Stopping Childhood Obesity in the United States: One Goal at a Time

Sam ShoberWhite Paper

Contents

I. Introduction 2

II. Section I

A. What is Obesity? 2

B. Physical Risks 5

C. Psychological Risks 6

D. Why Obesity? 7

III. Section II

A. Sports Benefits 8

B. Team Sports 8

C. The Programs 10

IV. Section III

A. Discussion 14

V. Moving Forward 15

VI. Index 17

VII. References 21

1

Introduction

It is estimated that the U.S. spends approximately $147 billion dollars on

obesity-related medical funding per year.1 That sum is greater than the entire GDP

of Hungary.2 Despite our best efforts for the past decade, the prevalence of

childhood obesity has not decreased (refer to figure 4, index). Estimates predict that

currently, approximately 60% of the nation’s obese kids will become obese adults,

who then in turn will contribute to the $147 billion obesity price tag.3 The

stagnation of progress in reducing childhood obesity prevalence is untenable.

Change is needed in our prevention and reduction strategies and I believe the

answer lies in youth sports participation. This paper proposes to answer the

question, are youth sports a viable solution to reducing the prevalence of childhood

obesity?

Section I

Section I addresses the definition and extent of childhood obesity in the U.S.,

the threats obesity poses to childhood health and wellbeing, and the reasons for

targeting childhood obesity as an important social issue.

What is Obesity?

1 Finklestein, Eric A., Justin G. Trogdon, Joel W. Cohen, and William Dietz. "Annual Medical Spending Attributable To Obesity: Payer-And Service-Specific Estimates." Health Affairs 28.5 (2009): 822-31. Print.2 World Bank Website http://data.worldbank.org/indicator/NY.GDP.MKTP.CD?order=wbapi_data_ value_2012+wbapi_data_value+wbapi_data_value-last&sort=asc, DOA = 3/12/143 Serdula MK, Ivery D, Coates RJ, Freedman DS, Williamson DF, and Byers T. "Do Obese Children Become Obese Adults? A Review of the Literature." Preventive Medicine 22.2 (1993): 167-77. PubMed. Web. 13 Mar. 2014.

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Before any progress can be made on combating childhood obesity, an

understanding of how it is measured first must be grasped. The most common

metric used by researchers and scientists today is the BMI (body mass index).

Invented in 1835 by the statistician Adolphe Quetelet, the BMI was originally an

attempt at defining the “average man” in terms of human measurements.4 Out of this

research came an equation that is still used by scientists across the world, BMI=kgm2

,

or a person’s weight divided by the square of their height. The resulting BMI ratio is

used today as a heuristic measure of health.

Using national data collected over many years, BMI charts have been created

that map out normal growth for children (refer to charts 1 and 2, in index). From

these charts scientists derive their definitions for obesity and overweightness. For

children ages 2 through 19, a BMI equal to or above the 85th percentile is defined as

overweight and a BMI equal to or above the 95th percentile is defined as obese.5 It’s

important to note BMI is not a fully accurate measure of childhood obesity as

different body types may elicit high BMI numbers that are not representative of a

child’s actual health. But for the vast majority of American children, BMI is a helpful

predictor of health, leading to its widespread use in medicine and research. Now

that we have defined obesity, let’s take a look at the magnitude of the childhood

obesity crisis in the U.S.

4 Eknoyan, Garabed. "Adolphe Quetelet (1796–1874)—the average man and indices of obesity." Nephrology Dialysis Transplantation: Oxford Journals. 23.1 (2007).5 Barlow SE and the Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120 Supplement December 2007:S164—S192

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Despite recent improvements in obesity prevalence in children ages 2 to 5,

obesity prevalence in youth overall has not improved.6 From recent 2010 data, it

was found that 17% of children aged 2 to 19 were obese and 32% were overweight.7

The truly worrisome trend is that these percentages have not declined in over a

decade. Data from a similar NHANES (National Health and Nutrition Examination

Survey) study showed no decline in overweightness and obesity since1999-2000.8

Childhood obesity prevalence levels have not improved in ten, or possibly even

fifteen years. This data is worrying, it signifies that new generations are progressing

toward adulthood at a much higher risk of adult obesity than ever before in human

history.

