According to World Health Organization, health is a state of total mental, social and physical completes as opposed to earlier definitions that it is the mere absence of sickness. Healthcare on the other hand is the preservation of all these through medical services. Urbanization is the migration of people from the rural areas to urban areas. This is so because the urban areas have offered more and better opportunities for the socio-economic well-being of their people. The more financially empowered people in these urban areas have attracted better services and the provision of social amenities to them like entertainment facilities, good housing, good transportation, and good healthcare is not an exception.
Obesity is a medical state whereby there is an accumulation of excess fat creating dangerous health effects that may even lead to reduced life expectancy. The condition leads to vulnerability to various diseases and complications such as heart diseases, some types of cancer, breathing difficulties and even diabetes. It has been argued that to some people the condition is genetic but there has been little or no evidence to support that. The evidence available shows that obese people spend more on their bodies as compared to the rest as the energy required to maintain that much body weight is a lot. It is also a product of lack of physical activity and excessive dietary calories.
Health in Newham has been a challenging issue for the government whereby the health of the people living here is the worst in England. Mortality is also highest in Newham more than anywhere else in the rest of England. Newham also has the highest birth rate in the country with children and teenagers accounting to almost two thirds of its total population. About combating obesity in primary school children it still remains hard as targets have still not been reached. Like other health issues, Newham has more children who are obese than the rest of England.
Efforts by the local authorities to combat childhood obesity are slowly bearing fruits as the provision and encouragement of sporting activities both in schools and in their communities have seen them meet their target of almost all children engaging in three hours of physical education per week. This has also targeted developing prevention approaches from a young age until they reach school age. The high rate of malnutrition on Newham has also led to high rates of type 2 diabetes in children which is linked to poor diet. The council plans to restrict the operation of fast foods outlets near schools.
Tackling childhood obesity is a key national priority as evidenced in the Public Health White Paper, “Choosing Health” in 2004. The development of the “Healthy Weight, Healthy Lives” cross-government strategy also bears witness to this. These programs are meant to foster a culture of adoption of healthy lifestyle choices so as to reduce cases of obesity among children.
Obesity in Children
The problems that affect children mostly with obesity are psychological and emotional. It can also bring heart diseases, high blood pressure or diabetes among children. Adolescent obesity has also been known to lead to early mortality during adulthood. Children may also develop low self esteems and depression from teasing by their peers. The Body Mass Index – BMI (explained later in this paper) of children vary with age and sex. Obesity in children has been explained by the centre for disease control to be above the 95th percentile. This explanation by the Center for Disease Control varies for all children including those in Newham and not only for the ones in the U.S. as shown in the graphs below.
Figure 1 A graph of BMI in kg/m2 (vertical axis) against Age in years (horizontal axis) showing age percentiles for boys aged 2-20 years.
Figure 2 A graph of BMI in kg/m2 (vertical axis) against Age in years (horizontal axis) showing age percentiles for girls aged 2-20 years.
Obesity; the leading preventable cause of death worldwide.
According to Barness (2007), obesity is one of the world’s leading preventable causes of death. Studies have also advanced that mortality risk is low at 25kg/m2 in non-smokers and 27kg/m2 in smokers. Among women, a double mortality rate has been associated with a BMI above 32. In the U.S. causes an excess of between 111,909 – 365,000 deaths per year. This is again reinforced by the fact that 7.7% of the deaths in the European Union are caused by excess weight. (Fried et al 2007). On average, a BMI of 30-35 reduces life expectancy by approximately 3 years while BMI >40 reduces life expectancy by 10 years. (Whitlock et al 2009)
Figure 3. The Relative Risk of Death for Men in the U.S. by BMI (Freedman et al 2006)
Figure 4. The Relative Risk of Death for Women in the U.S. by BMI (Freedman et al 2006)
The list of complications and health consequences caused by obesity is endless. There are also risks of mental conditions. These are more commonly shown in a combination of medical illnesses like diabetes type 2, high blood cholesterol and high blood pressure. These health conditions are classified into those which can be attributed to an increased mass of fat and those due to an increased number of fat cells (Bray 2004). Those due to excess fat mass include obstructive sleep apnea and osteoarthritis while those due to an increased number of fat cells include cancer and diabetes.
An increase in body fats is well known for alteration of the body’s insulin response leading to a condition known as insulin resistance. These complications are either caused by obesity directly or through a mechanism that shares a common cause of poor diet. The link of a medical condition and obesity also differs, for example, type 2 diabetes has a very strong link and recent studies show that excess body fat is responsible for 77% diabetes cases in women as compared to 64% in men.
