Chapter 6: Collaborative Opportunities and Challenges
6.3 Advantages of Involvement
6.3.1 Economic Advantages ··························································
A multidisciplinary holistic approach is required for the treatment and prevention of overweight and obesity in children. The immediate goal is to reduce the rate of weight gain, followed by a period of weight maintenance and, ultimately, weight reduction to improve body mass index. The long-term goal is to significantly improve quality of life and reduction of morbidity as well as mortality associated with overweight and obesity.
Dietary manipulation should aim at weight maintenance or weight loss without compromising appropriate and essential calorie intake and nutrition, particularly in children. In obese children
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8 years or older, the Dietary Intervention Study in Children intervention diet can be introduced without compromising growth, development, and pubertal maturity (Van Horn, Obarzanek, Friedman, Gemhofer, & Barton, 2005). This diet distributes 58% of total calorie intake to carbohydrates, 28% to fats, and 14% to protein. Age-appropriate serving sizes including five or more servings of fruit and vegetables, three or more servings of low fat milk or dairy products, and six or more servings of whole-grain and grain products per day as well as adequate amounts of dietary fiber (age in years + 5 g per day) should also be encouraged (Daniels et al., 2005).
One study that investigated community interventions to reduce overweight and obesity among children and adolescents in China reported that the nutrition education components that may be effective in reducing obesity in that country should include the following recommendations:
(a) eating slowly during meal times; (b) eating foods of lower calories or energy, (c) avoiding sweetened beverages, snacks, and Western fast foods, and (d) no more food consumption after dinner (Gao, Griffiths, & Chan, 2008).
The recognition that declining energy expenditure is an important contributing factor to the increased prevalence of obesity has provided the desired impetus for promoting physical activity for public health. It is clear that current levels of activity among children and adolescents as a population are currently inadequate to prevent obesity from increasing. Regular participation of physical activity of moderate intensity should be encouraged and promoted among children to prevent as well as to treat the overweight and obesity dilemma. Children and adolescents should engage in not less than 60 minutes of moderate to vigorous physical activity per day to achieve optimum cardiovascular health (Strong et al., 2005). Overweight and obese children should target higher levels to achieve similar results. Longer periods of moderate intensity exercises, like brisk walking, burn more fat as energy sources and, thus, are excellent for reducing body fat (Poirier & Despres, 2001). Children should be prescribed physical activity that is safe, appropriate, interesting, fun, enjoyable, and practical, and that has a social component to ensure that they adhere to the program of regular physical activity and to maintain an active lifestyle (Sothern, 2004). In addition to weight reduction, exercise training has been shown to be beneficial in terms of changes in body fat and lean body mass, cardiorespiratory fitness, muscular strength, endothelial function, and glucose metabolism, all of which significantly reduce the morbidity associated with excess body weight (Watts, Jones, Davis, & Green, 2005).
In recent years, it has been reported that children and adolescents typically indulge in sedentary activities like watching television and sitting in front of computers and video games.
Every hour of sedentary activity increases the chance of obesity and is also contributory to the failure of many weight reduction attempts in adolescents and children. So, screen time should be restricted to less than two hours per day as the sedentary habits are associated with increased adiposity and higher weight gain (Mendoza, Zimmerman, & Christakis, 2007). In addition, excessive television viewing is often associated with higher intakes of energy, fat, sweet and salty snacks, carbonated beverages, and with a reduction in the consumption of fruits and vegetables (Coon & Tucker, 2002). This makes television and computer time restriction an excellent opportunity to complement dietary management.
Prevention and treatment of obesity and overweight may be somewhat easier in children than in adults because children are still growing in height (Doak et al., 2006), and their behaviors and lifestyle are still developing. School provides an ideal opportunity in terms of both the physical and social environment for preventing and treating obesity. Therefore, school-based obesity interventions have been applied worldwide. Previous pilot study and effectiveness evaluation study of school-based nutrition and/or physical activity intervention programs in
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China reported that childhood obesity interventions were feasible, effective, and sustainable in Chinese students (Yan, 2006). Hence, physical education programs in schools are potentially important interventions through which physical activity and fitness may be promoted among young children (Carter, 2002; Center for Disease Control and Prevention, 1997).
It can be summarized that high daily caloric intake and physical inactivity are common among obese and overweight children. So, it would seem that in order to maintain a stable weight and to maximize health, a combination of lots of healthy and varied food plus adequate regular physical activity would provide the best approach. Community level interventions should include advocacy to increase physical activity in schools and at home through the creation of environments that support physical activity. These efforts could include creation and maintenance of recreational parks, inclusion of child-friendly walking and bicycle paths as well as creating awareness about locally available physical activity options. Early intervention is therefore required in these overweight and obese children. It is recommended that both parents and teachers participate in guidance of school children with regard to self-discipline in eating habits, money management, and time management. Emphasis should be given to reduction of eat outs, planning for healthy snacks, maintaining a balanced diet with adequate intake of fruits and vegetables, fiber content, and the avoidance of high calorie or fat foods. The effective strategy for healthy weights in children is enhanced physical activity and reduced sedentary behaviors.
Conclusion
Chilhood obesity has risen to significant levels globally with major public health consequences. It poses a serious hazard to the basic health care system in the affected countries.
The reversibility of this epidemic with appropriate intervention strategies should be given top priority, and enforcement of these strategies is vital to curb this phenomenon in the Asian region.
Some of the recommended strategies to overcome the increasing trend of childhood obesity include specifying the nutrition composition of foods served in school canteens and eating outlets; providing infra-structure, equipment, and qualified teachers for physical education in schools; increasing the availability of modern facilities to encourage regular participation in physical activities as well as creating more time to utilize these facilities; and implementing relevant courses, seminars, or programs to educate both parents and teachers on the importance of sound nutrition and participation in physical activities for the children. The most challenging task would be influencing policymakers and legislation to ensure that the present generation of children is provided with proper healthy diet and adequate space and facilities to make play and other forms of physical activity fun and enjoyable. In short, childhood obesity in Asia is preventable provided that appropriate and relevant measures are implemented and enforced.
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