2010 JAMA data also shows that children are getting proportionally bigger as

they get older. Prevalence of obesity in 2 to 5 year olds was 8% but in adolescents

aged 12 to 19; the prevalence increased to 18.5%.9 Additionally, the data also shows

minorities are at a higher risk of obesity than non-Hispanic white children. 2010

data shows that the prevalence of obesity among Hispanic children is 21% and for

non-Hispanic black children the prevalence of obesity is 24%.10 Three salient points

emerge from this data:

6 Ogden, Cynthia L., PhD, and Margaret D. Carroll, MSPH. "Prevalence of Childhood and Adult Obesity in the United States, 2011-2012." JAMA Network. America Medical Association, 26 Feb. 2014. Web. 12 Mar. 2014.7 Ogden, PhD, MRP, Cynthia L., Margaret D. Carrol, MSPH, et al. "Prevalence of Obesity and Trends in Body Mass Index Among US Children and Adolescents, 1999-2010." JAMA. 307.5 (2012): n. page. Web. 18 Feb. 2014.8 Ibid.9 Ogden, PhD, MRP, Cynthia L., Margaret D. Carrol, MSPH, et al. "Prevalence of Obesity and Trends in Body Mass Index Among US Children and Adolescents, 1999-2010." JAMA. 307.5 (2012): n. page. Web. 18 Feb. 2014.10 Ibid.

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1) The childhood obesity epidemic is a serious, pressing issue; over a third of our

nation’s children are overweight.

2) Childhood obesity rates are increasing substantially throughout childhood,

demonstrating that the epidemic affects children of all ages.

3) Hispanic and African-American kids are at a higher risk of being obese than

other children, suggesting this demographic should be the focus of obesity

prevention programs.

The extent of the childhood obesity epidemic is staggering, but what are the

actual dangers of being obese?

Physical Risks

The adverse effects of obesity are diverse and severe in magnitude. In an

expansive thirty-year program named the Bogalusa heart study, 16,000 participants

were followed from childhood to adulthood. From the study, it was determined that

heart disease and cardiovascular complications begin as early as six years old11. It

was also discovered that kids at this age could already have plaque in their arteries,

which leads to high blood pressure (HBP) and elevated cholesterol.12 In addition, the

study found that obese children are eight times more likely to develop HBP than

healthy kids; 77% of obese kids will become obese adults (while only 7% of normal

weight kids will become obese adults); and childhood obesity can lead to insulin

resistance, which sets the stage for type II diabetes.13 In a recent study, the case for

childhood diabetes is even more severe. For kids born after the year 2000, 1 in 3

11 Chaykin, Dan, dir. "Consequences, Choices, Children in Crisis, Challenges." Prod. Sheila Nevins, and Jon Hoffman. Weight of the Nation. HBO: 14/05/2012. Television.12 Ibid.13 Ibid.

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will be diagnosed with type II diabetes, and among black or Hispanic kids, that ratio

increases to 1 in 2.14 Finally, a variety of other chronic diseases and ailments are

strongly linked to obesity such as, cancer, arthritis, kidney disease, decreased brain

function, dementia, liver disease, gallbladder disease, and asthma.15 Unfortunately,

the dangers of obesity do not stop at physiological damage; they also affect the

psychological.

Psychological Risks

The psychological stigma of being obese as a child may be just as damaging

as all the health consequences outlined previously. In a 2004 study published in

Pediatrics, researchers found that obese children aged 11 to 16 were more likely to

be the recipients of all forms of bullying, including verbal, physical, and social

attacks.16 In addition, boys aged 15-16 were also at a risk of being perpetrators of

bullying as well.17 What is the effect of this bullying? In a report published by Yale

professor Dr. Rebecca Puhl, she states that harassment caused by obesity or

overweightness can lead to an array of adverse effects such as poor body image,

unhealthy eating behaviors, binge eating, low self-esteem, and an increased risk of

depression.18 Dr. Puhl continues, explaining that recent experiments show that

childhood obesity may heighten the risk for children to experience negative physical

reactions to “psychosocial stressors" and that these negative experiences may in

14 Chaykin, Dan, dir. "Consequences, Choices, Children in Crisis, Challenges." Prod. Sheila Nevins, and Jon Hoffman. Weight of the Nation. HBO: 14/05/2012. Television.15 Ibid.16 Janssen, PhD, Jan, Wendy Craig, PhD, et al. "Associations Between Overweight and Obesity With Bullying Behaviors in School-Aged Children." Pediatrics. 113.5 (2004): 1187 -1194. Print.17 Ibid.18 Puhl, Rebecca M., and Janet D. Latner. "Stigma, obesity, and the health of the nation's children." Psychological Bulletin. 133.4 (2007): 557-580. Web. 18 Feb. 2014.

