Childhood Obesity is being recognised as a major health problem and is globally significance. Obesity is defined as an excessive accumulation of body fat or if the body mass index is greater than 30. According to AAP (2003), above 85th percentile BMI for age and sex are considered obese. BMI is a measurement of body fatness. In clinical practice, BMI is used as a surrogate measure of obesity because it correlates well with adiposity stated by (Moy, Gan, and Siti Zaleha, 2004). These are inclusive for both boy and girl according to their age and height. The BMI is calculated by body weight in (kilograms) by height in (metres) squared. The BMI is a standard guide to determine the level of being overweight or obesity. According to World Health Organisation (WHO), the prevalence of obesity in school aged children is estimated to be 10 percent worldwide as stated by (Anonymous, 2001). Many studies have shown that western and Middle East countries are high prevalence of both adult and childhood obesity. However, the population of Asian is starting to increase in the number of obesity. This paper will focus on childhood obesity specifically in Malaysia and will explore why it is happening, its causes and what we can do to combat this problem with relevant evidence of literature.
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The society of Malaysia has changed greatly since the mid 20th century. This change has increase in the numbers of children ranging from infants to adolescents becoming obese. Malaysian culture and socio economy has changed vastly over the two decades, whereby it has a great impact on the healthcare system. In Malaysia, the rapid and marked socio economic advancement has brought significant changes in the lifestyles of communities mentioned by (Sidik and Ahmad, 2004). These include significant changes in the dietary patterns, example an increase in consumption of fats, oils and carbohydrates. In addition, changes in meal patterns are also evident whereby more families eat out, busy executives skip meals and younger generation rely too much on fast food while this has resulted in increased percentage of fat that has been observed by (Tee, 1999). Obesity is also associated with significant morbidity and mortality, including cardiovascular, respiratory, orthopaedic, and gastrointestinal and etc by (Segal & Sanchez, 2001).
Childhood obesity is the most common nutritional problem in most developed countries stated by (Sorof & Daniels, 2002). The childhood obesity prevalence is 14 to 20 percent in industrialised countries but the highest rate is seen in developing countries such as Chile and China as argued by (Finer, 2003) in (Sidik & Ahmad, 2004). The Worldwide prevalence almost 22 million children under the age of five are overweight according to (Finer, 2003). A national survey has been conducted in USA from 1971 to 1974 where 4.0 percent of children are overweight from age six to eleven, where else in 2003 to 2004 18.8 percent has been increased in weight. In Malaysia, there is no known national survey carried out with the specific purpose to determine the prevalence of overweight among children, but many studies have been reported. According to WHO (2003), a recent survey has been carried out among children both sexes aged 12 to 17 years in four main region of peninsular Malaysia which reported that 19 percent of children are overweight. Another study has been conducted by Foong (2004) in school aged children from 10 to 16 years of age in three main ethnic groups in Malaysia. The overall prevalence was 7.8 percent for the Malay student, 6.7 percent and 7.0 percent for the Chinese and Indians students. Same studies reported children obesity in school in Singapore in the year 2000 was 14.7 percent for those ages 12 to 13 years and 13.1 percent for those aged 15 to 16 years. Malaysia is very much low in prevalence compared to developed countries like United States.
There are several reasons why children are becoming obese. One factor alone would not make a major impact on this epidemic. Studies have shown the causes of childhood obesity in Malaysia due to potential interest of food availability, children's lifestyle and eating behaviours. Many researchers believe, hereditary plays a pivotal role in determining weight problem. There are still ongoing studies in obesity based on genetic. Studies of Anderson, Butcher & Levine (2003) found that there is a correlation between parent and child obesity. These are because the family shares both and more likely, genetic determines the susceptibility of the disease towards obesity. The risk of becoming obese is greatest among children who have two obese parents. This may be due to powerful genetic factors.
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Marketing and media are clustered together and have been debated and proven many years ago that the main key causes of childhood obesity as argued by (Robin, 2007). According to Giammattei, Blix, Marshak, Wollitzer and Pettitt (2003), children who spend more time watching television have a highest percentage of body fat. This is because the amount of time has been wasted watching television rather than performing physical activities. Survey of Dennison & Edmunds (2008) detected 2% prevalence of obesity among adolescent who view each additional hour per day that has been recommended. High sedentary behaviour and high fat diet appear to worsen the condition of children. The broadcast media plays an essential role in the socialization of children. Young children are uniquely vulnerable when exposed to media advertising because of their immaturity and have not learned to discern the difference between television programmes and television advertisement as stated by (Dennison et al, 2008). Therefore, they are exposed to the largest number of food advertisements. Healthy eating is very crucial among young children thus; many studies show dietary factors such as intakes of fat and cholesterol affects the risk of cardiac vascular diseases. A bad eating habit and lack of exercise are factors which causes obesity among children.
