Childhood obesity is a national public health problem in the United States. Despite serious health, social, and economic consequences associated with the problem, the number of children with obesity is on the rise. Obesity in children is likely to lead to obesity in adulthood besides other dangerous health problems such as high blood pressure, high cholesterol level, stroke, heart disease, and different types of cancer. In fact, statistics indicate that over 13 million young people in the United States are overweight and obese. In the state of Washington, the situation is not much different because over 29% of the population of children and adolescents in the state are overweight and obese. As a result, the state Department of Health in collaboration with other stakeholders has embarked on concerted efforts to prevent childhood obesity in communities and schools throughout Washington. Most of the on-going programs and initiatives are aimed at encouraging healthy eating habits and physical activity among schoolchildren and adolescents in order to ensure that the prevalence of obesity is hindered.
However, despite the efforts made by different partners and collaborators, a number of challenges in solving the problem of childhood obesity are still evident. For instance, the issue of access to obesity prevention services for low income earners and rural dwellers has not been adequately addressed. Therefore, many people still lack access to these important services. Furthermore, issues of politics are hindering efforts aimed to solve the problem because many local businesses and industries are not willing to stop producing or stocking unhealthy foods, which have been blamed for the growing number of obese children in the state.
Therefore, to win the war against childhood obesity, the state Department of Health should gain support of different stakeholders including state agencies, local businesses and industries, professional associations, institutions, community members, churches, and other advocacy groups. In the long run, it is recommended to prioritize school-based programs for prevention of obesity because they are very effective in solving the problem. Additionally, primary care givers must be encouraged to explore other low-cost obesity prevention interventions in order to rid the local community of extra costs. Lastly, local businesses and industries must be encouraged to produce and stock healthier foods to encourage healthy eating habits among local people.
Childhood Obesity in Washington State
Obesity in children is a serious public health problem in the state of Washington and in the United States in general. In fact, obesity in children and adults is considered an epidemic in the United States because it has serious health, social, and economic consequences. Studies indicate that childhood obesity significantly affects people’s health. For instance, obese children are susceptible to cardiovascular diseases including high blood pressure and high cholesterol levels. More specifically, over 70% of obese children and adolescents aged 5-17 years have higher risk of developing various cardiovascular diseases. Furthermore, obese adolescents have high glucose levels, which create high probability of development of diabetes in adulthood. Moreover, the risk of bone and joint injuries and other psychological problems is very high among obese children and adolescents (Budd & Volpe, 2006).
Most importantly, childhood obesity is associated with many long-term health problems. For example, development of obesity in childhood increases the likelihood of occurrence of the same condition in adulthood. Therefore, it is highly probable that certain health problems associated with obesity such as heart disease, cancer, and osteoarthritis will continue affecting children in the future. Furthermore, overweight and obesity in children increase the risk of many dangerous health problems, particularly cancer. In fact, childhood obesity is associated with breast, endometrial, kidney, gall bladder, ovary, and prostate cancers. In the last 20 years, the prevalence of obesity in children has increased rapidly by as much as 3 times, and it is currently estimated to be around 30%. Generally, obesity in children and adults is diagnosed by the body mass index (BMI), which is a useful measure of adiposity. As a result, gender- and age-based BMI percentiles are the most recommended measures for determining the number of overweight children and those at risk of becoming overweight (Budd & Volpe, 2006; Thompson, 2010; Safron et al., 2011).
Screening and diagnosis of obesity in children allows to divide children into two groups. The first group includes level 1 or at risk for overweight (85th- 95th BMI percentile). The second group includes level 2 or overweight (more than or equal to the 95th BMI percentile) people. Currently, it is estimated that over 17% of children and adolescents aged 2-19 years can be considered overweight. However, the use of the term “obesity” when referring to overweight children is not recommended because it could be stigmatizing (Budd & Volpe, 2006; Thompson, 2010).
Nevertheless, childhood obesity is a reality in many schools across the state of Washington and the United States at large. Therefore, there is a need to target this problem for the purpose of initiating primary prevention measures. This paper further describes the on-going efforts aimed to prevent obesity and reduce the growing number of overweight children in the state of Washington. It also highlights inherent barriers to prevention of childhood obesity. Most importantly, this paper identifies various stakeholders who should take full responsibility for all efforts aimed at preventing childhood obesity. Finally, the paper recommends various strategies that can significantly help in the process of solving the problem.
