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OBESITY
A Behavioral Study
Christina L. Chapan
A course paper presented in partial fulfillment
of the requirements of
Special Education 831
April, 2006
Abstract
The intent of this paper is to discuss the problem of obesity. The focus is
to provide schools, parents, advertisers, government agencies, and those
interested in helping youth combat the increasing problem of obesity. This
paper will be divided into three sections. The first section will explore
the problem of obesity; the second section will deal with the cause of
obesity, and the third section will discuss some possible solutions.
The Problem of Obesity
Youth t obesity is at an all-time high. Someone who is obese is classified
as someone who is in the 95th percentile of their Body Measured Index or BMI
(Patton, 2004). Current statistics show that 10.4% of 2- to 5-year-old
children are obese, 11.5% of 6- to 11-year-old children are obese, and 15.5%
of 12- to 19-year-olds are obese. (MacKinnis, & Rausser, 2005). Nine
million adults—65% of the population—are considered obese. (Anderson, 2005).
Obesity has tripled five times since 1970. Eighty percent of obese children
become obese adults (Best, 2003). Fewer than one in four youth get the
physical activity they need each day (Patton, 2004). Seventy-five percent
of all students eat out five days a week. Children and youth 4-19 years old
eat six pounds of fast food a year. Caloric surplus plus the daily
consumption of hot dogs and sausage are common, particularly in metropolitan
areas. Fresh fruit and vegetables are not readily available in low income
grocery stores ( Kaplan, Liverman, Kraak, 2005).
In 1977, the average caloric consumption was 3300 per day. In 2004, the
caloric consumption is up by 500 calories to 3800 calories per day (Patton,
2004). Many toddlers—nine to eleven months old—eat candy 60% everyday and
salty snacks 16% everyday. The numbers increase to 27% everyday in kids 11-
19 months old with salty snacks. Toddlers are getting set up to eat comfort
food that is high in sugar and saturated fat and to learn how to use food to
console themselves. This is a flirtation with disaster since it teaches
kids bad habits at a young age. (Patton, 2004).
One out of every four teenagers becomes overweight. This is certainly a
problem since obesity contributes to 300, 000 deaths annually (Patton,
2004). Obesity as a whole will claim more lives than AIDS and tobacco this
year (TLC, 2004).
The effects of childhood and teenage obesity are many and include high blood
pressure, heart disease, problems with weight bearing joints, sleep apnea,
gall bladder disease, stroke, respiratory problems and some types of cancer
(American Dietetic Association, 2001). Obesity may be a medical issue, but
it can become a psychological one that brings on self-hatred, depression,
anxiety, social isolation and alienation (Mintle, 2005). Other
psychological effects of youth obesity include a lower self-esteem, inferior
body image, poor relationships with peers, and more fights with peers and
those in authority (Patton, 2004 and Chapan, 2004).
Obesity is also expensive. Childhood obesity cost $35 million in 1979-81,
and it quadrupled to $127 million between 1997-2000 (Zametkin, Zoon, Klein,
& Munson, 2004). Youth obesity has increased 197% in the last thirty years,
gallbladder disease 228%, and sleep apnea 438%. Obese kids are five and a
half times more likely to report an impaired quality of life than healthy
normal weight children. More days are taken off for illness—an average of
three more days than their average weight peers. School performance suffers
and severely obese children report a quality of life as bad as that reported
by children with cancer who have been treated with chemotherapy (Patton,
2004).
Students who are obese are at risk for diabetes. Type II diabetes, a
disease that, in the past, used to strike older people has spread to the
younger generation and now afflicts children as young as three (TLC, 2004).
There has been a ten-fold rise in childhood obesity in the last decade.
Hospital costs have skyrocketed for Type II, costing $35 million between
1979-81 and $127 million between 1997-99 (Taking Action for Healthy Kids,
2004). One half of all Hispanic and African American babies born in 2003
will develop diabetes before they are 18 years old. One third of all babies
born in 2004 will develop diabetes before they are 18. Children who suffer
from Type II Diabetes are often on route to heart disease, heart attacks,
kidney failure, blindness, amputation, miscarriages, and if their condition
goes untreated, they will see an early death.