Lack of physical activities such as participation in sports in school can result in obesity. Along with this is the increased in usage of computer and other non physical form of entertainments, example video games. Most children spend hours and hours on computer games rather than physical activities. Weight change is an imbalance in the amount of energy taken in and the amount of energy expanded.
Today's world is extremely fast moving and nutritional factor has been affected due to fast food consumption by younger generation. This is one of the leading factors of childhood obesity in many countries especially in Malaysia. Fast food such as Kentucky, Mc Donald, Pizza typically include all the things that nutritionist warn against. Each meal of fast food contains of 2,200 calories which at burn rate of 85 to 100 calories per miles equal ant near a full marathon to expend discussed by (Anderson et al, 2003). In addition, most schools serve lunches that are high in fat and snack foods which are not balanced in nutrition. Moreover most schools in Malaysia have fast food outlet nearby and this would be convenient for children to eat more fast food during break time. Teachers only focus on children's education and exams in the school but fail to show importance in their nutritional status. Parents who work outside the home are at higher risk of childhood obesity due to time constraint. In contrast, this would be an advantage for the children to consume unhealthy nutritional choice. Parents are the biggest culprits when children get load on the pounds. Many parents fail to recognise when the child is overweight as argued by (Linsay, Sussner, Kim & Gortmaker, 2006). Another philosophy of children is, when observing what and how their parents eat also may shape children's food preferences. Consequently if their parents like to eat high fat food or junk food and the children will likely to do the same. Some parents may be thinking if my child is overweight which means the child is well nourished but the fact that the children are facing major chronic health problem due to unnecessary consumption of high fat food. Most parents fail to understand this. Most children are lacking of minerals and essential vitamin and fiber that the body needs, this is because most children do not eat vegetables and fruits. Parents and teachers should show a good example for their students and children on healthy nutritional status.
Other major issues could be physiological changes among boy and girl which are hormonal changes when they reached puberty. According to Wisniewski and Chernausek (2009) puberty can be transient decrease in level of insulin sensitivity in young boy and girl however; it is mainly affect the girls who more advanced in the sexual maturation and high in body fat contribution than boys. This would also affect the amount of fat distribution and it is variables among genders and age. Moreover, stated by Gidding (1996) other abnormalities are skin problems, gout and etc. High formation of uric acid in the body can result in Gout and later could lead to arthritis. In other words, children can experience joint pain, lower extremities pain due to being overweight or high fat accumulation in the upper body.
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The long term effect of obesity can be results in many factors including the country's economy status. Currently, the cost of paediatric population in Malaysia is relatively small but the cost of childhood obesity might increase in the long run if corrective action is not taken by the health government. However, globally obesity is an alarming problem among children and adulthood and has a great impact on the global economy status. This have been proven by many studies especially in western countries such as United States. Obesity imposes a great financial burden of the country whereby it increases medical costs, can cause morbidity and mortality among children. 40% of overweight children will be obese in adulthood as proven by study's of (Freedman, 2004). The report of International Obesity Task Force (IOTF) (2005) stated almost 300 million people are obese worldwide.
The medical complication of childhood obesity can lead to life threatening disease in the long run for children when they reach adulthood. Obesity increases the risk of coronary heart disease (CHD) stated by Wang (2004) especially with imbalance eating patterns and low physical activities. Later years it can also lead to secondary disease which is diabetic type 2 formerly known as non insulin dependent. The prolonged of insulin resistance can occur if obesity continues from childhood to adulthood. There are other diseases that could trigger due to onset of CHD in later years which are hypertension, imbalanced cholesterol level in the body, osteoarthritis, kidney disease and etc. The observational study of Nestle (2003) mentioned that CHD can lead to thrombosis, abnormal clotting and induced myocardial infarction. The risk factor can be reduced if obese children lose weight. The cost of medical expenses can be high whereby the insurance for children will be expanded and shrink. The country needs to invest more finance in treatment for obesity like new drugs or surgery intervention and this would raise the country's expenditure.
Asthma in obese children is very large and life threatening. A Study by Gilliland, Berhane, Talat, Mcconnell, Gauderman, Gillian, Avol & Peters (2003) cited in Sidik et al (2006) that asthma and obesity are linked together because most asthmatic children usually lack physical activity and this will induce more weight. This study suggests that activity level and dietary habit of the children are related to onset of asthma. Another complication is that obesity may enhance non eosinophilic inflammatory pathway whereby it causes bronchial hyper responsiveness in asthmatic than non asthmatic children as stated by (Gilliland et al, 2003) in (Sidik et al, 2004). In other words, children who are obese and have asthma can be prone to infectious disease.