As it was noted earlier, the prevalence of childhood obesity in the United States has increased rapidly over the last few decades. Currently, it is estimated that over 13 million children and adolescents in the United States are above 95th BMI percentile. This indicates that they are overweight and obese. In the last 40 years, the prevalence of obesity almost tripled from 5% to 14% in children aged 6-11 years and tripled from 5% to 17.1% in adolescents aged 12-19 years. In the state of Washington only, it was estimated that the percentage of overweight and obese children was 10.8% in 2003. In 2005, the percentage of overweight and obese children in the state of Washington increased to about 25.0% (Washington State Department of Health, 2012). Moreover, the rate continued to increase further in 2007, when the percentage of overweight and obese children hit 29.5%. These statistics are worrying, considering that there is an 80% probability that obese children will become obese adults. Moreover, it is estimated that 61% of obese children and adolescents are subjected to one or more risk factors of different health problems, most notably, high blood pressure and cancer.
The financial burden of childhood obesity on state and national healthcare resources is obvious considering that over $14 billion per annum is spent on initiatives and programs aimed at solving the problem. Furthermore, despite the efforts made by different interest groups and state agencies in combating the problem of childhood obesity in schools and communities, statistics indicate that approximately 30% of children and adolescents in the United States do not engage in any form of physical activity. Besides, more than 75% of young people in high schools do not consume the recommended dietary portion of fruits and vegetables (Washington State Department of Health, 2012).
Available Resources for Preventing Childhood Obesity
Due to the growing number of children and adolescents with obesity in the state of Washington, the issue has drawn increased attention and support from different partners, whose efforts are aimed at preventing obesity. As a result, different parties interested in prevention of childhood obesity have initiated a number of policy programs, initiatives, and activities that aim at increasing access to healthy foods, facilitating the consumption of healthy food in schools, and increasing physical activity among young people. With the same purpose, the Washington State Nutrition and Physical Activity Plan was launched in 2003. This plan aimed at providing a framework upon which all concerned partners from the state organizations, local communities, and institutions can organize their efforts in preventing childhood obesity. Basically, the plan entails three nutrition objectives which include increasing access to health-promoting foods, reducing food insecurity in the state of Washington, and encouraging mothers to breastfeed their infants and toddlers (University of Washington Center for Public Health Nutrition, 2009).
Furthermore, the plan involves three objectives related to physical activity which include increasing the accessibility of recreational facilities for physical activity among adult population, increasing physical activity among children, and promoting active community environments. Apart from the six objectives, the plan also includes a total of 15 important recommendations to guide activities of agencies, institutions, and groups involved in the prevention of childhood obesity. Most importantly, objectives of the plan are achieved and communicated effectively by the Washington State Department of Health as well as by other partner agencies through media, state/local gatherings, and conferences. Moreover, Washington State Department of Health and partner agencies initiate campaigns with the aim of promoting environmental and policy changes in communities and institutions. For example, since its launch in 2001 and 2002, the plan has led to an increase in the use of trails and paths in Washington state communities through the use of simple signs and increased media coverage (University of Washington Center for Public Health Nutrition, 2009).
Furthermore, individual partner agencies working under umbrella body Partners in Action are involved in various programs aimed at preventing childhood obesity. For instance, Access to Healthy Foods Coalition is a group of local business people and government agencies operating in the state of Washington. Their activities involve concerted efforts to increase access to healthy foods in schools, community settings, and food assistance programs. Additionally, this statewide group works towards changing food delivery systems. It is working hand in hand with policy makers in the state in order to make relevant decisions that can promote change. This group also ensures that its activities are well known to communities and institutions. For this purpose it organizes annual summits, in which keynote speakers, particularly food policy professionals, talk about the importance of making smart food and nutrition choices in order to prevent an increase of child obesity (University of Washington Center for Public Nutrition, 2009).