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turn lead to higher risk of heightened blood pressure, cortisol reactivity, and risk for

hypertension.19 The implications of the previous studies are dire; they reveal that

obese children not only have health risks, but that psychological stress is damaging

their emotional and physical lives as well.

The perils of childhood obesity are grave. As evidenced by previous sections,

being obese at a young age puts children at a much higher risk of a plethora of

ailments. Childhood obesity is deeply entrenched in American society and for this

reason we must dig it back out.

Why Obesity?

So far, we have seen the distressing magnitude of obesity prevalence in the

U.S. (1/3 of children are overweight or obese). We have seen the severe health risks

for which obese children are at a much higher risk of contracting (obese kids are 8x

as likely to develop HBP). We have seen the intense psychological detriments obese

children suffer as a result of bullying (lower self-esteem, binge eating, depression).

There is no question or controversy that childhood obesity is a pressing issue in this

country and it is my hope that one of the strategies by which we address this issue is

through youth sport.

19 Puhl, Rebecca M., and Janet D. Latner. "Stigma, obesity, and the health of the nation's children." Psychological Bulletin. 133.4 (2007): 557-580. Web. 18 Feb. 2014.

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Section II

In this section I will examine the benefits of youth sports, the viability of

team sports in preventing obesity, and assess the feasibility of implementing youth

sports through a national program.

Sports Benefits

What are the actual benefits of sports? Compared to kids who don’t

participate in sports, kids who do have greater daily total energy expenditure,

develop less adipose tissue, and have better cardiovascular health, muscle

endurance and strength, anaerobic and aerobic capacity, body coordination, and

flexibility.20 Second, sports can have a positive social impact for kids. Participation in

sports can aid in the development of social skills, self-esteem, moral judgment, and

responsibility.21 Last, in many studies, sports have been shown to have an

educational benefit. Participation in youth sports has been correlated to

improvements in concentration, memory, school attendance, and behavior.22

Identifying the benefits of sports serves as a confirmation of the potential positive

growth that youth sports can provide to children.

Team Sports

20 Strong, William B., MD, Robert M. Malina, PhD, and Cameron JR Blimkie, PhD. "Evidence Based Physical Activity for School-age Youth." ScienceDirect. The Journal of Pediatrics, June 2005. Web. 11 Mar. 2014.21 Ewing, Martha E. Paradoxes of Youth and Sport. By Margaret Gatz, Michael A. Messner, and Sandra Ball-Rokeach. Albany: State University of New York, 2002. 31-43. Print.22 Ibid.

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Team sports have long been touted as a great way for kids to learn

cooperation, sharing, and communication. However, can team sports also help

prevent and reduce obesity? Research over the past decade may be saying just that.

In a recent study by Stanford researchers, obese children were separated

into two groups, an experimental soccer group and an active control health

education group. Every week, the soccer group would meet three to four times to

practice and play soccer with no emphasis on diet. The health education group met

for the same amount of time, but their time was spent being taught health education

by experienced Stanford health professionals. After six months, the BMI’s of the two

groups were measured. Compared to the control dietary education group, the

experimental soccer group experienced significant effects on BMI and BMI z

scores.23 This suggests that youth sports may have a more significant effect on

reducing obesity in children than dietary education.

Sports may be linked to the reduction of preexisting overweightness and

obesity, but what about prevention? In a comprehensive meta-analysis, a team of

thirteen distinguished doctors and PhD’s analyzed over 850 different articles on the

relationship between youth obesity and physical activity. They consistently found

that the effects of physical activity were lower total adiposity, better cardiovascular

health, and better muscular endurance and strength. From these findings, the

research team confirmed the viability of exercise as a major childhood obesity

prevention strategy.24

23 Weintraub, Dana L., et al. "Team Sports for Overweight Children: The Stanford Sports to Prevent Obesity Randomized Trial (SPORT)." Archives of pediatrics & adolescent medicine 162.3 (2008): 232.24 Strong, William B., et al. "Evidence Based Physical Activity for School-age Youth." The Journal of Pediatrics 146.6 (2005): 732-37. ScienceDirect. Web. 10 Mar. 2014.