Despite all the risks associated with obesity and the negative health consequences, recent studies show that health conditions in some people are improved by an increase in BMI. This is a new advent known as the obesity survival paradox. This paradox has been seen work for people with heart failure and peripheral artery disease whereby those with between 30.0 and 34.9 BMI had a lower mortality than those with normal weights. Similar findings have stood in other types of heart diseases. This has been rooted in the fact that people who are ill progressively lose weight as time goes by. This is however limited to class 1 obesity between 30.0 – 34.9 BMI while with people who have higher degrees of obesity the risk further increases.( Romero-Corral 2006)
Obesity-Major Causes
Lau (2007) observes that obesity is a cause of a combination of a high intake of caloric diets and lack of physical activity. He also observes that at societal level, increasing rates of obesity cases is primarily due to ease in accessibility of palatable diets and a heavy dependence on cars.
However, in 2006, Keith, S W. et al. identified ten other possible factors that could be leading to an increase in the prevalence of obesity. These are;
Insufficient sleep
Assortative mating
Environmental pollutants interfering with lipid metabolism
Genetic factors taken up generationally
Decreased variability in ambient temperatures
Children from pregnancy at a late age
Decreased rates of smoking
Proportional increases in ethnic and age groups
Increased used of medications leading to weight gain, and,
Natural selection for higher BMI
These are however more applicable to adults as opposed to children and adolescents. Despite there being substantial evidence to support the above factors as contributors of obesity, the evidence still leaves a lot to be conclusive and these are less influential as compared to the others discussed like lack of physical activity and excess caloric intake. The major ones include;
Diet
Over the years, dietary energy supply has increased consistently whereby the average calories intake has also increased in all parts of the world except for Eastern Europe with the U.S. leading. Overeating and poor dietary choice has led to an increase in obesity rates in the larger Easter Europe including London from 14.5% to 30.9% between 1970 and 2000. An increase in the average calories consumption was also noted during the same period where for women it was 335 calories per day as compared to men’s 168 calories per day. Wright 2004 argues that most of these extra calories were due to increased carbohydrate consumption and not fat consumption. The main source of the extra carbohydrates is also believed to be coming from sweetened beverages which give 25% of daily calories in school going children and adolescents in Newham London.
The graph below shows the average per capita energy consumption of the world from 1961 to 2002.
Figure 5: the average per capita energy consumption of the world from 1961 to 2002.
Sedentary Lifestyle
The increasing use of mechanized transportation and labour-saving technology in different homes has led to a decrease in the physical exercise that people engage themselves in. The WHO (2009) notes that at least 60% of the world’s population lacks sufficient physical exercise.
Medical and Psychiatric Illnesses
Obesity is not classified as a mental disorder or psychiatric illness but the risk of getting obese remains higher in patients with psychiatric disorders as compared to those without. Also, certain types of medication used to treat mental illnesses can increase the risk of getting overweight. Eating disorders are also well known for increasing one’s chances of getting obesity, these are binge eating disorder and night eating syndrome. Some of the medications that cause weight gain include insulin, antidepressants, steroids and some hormonal contraceptives.
Genetics
The presence of genes that control appetite and metabolism expose one to the risk of getting obesity. This is inhibited by a combination of different factors; when sufficient calories are present and, when the favourable environment is also present. To reinforce this argument, Kolata (2007) observes that 80% of the off springs of two obese parents were obese as compared to less than 10% of the cases of off spring of two parents who were not obese.
Social Settings
Although obesity has been seen as an individual cause basing on the eating habits of different people, a combination of factors on a societal scale explains the increase in obesity cases within specific countries globally. Worldwide, the relationship between the social class and obesity differs. In the developed world, levels of teenage children’s obesity is associated with income inequalities, higher socio-economic classes are more obese than their counterparts in the lower social class.
Obesity Management
There are different ways in which obesity can be treated like the use of anti-obesity drugs which help inhibit appetite and reduce the absorption of fats, the use of an intragastric balloon so as to reduce the size and capacity of the stomach, proper dieting and physical exercise. The intragastric balloon is used to reduce the ability of the body to absorb nutrients from the body. (Imaz, et al. 2008)
The Body Mass Index (BMI) is the measurement used to define whether people are obese or not. This is calculated by dividing the mass of a person by the square of his height. The weight is calculated in lb(pounds) and the height in inches. A classification different BMIs is illustrated below.