Another example is King County Food and Fitness Initiative (KCFFI), which is a community-based healthy eating and active living initiative. It is aimed at enabling communities to increase access to affordable healthy food grown locally. It also focuses on creating safe and favorable environment for physical activity and play. By working in collaboration with other stakeholders, KCFFI has developed a community action plan aimed at promoting healthy foods and fitness in schools. The plan also aims at creating safe spaces for physical activity and encourages retail stores to stock healthy foods. In all its efforts KCFFI ensures that the youth are actively engaged in achieving objectives of the initiative in their schools and communities (University of Washington Center for Public Nutrition, 2009).
A number of state and regional initiatives promoting healthy communities are in place across the state of Washington. For instance, Healthy Communities is a local initiative targeting the Lake Moses, Grays Harbor, Mount Vernon, Spokane, Clark, Kittitas, and Marysville regions for the purpose of identifying barriers to the availability of healthy food in local communities. Additionally, the initiative aims at initiating community level environmental and policy changes based on recommendations of the Washington State Nutrition & Physical Activity Plan. Most importantly, Washington Department of Health provides grants to support activities of this and other initiatives in local communities such as Northwest Health Foundation. Local grant recipients are channeling available resources towards creating policies that promote healthy eating habits and physical fitness among children and youth in schools and local communities (University of Washington Center for Public Health Nutrition, 2009).
Moreover, schools across the state of Washington have been involved in different coordinated school health and wellness programs supported by school health advisory committees. For instance, Healthy Schools is a health policy initiative targeting policymakers, teachers, school staff, school officials, and parents and providing technical assistance for different efforts aimed at developing school policies and programs concerning the promotion of healthy eating and physical wellness in schools. This initiative is overseen by Washington State Department of Health and other partners. It aims at achieving 5 out of 6 Washington State Nutrition and Physical Activity Plan objectives (University of Washington Center for Public Health Nutrition, 2009).
Barriers to Preventing Childhood Obesity
The State of Washington made a number of notable efforts towards preventing childhood obesity in terms of enacting legislative policies and developing programs for healthy eating and physical wellness among children and youth. However, after these policies and programs have been developed and implemented, little is done to check whether intended outcomes have been reached. This implies that effective evaluation and follow-up programs have not been given required attention as far as prevention of childhood obesity is concerned. Without such programs, state government and other partners lack information necessary to guide the development of future programs and services to address inherent challenges. Moreover, there is lack of programs, which aim to incorporate healthy eating habits and physical education into school curricula. These programs could ensure that school children are aware of the importance of healthy food and physical activity fo preventing obesity (Hopkins, DeCristofaro, & Elliot, 2011).
Various state and regional childhood obesity prevention initiatives are in place across the state of Washington. Therefore, more services are available to communities and institutions. However, challenges of access cannot be overlooked since many communities still remain underserved. This is because many programs and initiatives are concentrated in urban areas. Therefore, there is a rural-urban disparity with regard to accessibility of services. Besides, there are major disparities between low-income earners and high-income earners in terms of prevalence of childhood obesity. This shows that despite the availability of obesity prevention programs, rural dwellers and low income earners still face challenges related to access to available services (Hopkins et al., 2011).
Target population is informed about childhood obesity prevention programs and initiatives through media, conferences, school programs, and community gatherings. However, communication challenges hindering efforts to prevent childhood obesity are those related to cultural competency. Washington is inhabited by people from different ethnic and cultural backgrounds who perceive nutrition and physical activity in different ways. Due to this, it becomes difficult to develop and deliver services, which can be accepted and used by all people. Most importantly, the language barrier is a major problem. This is especially true in communities, where English is not the first language of many residents (Safron et al., 2011).
Political class has made numerous contributions towards the prevention of childhood obesity in terms of passing necessary legislations on nutrition and physical activity. However, a conflict of interest still exists between state agencies and some local businesses and industries, particularly those producing and supplying unhealthy foods. This implies that it may take long to convince local businesses and industries to stop supplying unhealthy foods and turn to healthy foods for the benefit of state children and youth (Safron et al., 2011).