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What is the significance behind these findings? First, these studies link the

relationship between youth sports and the reduction and prevention of childhood

obesity. The first study illustrates how youth sports can reduce obesity prevalence

in children. More importantly, this study highlights the fact that youth sports may

have a greater effect on obesity than dietary education. The meta-analysis confirms

a positive relationship between physical activity and physical health, solidifying

youth sports as an instrument to prevent obesity. With the power to both prevent

and reduce childhood obesity, it becomes evident youth sports could be a potent

mechanism of change.

The Programs

Two prominent national childhood obesity prevention programs, Let’s Move

and Play 60, have been hailed as major players in the movement to combat

childhood obesity. What is their emphasis on sports?

Let’s Move

Let’s Move is a comprehensive childhood

obesity prevention campaign launched by Michelle

Obama in 2010. The program is focused on five

pillars of development recommended by the Task

Force on Childhood Obesity. The pillars are:

1) Create a healthy start for children

2) Empower parents and caregivers

3) Provide healthy food in schools

4) Improve access to healthy, affordable foods

Let's Move Logo

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5) Increase physical activity.25

25 Let’s Move About http://www.letsmove.gov/about, DOA = 12/3/14

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Of the five pillars, only the fifth pillar promotes exercise. The physical activity

recommendation from Let’s Move is: “60 minutes of exercise at least 5 days a week,

6 out of 8 weeks”.26 However, Let’s Move does also recognize the potential of youth

sports, so in many of programs it promotes the availability of sports. In a task force

report sponsored by Let’s Move, the report recognizes that: 1) sports participants

are more active overall 2) adolescent sports participants have lower cardiovascular

risk factors 3) adolescents who play sports have stronger mental health.27 With

these benefits in mind, Let’s Move has proposed to extend school after hours for

sports activities, decrease the costs associated with playing sports in elementary

and middle school, and has provided a wealth of opportunities for volunteers,

school officials, and parents to apply for resource grants to increase physical

26 Let’s Move Mission http://www.letsmove.gov/get-active, DOA = 3/10/1427 United States. White House. White House Task Force on Childhood Obesity Report to the President. By Melody Barnes. Let's Move. 09 Feb. 2010. Web. 15 Feb. 2014.

One of many sports programs offered by Let’s Move - http://straightsets.blogs.nytimes.com/2011/02/28/first-lady-teams-with-agassi-and-graf-to-fight-obesity/

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education or after-school sports programs.28 These findings confirm that the Let’s

Move program has a strong focus on promoting team sports.

Fuel Up to Play 60

Play 60 is a campaign jointly

sponsored by the NFL and the National

Dairy Council.29 Much like Let’s Move,

Play 60 focuses on specific dietary and

physical activity goals, to improve

school based nutrition and increase

access to physical activity programs both in and out of school. While Play 60 does

28 Ibid.29 Play 60 http://supporters.fueluptoplay60.com/about/whats-fuel-up-to-play-60/ DOA = 3/10/14

After-school youth football camp sponsored by Play 60 - http://greatlakes.coastguard.dodlive.mil/files/2012/07/120629-G-JL323-238-NFL-Play-60-eventblog.jpg

Fuel Up to Play 60 Logo

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not offer the same amount of funding that Let’s Move does, they provide much more

detailed action plans, sport and skills camps, and before/after school sports

programs. Central to this idea is the “Playbook”, an online tool consolidating all the

programs and ideas that Play 60 has to offer.30 Programs offered by the “Playbook”

range from flag football camps sponsored by the NFL, walking and biking to school

programs, dance marathons, and in-school physical activity breaks. Any school that

is sponsored by Play 60 is eligible for programs like these to come to their school.

These examples illustrate the vitality of sports in the Fuel Up to Play 60 program.

Identifying the strong presence of sports in national childhood obesity

programs is an important step in the analysis of how to combat childhood obesity in

the U.S. Research confirms the viability of sports as a tool to combat obesity, such as

the numerous positive physical, social, and educational benefits of sports and the

power of sports to reduce and prevent youth obesity. These results also confirm the

viability of sports programs as a tool to be implemented on a national scale. These

programs show that diet is not the only method of reaching kids across the nation;

youth sports are too.