According to the study by Reilly, Methven, Mcdowell, Hacking, Alexander & Kelner (2003) obese children will have higher chances for psychological problem in later stage than non obese children and girls are greater risk than boys. This is because of low self esteem and emotional disturbance by their physical appearance. Moreover, they get embarrassed when their peers tease them and they will try to avoid socialization especially in school. In contrast, this will lead to mental disturbance and stress thus, focus on studies will be down. Some obese children may tend to skip school due to embarrassment. Feeling of humiliation, anxiety could lead them to medical condition such as Major depression.
IMPLICATION / RECOMMENDATION
The old saying 'prevention is better than cure' in anything especially if we could safe our children lives and overcome early morbidity and mortality. Malaysian health government has established various ways to overcome specifically childhood obesity. The support and responsibility of everyone includes Parents, healthcare team, schools and children themselves playing a major role in order to reduce obesity. According to Sidik (2004) The Malaysian Health Ministry has established campaigns on nutritional status especially in school and with families. In addition, many nutritionists from various universities in Malaysia have been hired to run the campaign and educate mothers and children on the importance of diet.
WHO (2003) recommended mothers to breastfeed their babies from birth to six months and continued till age of two. The breast milk contains all the essential minerals and vitamins that the baby needs. This guideline has been implemented regardless of any race and ethnic group. Regular follow ups should be done for the infant in the clinic or home visit by nutritional expertise or Paediatric nurse to moderate weight gain and weight lose. Healthy food choices should begin at infancy. Study of Mayer, Rafis, Zhoul, Hu, Colditz and Gillman (2006) has proven that breastfeeding can decrease the incidence of obesity in children by 13 to 22%.
Practically, most schools influence the life of children in terms of diet, healthy behaviour and physical activities as discussed by (Ells, Campbell, Lidstone, Kelly, Lang, and Summerbell, 2005). The ministry of health and ministry of education in Malaysia implemented healthy food guidelines for school canteen or cafeteria and established frequent physical activities in schools to promote optimum health among school children as mentioned by (Tee, 1999). Fast food outlets should be moved far from school areas to prevent consumption of unhealthy diet. Tutoring should educate the pupils on the bad effects of fast food. Most school in Malaysia will be visited by a ministry health care provider who does routine check up and follow up on pupils regardless of any race to ensure healthy well being. These include immunization, dental check, BMI check and other routine check up as per the Ministry of health's regulation. Therefore, I believe that we need to have more resources like health care team to visit the schools regularly may be on a monthly basis instead of annually to monitor weight and height among school children. This will ensure that the children are well nourished and leading an active lifestyle.
The next example the writer would discuss is in relation to parents. Parents are the important and the ideal role model to foster healthy lifestyle among children and adolescents as stated by (Lindsay et al, 2006). Parents hold a huge responsibility in the prevention of childhood obesity. Parents should be aware of the food consumed by their children in school and at home. Children are most vulnerable to sweet and salty food. Again, household food choices are from parents, they should train children to eat more vegetables and fruits that are rich in vitamins, minerals and fibre. Do not restrict children on food but suggest to them a good variety of food and advice them on a healthy diet. To develop a good home healthy strategy, parents can seek help from Nutritional Nurse.
Ultimately, advertisement and physical activities too impose on prevention of childhood obesity. Studies of Dennison et al (2008) suggested implementing policy or guidelines on limiting television viewing and to increased daily physical activities at home and in school which will be a tremendous change in childhood obesity. Although many guidelines and policies are in place in our country but these should be more widely implemented especially in rural areas and should strictly be followed by all families. Numerous campaigns and forums have been conducted by our government to raise the awareness of the public on childhood obesity including in schools but parents and teachers should take additional responsibility in adapting the policy into practice. Parents can encourage their children about commercial which aren't always right and they shouldn't be persuaded by what's on the television. By doing this, children will learn the right way of viewing television especially in choosing programmes. Parents should be a role model therefore parents should watch healthy programmes like documentary, health news and educational programmes. It is not necessary that physical activities should only be conducted in schools but I believe, children need to have physical activity after school, weekends and during school holidays. Bringing children to the gym centre, trout fishing or enrolling them in dance classes, soccer and gymnastic centre could be a form of adventure for the children and at the same time children are able to burn body fats.
In summary, Healthy lifestyle and good nutrition are strongly associated with childhood obesity. Although many guidelines are in place, parents should start a well nourished diet from home especially at infancy. Parents should encourage children and adolescents to do regular physical exercises and actively participate in the event of health forum in the school and ministry level to help government in order to safe our children's future. Thus, Malaysia health and industrial government should be voluntarily be responsible on television commercial especially on healthy food advertisements and healthy lifestyle activities. In addition, the Ministry should be responsible on healthy food supplies to the school and healthy food in the market for consumers. Indeed, many questions needs decision making and acknowledgement from parents to ministry level to prevent childhood obesity. A serious preventative measurement should be put in place to ease off the childhood obesity.