Obesity affects all genders and races. This paper will focus on three races
I will discuss are Caucasian, African American, and Hispanic. Twelve
percent of Caucasian boys from ages 6-11 and 11.6% of Caucasian girls suffer
from obesity. African American children suffer from obesity in 17.1% of the
boys and 22.6 % of girls. Twenty-three percent of Hispanic boys are obese
and 19.6 % of Hispanic girls are obese (Ritter, 2004; Mainer & Alexander,
2005; Patton, 2004).
Obesity in teens climbs even higher. Twelve percent of Caucasian boys
suffer from obesity and 12.4% of girls. Twenty percent of African American
boys suffer from obesity and 26.6% of African American girls are obese.
Twenty-seven percent of Hispanic boys are obese and nearly 20% of Hispanic
girls are obese (Ritter, 2004; Mainer & Alexander, 2005; Patton, 2004).
Children living in metropolitan areas like Chicago tend to be more obese;
that trend seems to be linked to the abundance of nearby fast food
restaurants. Chicago is the epicenter of the obesity epidemic (Rado, 2005)
Seventy-eight percent of Chicago schools have at least one fast food chain
within half a mile of the school. Ninety-four percent have fast food
restaurants within one mile. There are, for example, twelve fast food
establishments within one half mile the Walter Payton Prep School (Rado,
2005) Students prefer Whoppers to healthy food, and each hamburger contains
at least 1,000 calories or one-third of a typical student’s diet (Ritter,
2004; Slide & Long ,2005; Mainer & DelRoy , 2004; Patton, 2004). The rate of
youth obesity in North Lawndale is 68%, South Lawndale 58%, Roseland 64%,
and Humboldt 65%.
Special Needs Children and Obesity
Research is very limited in obesity for special needs students.
Unfortunately, studying obesity in special needs students is not considered
a lucrative business. Many health clubs feel that disabled people are a
risk for their businesses, so they don’t encourage their use by their
disabled public. Obesity is doubled in special needs students when compared
with the general public. In a Chicago demographic study, 84% of people with
special needs were overweight, 62% were obese, and 22% were extremely
obese. In the Special Olympics, 64.5% of participants had a BMI <30 or
more. Sixty-eight students had dental carries. Obesity is a great problem
in the special needs population because people with disabilities often have
the bodies of their average counterparts, but 20 to 30 years older (America
Academy of Orthopedic Surgeons, 2004).
The Cause of the Problem
Obesity is caused by a variety of genetic, biological, psychological, and
environmental factors (Kaplan, Liverman, & Kraak, 2005). Some of the common
causes include heredity, excess consumption of calories, minimal exercise or
no exercise at all and poor nutrition (Patton, 2004; Mintle, 2005).
Problems in the family may increase the likelihood of obesity including
divorce, illness in the family or a way to be distracted from emotional pain
(Ritter 2004).
There are many factors to blame for obesity. First of which is a lack
of inactivity. In 1969, 80% of kids played sports. Now, only 20% of all
children play sports (Chapan, 2004). Mindless snacking and passivity is
another factor. Mindless eating and poor habits lead kids to grab the soda
or chips without thinking (Patton, 2004). Children eat out of boredom, and
they can not tell the difference between hunger and appetite. Children
have too many toys, and they are lacking imagination ( LoGuerra, 2006).
There are more than 2,000 types of food condiments and 1,000 more bakery
items since the 1970s (Chapan, 2004). School lunches have an average of
1,000 calories. Early elementary children should consume about 1,500-1,700
calories per day and middle school children about 2,300- 2,900 calories per
day (Spurlock, 2004 and 2005). Students consume twice as much soda than the
milk they consumed twenty-five years ago (Kelly and Moag, 2002). Food
rewards are given such as Krispie Cream donuts for an A on a report card,
Book-its (reading) for pizza, and Chucky Cheese tokens for good grades.
Fast food is also to blame. Many foods contain a multitude of calories:
Arby’s Beef and Cheddar has 490 calories, Burger King’s Double Whopper has
884 calories, Wendy’s Taco Salad has 666 calories, and KFC’s Xtra Crispy
Thigh has 406 calories. Children eat forty percent of all their calories
outside the home and twenty-five percent of all the vegetables served are
french fries (Brownwell, 2004). A typical kid’s meal is 1,700 calories, one
entire day’s supply for early elementary students in a cheeseburger, fries,
soda, and sundae at Outback Steakhouse. In conclusion, fast food is cheap,
easy, and readily accessible (Patton, 2004). But the future and permanent
effects are life threatening.