Discussion

Why should sports be in the same conversation as dietary education in the

childhood obesity fight? As demonstrated, sports have the ability to prevent and

reduce youth obesity. In addition to knowing how to eat a healthy diet, it is evident

that kids also need to go out and be physically active. There are many different ways

to be physically active, but youth sports are ideal for many reasons. Sports have a

30 Playbook http://school.fueluptoplay60.com/playbook/ DOA = 3/11/14

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wide range of benefits in education, behavior, and social interaction. Sports teach

responsibility and teamwork, improves interactions with peers, and gets kids

learning more efficiently. Importantly, sports can be fun! They can transform the

drudgery of physical activity into fulfilling entertainment and can be a mechanism

for inspiring kids to be active. With the knowledge that youth sports are a valuable

obesity-fighting tool, future programs can combine sports opportunities and dietary

education to help U.S. children achieve better health.

The childhood obesity crisis has been media news for a decade now, but why

does it really matter? Why should we care? Three reasons stand out. First, childhood

obesity is a serious health issue. Despite recent improvements, still almost 1/3 of

U.S. youth are affected by obesity or overweightness.31 By improving the health of

young children, we can help improve their quality of life and reduce physical and

psychological pain and suffering. Second, childhood obesity is an economic issue.

Obese individuals health costs are approximately $1,400 more in health care per

year than a normal weight person. An individual with diabetes incurs $6,000 more

cost per year than a person without diabetes.32 By reducing childhood obesity, we

can cut into that $147 billion check that society pays yearly in obesity costs. Lastly,

and most importantly, childhood obesity is a moral issue that affects minority

populations in a disproportionate manner. The psychological and physical risks

associated with childhood obesity are not something we would want our own

31 Ogden, PhD, MRP, Cynthia L., Margaret D. Carrol, MSPH, et al. "Prevalence of Obesity and Trends in Body Mass Index Among US Children and Adolescents, 1999-2010." JAMA. 307.5 (2012): n. page. Web. 18 Feb. 2014.32 Chaykin, Dan, dir. "Consequences, Choices, Children in Crisis, Challenges." Prod. Sheila Nevins, and Jon Hoffman. Weight of the Nation. HBO: 14/05/2012. Television.

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children burdened with (refer to figure 3, index), so instead of the current situation,

let’s create a healthful environment for our youth.

Moving Forward

The childhood obesity epidemic is complex, but helping to solve this problem

is not. Local elementary/middle schools, health centers, and national health

programs like Let’s Move or Play 60 treasure and value volunteers. Involved local

leadership in these institutions will increase community health awareness.

Secondly, everyone can strive to be a healthy role model for children. Parental

obesity and sedentary lifestyles are strongly correlated with child obesity and

inactivity.33 By being active, parents can influence their children and those around

them to be active. Finally, be vocal. We are the first society in the history of mankind

with the ability to reach billions in seconds with a comment, post, or tweet. Let’s use

this ability for change.

Childhood obesity is an issue that has progressed over the past three

decades, and is afflicting millions more children every year we allow it to continue.

What we are doing right now is not enough. Let’s use youth sport to tackle the issue

and finally put the ball back in the hands of U.S. children.

33 Jago, Russel, Kenneth R. Fox, Angie S. Page, Rowan Brockman, and Janice L. Thompson. "Parent and Child Physical Activity and Sedentary Time: Do Active Parents Foster Active Children?" BMC Public Health 10 (2010): n. pag. Web.

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Figure 1Figure 2

Figure 3

Figure 1 – CDC graph BMI for age, girls ages 2 – 19, http://www.cdc.gov/growthcharts/

Figure 2 – CDC graph BMI for age, boys ages 2 – 19, http://www.cdc.gov/growthcharts/

Index

Figure 3 – CDC info-graphic on the prevalence of childhood obesity http://images.agoramedia.com/everydayhealth/gcms/Childhood_Obesity_Infograph.jpg

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Figure 4

Figure 4 – Prevalence of Obesity in US Males and Females Aged 2 - 19

Ogden, PhD, MRP, Cynthia L., Margaret D. Carrol, MSPH, et al. "Prevalence of Obesity and Trends in Body Mass Index Among US Children and Adolescents, 1999-2010." JAMA. 307.5 (2012): n. page. Web. 18 Feb. 2014.

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