Inter-agency Scope of Delivery and Care
Many partners and collaborators have joined Washington State Department of Health in concerted efforts to prevent childhood obesity. However, the department faces major challenges in trying to get other state agencies such as Office of the Superintendent of Public Instruction, the Department of Agriculture, the Department of Social and Health Services, and the Department of Transportation to join the fight against childhood obesity. This is because other state agencies are pursuing other interests which are contrary to the objectives and priorities of State Department of Health (Washington State Department of Health, 2012).
Despite the fact that state budget office provides grants to support different obesity prevention programs, there are still major budgetary issues that hinder these efforts. For instance, there is lack of financing for obesity management programs from Medicare because obesity was not considered as illness for a long time. This implies that childhood obesity is not a priority for healthcare providers because there are no benefits that they can reap from its management (Washington State Department of Health, 2012).
Major challenges that hinder various concerted efforts for prevention of childhood obesity include time constraints and lack of qualified service providers. This implies that increasing number of obese children is outweighing available resources in terms of staff (nutritional specialists) and accessibility of services. Most importantly, personal attributes of service providers who have failed in the struggle to manage their own weight, may be a major challenge while trying to provide effective services to state children and youth (Hopkins et al., 2011).
Responsibility of addressing the problem of childhood obesity is not limited to Washington State Department of Health. It requires efforts of different partners and collaborators. Conflicting interests of State Department of Health and other state agencies slow down the progress of fighting the problem. Childhood obesity prevention efforts must be supported by the Department of Agriculture, Department of Transportation, Department of Social and Health Services, and the Office of the Superintendent of Public Instruction. Furthermore, various professional associations, local community members, institutions, and other advocacy groups must contribute to efforts aimed to prevent childhood obesity. Most importantly, professional associations and institutions of higher learning, such as University of Washington, must play a major role in educating local community about the importance of healthy eating habits and physical activity. Moreover, these associations and groups should provide effective policy guidelines to support other efforts made by the state such as Washington State Nutrition & Physical Activity Plan. Nonetheless, professional associations, state agencies, local businesses, industries, and other advocacy groups should play a leading role in implementation of policies and objectives of various obesity prevention interventions in local community and schools (Washington State Department of Health, 2012).
Based on the foregoing discussions, it is possible to say that it is important to acknowledge that State Department of Health and other partners have initiated a number of steps towards solving the problem of child obesity. However, more needs to be done in order to ensure that all programs and initiatives in place produce desirable results. Therefore, the remaining part of the paper provides recommendations on the issue.
- School-based programs must be prioritized in an effort aiming to reduce the number of overweight and obese children. This is because children spend approximately 6-8 hours at school and eat 1-2 meals there. Therefore, obesity prevention practices targeting school children must be incorporated into classroom curriculum and must be implemented by teachers. In fact, studies reveal that school-based programs are effective in modifying behavior of children in relation to various objectives for obesity prevention. For instance, studies indicate that children can reduce the time spent on watching television and computer work if they are taught about harmful effects of sedentary lifestyles. Furthermore, school-based programs have been used in various efforts aimed at reducing consumption of high-fat and sugary foods and increasing the intake of fruits and vegetables among young people (Budd & Volpe, 2006; Melnyk, 2009).
- Primary care providers should take a leading role in managing childhood obesity using evidence-based interventions. According to Hopkins et al (2011), there are many effective programs aimed at solving the problem of obesity in children. However, lack of resources has become a factor hindering their implementation by community care providers and families. Based on this situation, primary care providers should seek less expensive non-pharmacological interventions, which focus on behavioral and lifestyle modifications through a staged treatment plan. This strategy has been extremely effective and convenient for many families because it is cost effective and less aggressive.
- Local businesses and industries should be encouraged to produce and sell locally grown fruits and vegetables in order to reduce the price of healthy foods. This should also be done to encourage healthy eating habits among low income earners. As noted earlier, many families are unable to consume recommended dietary portions of different healthy foods because they are unavailable in their localities. Even if these products are available, they are sold at high prices. Therefore, it becomes difficult for low income families to follow healthy diets. As a result, they turn to unhealthy foods and poor diets despite knowing about their negative impact on health (Streichert, Johnson, & Drewnowski, 2008).