachusetts children, identifying the percentage of children who were overweight/obese versus the percentage of children in each community residing in low-income homes. We compared activity patterns and diet in 999 sixth graders residing in 4 Michigan communities with varying annual household income. In Massachusetts, percentage of overweight/obese by community varied from 9.6% to 42.8%. As household income dropped, percentage of overweight/obese children rose. In Michigan sixth graders, as household income goes down, frequency of fried food consumption per day doubles from 0.23 to 0.54 (P < .002), and daily TV/video time triples from 0.55 to 2.00 hours (P < .001), whereas vegetable consumption and moderate/vigorous exercise go down. The prevalence of overweight/obese children rises in communities with lower household income. Children residing in lower income communities exhibit poorer dietary and physical activity behaviors, which affect obesity.

Let's Get Technical! Gaming and Technology for Weight Control and Health Promotion in Children

Most children, including lower socioeconomic status and ethnic minority children, play video games, use computers, and have cell phones, and growing numbers have smart phones and electronic tablets. They are comfortable with, even prefer, electronic media. Many expect to be entertained and have a low tolerance for didactic methods. Thus, health promotion with children needs to incorporate more interactive media. Interactive media for weight control and health promotion among children can be broadly classified into web-based educational/therapeutic programs, tailored motivational messaging systems, data monitoring and feedback systems, active video games, and diverse forms of interactive multimedia experiences involving games. This article describes the primary characteristics of these different technological methods; presents the strengths and weaknesses of each in meeting the needs of children of different ages; emphasizes that we are in the earliest stages of knowing how best to design these systems, including selecting the optimal requisite behavioral change theories; and identifies high-priority research issues. Gaming and technology offer many exciting, innovative opportunities for engaging children and promoting diet and physical activity changes that can contribute to obesity prevention and weight loss maintenance. Research needs to clarify optimal procedures for effectively promoting change with each change procedure.

Understanding childhood obesity

Robert Nelder and colleagues present insights from a study that compared the body mass index of school children between 1995 and 2005 in Plymouth

NAPNAP updates

NAPNAP updates