BMI
Classification
< 18.5
underweight
18.5–24.9
normal weight
25.0–29.9
overweight
30.0–34.9
class I obesity
35.0–39.9
class II obesity
? 40.0
class III obesity
Figure 6 Classification at different levels of Obesity (WHO 2000)
Diet
Although diet programs have been advocated for to be the best in obesity management, it can also be ineffective if one does not maintain a lower calorie diet a permanent part of his or her own lifestyle. The success rate of this method of combating obesity has been low ranging at below 20% in the short run. Studies show that many of the people who lose at least 10% of their body weight through this method do so after the first year.
Diet
Again diet becomes therapy for weight loss just as it is for weight gain. Studies have shown four diets that promote weight loss and these are; low-carbohydrates, low-fat, low-calorie and very-low calorie. In almost all studies, these methods have resulted in similar weight loss and have therefore been proofed some of the most effective ways of losing weight.
Physical Exercise
Walking, running and cycling have been known as effective ways of reducing body fat. During exercise, there is the use of body fat as fuel. The use of stairs is also encouraged and the use of community campaigns towards this has proved effective in other parts of the world. The 70miles road block on Sundays in the city of Bogota, Colombia has made it mandatory for the citizens to get the exercise they lack during weekdays. This is an effort by the government to combat diseases like obesity.
Medication
There are two different types of medication, orlistat, which reduces intestinal fat absorption and sibutramine which deactivates neurotransmitters in the brain to decrease appetite. These methods are long term and FDA notes that sibutramine increases the risks of heart attacks for patients with a history of such diseases. There are however other medications used but most of them are appetite suppressants that act on neurotransmitters of the brain.
Surgery
The surgery for weight-loss is known as Bariatric Surgery. This is done to reduce the volume of the stomach for patients who have failed to lose weight by the use of the other methods of dietary and pharmacological ways. It is however important to note that complications associated with weight loss are frequent after this surgery. Despite this, the method has a proved decrease in the risk of acquiring diabetes mellitus and cancer. Weight loss also occurs a few months after the surgery and it is long-term.
Conclusion
Childhood obesity has reached alarming levels in the wake of the 21st century with its rates rising in both the developed and developing countries. Changing diets and lack of physical exercise due to the high mechanization in homes and transport have been identified as the two main factors responsible for this condition. A call on dietary change should be emphasized more and physical exercise should be encouraged.
References
Bray GA (2004). “Medical consequences of obesity”. J. Clin. Endocrinol. Metab. 89
Department of Health, Public Health White Paper, presented to the Public, Older people, Parents & Professionals on 16 November 2004
Freedman DM, Ron E, Ballard-Barbash R, Doody MM, Linet MS (2006). “Body mass index and all-cause mortality in a nationwide US cohort”. International Journal of Obesity (London)
Fried M, Hainer V, Basdevant A, et al. (2007). “Inter-disciplinary European guidelines on surgery of severe obesity”. International Journal of Obesity, London
Imaz I, Martínez-Cervell C, García-Alvarez EE, Sendra-Gutiérrez JM, González-Enríquez J (2008). “Safety and effectiveness of the intragastric balloon for obesity. A meta-analysis”. Obesity Surgery 18 (7): 841–6
Keith SW, Redden DT, Katzmarzyk PT, et al. (2006). “Putative contributors to the secular increase in obesity: Exploring the roads less travelled”. International Journal of Obesity (London) 30
Kolata,Gina (2007). Rethinking thin: The new science of weight loss – and the myths and realities of dieting. Picador. pp. 122. ISBN 0-312-42785-9.
Lau DC, Douketis JD, Morrison KM, Hramiak IM, Sharma AM, Ur E (2007). “2006 Canadian clinical practice guidelines on the management and prevention of obesity in adults and children [summary”]. CMAJ 176
Romero-Corral A, Montori VM, Somers VK, et al. (2006). “Association of bodyweight with total mortality and with cardiovascular events in coronary artery disease: A systematic review of cohort studies”. Lancet 368 (9536)
Whitlock G, Lewington S, Sherliker P, et al. ( 2009). “Body-mass index and cause-specific mortality in 900 000 adults: collaborative analyses of 57 prospective studies” Lancet 373 (9669)
World Health Organization (2009), “WHO | Physical Inactivity: A Global Public Health Problem”. Retrieved February 22, 2009.
Wright JD, Kennedy-Stephenson J, Wang CY, McDowell MA, Johnson CL (2004). “Trends in intake of energy and macronutrients—United States, 1971–2000”. MMWR Morb Mortal Wkly Rep 53 (4)