McDonald’s is the leader of these abuses. Eighty-three McDonald’s are in
Manhattan alone, and when I googled the restaurant, I found four less than
ten miles from my house. At my present place of employment, they have a Mc
Donald training kitchen and many of the staff and students order from it
everyday. The golden arches served over four billion in 2002 (Nahhas &
Hibbs, 2002). One hundred percent of all children have visited a McDonald’s,
98% in Japan, and 93% in the United Kingdom. Seventy-five percent of all
children visit McDonald’s every month. A Big Mac has 550 calories, a
McDonald’s fish sandwich has 370 calories, a large fry has 440 calories, an
apple pie has 260 calories, and a Coke has 200 calories (Spurlock, 2004).
Advertising is another cause of obesity. Television in general causes
children to eat more high-calorie foods. Thirty billion was spent on total
advertising in 2003 (Brownwell, 2004). In the area of advertising,
thirteen billion was spent targeting advertising on children alone. In 2003
in the area of advertising, $1.4 billion was spent by McDonald’s, $1 billion
by Pepsi, and $200 million by Hershey. The Five-a-Day Program spent a mere
$2 million. In a typical TV programming morning on Nickelodeon, there were
over 52 commercials for food products. Kids are more likely to identify
Ronald McDonald than Jesus (Spurlock, 2004 and 2005). A child sees 10,000
food commercials every year (Brownwell, 2004).
Television also causes obesity. If children are watching television, they
are idle. Those children who watch more than two hours of day of television
are more likely to be obese. Some children watch it over four hours a day.
Teenage girls of all races watch the most television. The average American
youth spends 20-30 hours a week watching television. Before the age of 18,
American kids spend three years of their waking lives in front of the
television. It is used a babysitter for latch key kids, and unfortunately,
television only burns 50 calories an hour compared to walking moderately
which burn 150 calories per hour. Seventeen percent of all youth obesity is
traced back to television viewing, 15% for raised cholesterol and 15% poor
cardiovascular fitness (Patton, 2004). We are trading safe kids for unsafe
futures and our current lifestyles.
Labor-saving devices and remote controls allow people to accomplish more
tasks in less time and cause less physical activity while encouraging
sedentary lifestyles. A drastic reduction in kids walking or riding bikes
to school also causes obesity. Obesity is also caused by psychological
factors. Food is used as a reward, withheld as a punishment, and is used as
an education tool in behavioral modification programs.
The students are also to blame for their obesity. Our youth are known as
the sedentary generation. Less than half of US children engage in activity
sufficient for health benefits. Activity declines as grade levels increase,
especially in girls. Twenty-five percent of young people 12-21 engage in no
vigorous exercise, and 14% report no recent light-to-moderate activity
(Patton, 2004).
In the limited amount of information I found on special needs obesity, I
discovered that there are some medical causes for being overweight.
Sometimes an irregular hypothalamus is damaged or quits functioning. Some
of the disorders encountered in special education that may predispose
children to being overweight are Prader-Willi, Bardet-Biedl, and Carpenter
Syndrome. In these disorders students do not have the mechanisms to have
self-control not to quit eating.
Schools are also part of the problem. The No Child Left Behind Act has
forced schools to put a strong emphasis on academics; physical education and
activity has suffered. Only one-third of elementary and secondary schools
offer daily physical education classes. Illinois is the only state that
requires daily physical education and private schools are not required to
fulfill this requirement. High school enrollment in PE classes has declined
from 42% to 25%. Summer school physical education programs have replaced
physical education classes with a mere six weeks of physical activity. In
the Minneapolis Public School system, there are 52 physical education
teachers for 118 elementary schools and physical activity is only offered
once or less than once a week .
Despite the part schools play in physical fitness, families are the most
important influence in a student’s life. Parents who are overweight have
overweight kids. With two obese parents, there is an 80% chance their
children will be obese and a 50% chance if one parent is obese. When both
parents are average weight, their children have only a 10% chance of being
overweight. One half of all parents never exercise vigorously (Patton,
2004). The over-consumption of inexpensive, processed food further
exacerbates the problem. Children who do not eat with their families run a
greater risk of obesity and are also more prone to depression, suicide, and
risky sexual behavior (Mintle, 2005).
