CHAPTER 2

RELATED STUDY AND LITERATURE REVIEW ON CHILDHOOD OBESITY

The review of literature for this study broadly focused on Childhood
Obesity; its prevalence across the Philippines and around the world, as well
as the cause and consequences related to children's health. Specific
attention was given to studies presenting data on current diagnosis,
management and treatment strategies used by providers. Moreover, the
literature was examined for variables which may challenge providers and
influence health outcomes for children. Many of the studies identified unique
factors which may be linked to the continued rise of children's weight and
associated co-morbidities. These included home and school environment,
region of residence, race and ethnic culture. Most researchers argue that
environmental factors in early life can determine the risk of later obesity.
Very young children appear to have the innate ability to balance their caloric
intake with the physical outflow. In other words, their intake is based on their
energy needs. As they grow older, however, they seem to lose this ability
and instead respond to external cues, such as the amount of food available
(Anderson, et al., 2006).
A study of 8,2354 children reveals factors that are statistically
significantly associated with childhood obesity including sedentary behavior
and dietary patterns among others. The odds ratio of developing obesity has
a positive linear correlation with the number of hours of television viewing
(Reilly, et al., 2005). Children who spend more time watching television are
less likely to participate in physical activity (Lindsay, et al, 2006). In addition,
junk food consumption pattern at age 3 was significantly associated with
obesity at age 7. Television viewing may also induce poor eating habits by
exposing children to commercials for non-nutritious foods that greatly
influence their preferences for foods. In 1985, Dietz and Gortmaker found
that an additional hour of television viewing is associated with 2 percent of
increase in the prevalence of obesity. Built environment such as proximity to
school, recreational activities, green space and the safety to neighborhood
have also been identified as factors influencing the development of
childhood obesity (Reilly, et al., 2005).
The 2004 National Health and Nutrition Examination Survey (NHANES II)
surveyed children 3958 children between the ages of 2 and 19 across the
United States. The findings were compared with data from 2000 and earlier
to look at prevalence trends for obesity. BMI for 17.1% were measured at or
above the 95th percentile for age (Hedley, Ogden, Johnson, Carroll, Curtin et
al, 2004). Using logistic regression, trends were adjusted for race, ethnicity
and age and showed a significant increase in obesity for children and
adolescents living in the United states between 2000 to 2004 (Hedley et al,
2004). An increase in childhood obesity has been noted in many countries,

with China showing an increase of > 11% of Obesity prevalence and Great
Britain's prevalence nearly tripling. Prevalence trends differ by race and
ethnic origin for children (Ogden, Carroll, Curtin, Mcdowell, Tabak, et al.,
2006; Wang, Monteiro, & Popkin, 2002).
O'Rahilly and Farooqi (2006) argue that causative mutation in human
genes and the highly heritable nature of obesity is the true cause of the rise
in the prevalence of childhood obesity. Their research finds the mutation to
disrupt the function of hypothalamic integrative centers that leads to
increase food intake. The study finds the estimated heritability of BMI to
range between 64% and 84%. Various studies on the genetics of childhood
obesity also concluded that approximately 25 to 40 percent of BMI is
heritable (Anderson, et al., 2006). Even if mutations in our genes have made
us more susceptible to obesity, the pace at which obesity has been
increasing the past decades is far greater than genes can evolve. A study by
Anderson and Butcher (2006), also demonstrated a correlation between
elevated BMI in children and soda intake. The nutrition empty, ease of
consumption and its replacement of oner, more nutrient laden substances.
This same study identified breast feeding, while not a consistent factor, as
having a lowering affect on children's overall weight. Moreover, the research
found that very young children seem capable of adjusting their food intake to
match their energy outflow. As children grow up their for intake becomes
more reliant on external cues, such as the amount and type of food
presented. Other studies concluded that a child's environment contributes to
obesity. With increased availability of snack foods, less physical education in
schools and increased screen time (computer and television viewing), the
environment promotes imbalance of energy intake and expenditure resulting
in more overweight children (Zhang, Cristoffel, Mason, & Liu, 2006).