Nature or Nurture
Is obesity is a product of nature or nurture? Studies show that obesity
results from a combination of both. Thirty to fifty percent of all obesity
falls is hereditary but controllable with a combination of diet and
exercise . ( Patton, 2004) Infants born to overweight mothers have been
found to be less active and gain more weight by three months than infants
born to mother with normal weight. Good habits are learned by example and
start early. By adolescence, the influence of the family decreases. Obese
parents may be reluctant to see that they and their children have a
problem. Unconditional love can be a blessing or an opportunity to be self-
indulgent. Exercise, coupled with the influence of more active parents,
makes a child six times less likely to become obese (Patton, 2004)
Solutions
What can be done? Anyone who is involved in the life of a child must focus
on a balanced diet consisting of complex carbohydrates, high quality lean
proteins, lean meats, and skim milk. Fats should not be restricted, but
there should be a limitation on saturated fats; they should not make up more
than 10% of a child’s diet (Patton, 2004). Children under 2 should have no
restrictions on the percentages of fat in their diets. Plenty of fiber, 5-
10 grams daily, must be a part of a child’s diet. There should be a greater
emphasis on eating more fruits and vegetables from the farmer’s market and
less of an emphasis on eating processed foods (Patton, 2004).
Weight loss should not be the primary focus in changing children’s diets,
but rather it is more important that they grow into their weight as they
mature. Only then will their BMI go down, and they will eventually arrive
at a normal body weight. It is estimated that for every 20% in excess of a
child’s ideal body weight, the child will need 1 ½ years of weight
maintenance to attain their ideal body weight. Diets do not work, but
healthy lifestyles do (Patton, 2004).
To motivate the overweight child, parents, coaches, and teachers should keep
upbeat attitudes about healthy eating and exercise. Physical activity
should be more centered on cooperation than competition and place more of a
focus on teamwork and participation than on winning and losing. More
attention should be directed to the duration of the activity than the
workload, and the child should be allowed to rest as needed. It is also
important to find out what activities the child enjoys and to focus on
little victories—stringing them together as they work toward accomplishing
the goals of a healthy lifestyle.
Children should also be taught to plan ahead for healthy eating. Parents
should ensure that healthy snacks are available and should lead by example.
Teachers, principals, parents, and coaches play a very important role in
encouraging the practice of healthy eating. Those who interact with the
child can even make a pact to encourage consistency with other family
members and peers, thus helping the child develop a healthier lifestyle.
Schools play an important role in educating children. When a school takes
serious steps to make their cafeteria more nutritionally friendly, provide
more opportunities for activity, and involve youth and parent nutrition
education in their curriculum, they can have an important impact on their
students’ lives. When nutrition is improved in schools, there are
significant improvements in math and writing scores and less disruptions
stemming from classroom behavior. Healthier options such as a salad bar and
fresh fruits and vegetables help a student do better in school (Patton,
2004).
Schools should select programs for healthy eating similar to the project by
Natural Foods in Appleton, Wisconsin. At Appleton Alternative High School,
they got rid of the fattening foods sold in the vending machines and started
serving healthy food. Their menu consists of low sugar and fresh produce.
The student’s behavior has improved and teachers are telling the
administration that they are able to get done more work during the day. The
cost of the program was similar to an average lunch program. Another
solution is to have part of the schools’ food budget go to farmers who bring
in healthy, fresh produce (GAO, 2005).
Physical activity must be increased. It is estimated that only three
minutes of a typical gym class is spent in vigorous activity (Wallis,
2004). School physical activities should focus on structured and
unstructured activity time. Recess should be daily. Physical education
programs should focus on muscle endurance, flexibility, and cardiovascular
fitness (Rimmer, 2006). If gym classes could extend by just 60 minutes a
week, there would be a decrease of 43% of obesity in girls and 60% of at-
risk girls in grades K-5. There is no significant impact on boys (Spurlock,
2005). Only 8% of all elementary students, 6.4% of middle school students,
and 5.8% of all high school students have physical education everyday. This
has to change.
Madison Junior High in Naperville, Illinois has a successful physical
education program that uses fitness machines, free weights and bikes that
power video games. This program was not started by tax money but by fund
raisers and parental financial support. School programs should offer
athletic programs such as interscholastic sports and intramural clubs to
encourage both the athlete and the casual exerciser alike (Kaplan, Liverman,
and Kraak, 2005).
Children who work out improve their cardiovascular system and improve their
strength and endurance. This helps them build healthy bones and muscles and
control weight. They also learn to reduce anxiety and stress and increase
their self-esteem. They lower their blood pressure and their cholesterol
levels. Students with ADHD or other problems with hyperactivity and
focusing have fewer symptoms after playing outdoors and performing physical
activity (Lawson, 2004). The goals of a successful physical education
program emphasize enjoyable participation in fitness in a way that
translates into lifelong enjoyment of physical activity.
The guidelines for heavy children include one hour or more of light to
moderate activities daily. Strength training is a great complement and
should include supervised light weights and body weight-bearing exercises.
Emphasize the total calories burned rather than the intensity of the
activities. Allow the child to accumulate activity throughout the day.
Reward and praise the child for successful attempts and progress (Patton,
2004).
Insurance providers should provide fitness discounts to their customers and
no health club should charge an extra fee to disabled individuals. Physical
fitness facilities should hire staff and provide accommodations for those
with special needs. Education should also be provided to personal trainers
and group fitness instructors to understand the unique needs of children and
of those with disabilities. Local government, private developers, and
community groups should work together to develop recreational facilities and
make safe bike and walking trails (Kaplan, Liverman, and Kraak, 2005).
Fast food restaurants should have their nutrition information posted at
their establishments. Nutritional information should be posted in both
English and Spanish (GAO, 2005). Much of this information is also found on
the web. Patronize restaurants that offer healthy options and let them know
that is why you are there.
Television time must be limited to 1-2 hours per day. Children under 2
should not watch television at all. Preschool children who watch television
are 6% more likely to be obese for every hour that they watch television
(Brownwell, 2004). Parents and teachers should write, e-mail and call
products to have healthy foods advertised during children’s programming. In
Canada, there are no ads for children thirteen years of age allowed in their
television programming and in Belgium no ads are to be shown five minutes
before, during, and after a children’s television show. England may soon
follow suit. (Brownwell, 2004).
The family is the most important piece of the puzzle to combat child and
youth obesity. Families should identify opportunities to exercise
throughout the day. Walk to do errands, take the stairs, and have children
walk to school with their parents. Buy toys and gifts that allow for
creativity and promote activity. Assign chores and make exercise one of the
lists of tasks for an allowance every week. Use moderation, but don’t
restrict food. Never take food away as a punishment.
Encourage teenagers to seek active jobs such as paper carrier, lawn service
or attendance runner at school. They should participate in fund-raisers or
events that promote activity instead of food. Incorporate physical activity
in celebrations and special occasions. Add exercise to weekend plans such
as swimming, flying a kite, hiking and biking. Play one physical activity
event each week for the whole family such as walking, biking, hiking, and
playing tennis. Encourage the family to take up active pursuits. Have kids
walk/bike to their destination and park away from stores and walk to the
entrance. Plan snacks at set times and discourage late night snacking
(Rodriguez, 2004).
At mealtimes, cook only enough for everyone to have reasonable portions.
Don’t encourage a clean plate. Don’t buy junk food and avoid allowing
children to eat while they are reading, doing homework, or watching
television.
Avoid fast food, and if you must eat it, don’t buy super-sized portions.
Encourage good choices at fast food restaurants. Only let kids buy lunch at
the school once a week. Split meals at restaurants or have them take a
portion home, since serving sizes in restaurants are often large. On car
trips, take along a cooler of healthy snacks. Avoid sodas and encourage
children to drink water. Make sure that kids eat breakfast and drink low-
fat or skim milk. Children over the age of 2 do not need whole milk.
Finally allow children the responsibility of helping cook and try new
things. Use smaller plates and give them opportunities to try new fruits
and vegetables. Make food fun with plates decorated for kid-friendly eating
and encourage your children to eat slower. Buy bite-sized fruit to put into
lunches.
Summary
Childhood obesity does not have to happen. Schools can provide a learning
environment with healthy food options and nutritional education. They can
also dedicate more time to physical education, even if that means the
academic school day is extended. Advertisers can make the effort to provide
healthier products, and fast food establishments can make nutritious options
available at their restaurants. Parents are the most important influence in
a child’s life. They must work together as a family, eat nutritiously
balanced meals, and make exercise a family activity. With positive
encouragement, we can turn the tide and give our youth a brighter future and
tomorrow.
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