Psychosocial and Social Ecological Review of Childhood Obesity
- Kaylee
- Jul 2, 2019
- 6 min read
Updated: Jul 2, 2019
Childhood obesity is an ongoing epidemic around the world. Many understand the cause of obesity to be lack of physical exercise and overeating, but it is much more complicated than that. A multilevel approach to understanding childhood obesity is important. In 2017, 30% of children in Canada were considered obese, which is minimally better than 2004’s 35%, but still not back to or better than 1979’s 23% (Public Health Agency of Canada, 2018). Childhood obesity has been linked scientifically to increased risk of developing diabetes, cardiac disease, and/or respiratory issues (Public Health Agency of Canada, 2018). The Canadian government is struggling with controlling this issue. Obesity and other chronic diseases have created a large strain on the Canadian health care system as well as lowered the life expectancy of the individuals suffering.
In the field of medical imaging, specifically in computed tomography (CT), obesity becomes a huge factor in radiation dose and production of diagnostic quality imaging. The guiding principle for applying radiation to patients is ALARA (As Low As Reasonably Achievable). When obese patients are being imaged, there is a fine line between achieving diagnostic quality images and keeping patient dose low. In some cases, diagnostic quality images are not achievable at all even with increased doses because of the density and size of the patient. There are also issues with table weight limits, and the size of gantry not accommodating the size of the patient. In CT, contrast agents are also used. These also pose issues with the obese community, as kidney function is generally reduced in these patients. Screening for kidney issues is done to ensure that patients have the ability to filter the agent out of their bodies without causing kidney failure. For diagnosis, contrast agents are used more often than not. If kidney function is lowered, the risk versus benefit model must be used for the patient, and may compromise their diagnosis. Morbidly obese patients generally also require a higher volume of contrast due to their size. Obesity is an ongoing issue in the medical imaging world as it is simply more difficult to adequately image these patients.
Aside from the specific difficulties involved for a medical radiation technologist, the increase in diseases linked to obesity put further strain on the Canadian Health System. Increases in physical health problems such as high blood pressure, heart diseases, diabetes (type-2), sleep apnea, breathing problems, abnormal menstrual cycles, bone and joint problems and reduced balance are all health problems that could develop from childhood obesity (Public Health Agency of Canada, 2018). Emotional health problems also arise, such as low self-esteem, negative body image, depression and bullying (Public Health Agency of Canada, 2018). These all increase the use of medical resources such as physicians, nurses, procedures, tests, etc. Interestingly enough, the most recent reports from the Government of Canada's website regarding the issue of childhood obesity date back to 2012. Ontario specific plans and documents all date back to 2011-2013, and yet, in 2017 30% of children in Canada were considered obese (Public Health Agency of Canada, 2018). There have been updates to Canada’s food guide in 2019, but the reports that state the Government of Canada’s plans for this issue have not been updated. Childhood obesity is one of the largest issues in Canada and around the world and needs to be addressed.
To understand the underlying cause of childhood obesity, the social ecological model (SEM) can be used. The SEM considers the complex links between individual, relationship, community, and societal factors for each individual. This model focuses on the entire world of an obese child including their demographics, home and school lifestyle, culture/religion, socioeconomic status (familial), disability, etc. Socioeconomic status is a key factor linked to obesity among men, women and children. Put simply, it is much cheaper to eat 'unhealthy' than it is to eat clean, organic, farm fresh foods. "Impoverished environments with limited availability of healthful foods, higher than average availability of fast-food restaurants, and exposure to ethnically targeted food marketing may all contribute to higher overweight/obesity among children" (Stein, Weinberger-Litman, & Latzer, 2014). Families with higher income are proven to have less likelihood of obesity (Strauss & Knight, 1999). Obesity can be caused (in part) by lower wages due to parents or caregivers working longer hours and therefore having less time to cook, as well as less time to educate their children. The table below from Strauss and Knight's 1999 study shows socioeconomic factors and their cumulative incidence percentage compared to a reference group.
The home environment is another important component of the social ecological model with regards to childhood obesity. A parent/caregiver can influence their child without even noticing it. Obesity can be due to incorrect portion sizing, lack of balanced foods, and inactivity. "The home environment is a critical factor in the development of childhood obesity" (Strauss & Knight, 1999). This healthy environment is made by parents and caregivers, and without it, children will overeat and under exercise, leading to obesity - which then can lead to many other issues for children such as bullying. This also involves education – whether that be from parents or in schools. Children need to be educated young about healthy eating and staying active. They also need their caregivers to be positive role models and influences. This can also include cultural or religious barriers to healthy active living in the home. Parents who are overweight are more likely to influence their children to be overweight.
Another model to consider in the case of childhood obesity is the psychosocial model. A psychosocial approach to childhood obesity should take into consideration the social-ecological model (and vice-versa), and a combination of these two models results in an in-depth multilevel approach to childhood obesity. The psychosocial model looks at individuals (in this case children) in the context of the combined influence that psychological factors and the surrounding social environment have on their physical and mental wellness as well as their ability to function ‘normally’. "The potential strain on the body because of stressors is particularly important to consider for children, who are still developing biologically, cognitively and socially" (Gundersen, Mahatmya, Garasky & Lohman, 2011). It is becoming more and more well known that mental health is correlated with low-income families, which then connects to increased stressors in both adults and children. The psychosocial categories in household level include events and conditions such as "parental divorce, poor parental marital quality, poor parental mental health, chronic physical health conditions of family members, domestic violence, child abuse and general relationship strain amongst family members." (Gundersen et al, 2011). On an individual level, risky behaviours and poor mental health should also be considered. As Gundersen et al reviewed in their 2011 article, “these physical health reactions to stressors have also been linked to weight gain in children via direct metabolic changes and maladaptive coping behaviours, such as lack of exercise and over‐eating". In their 2014 article, Stein, Weinberger-Litman and Latzer found that early-life trauma correlates with obesity due to processes such as greater rates of skipping meals to lose weight, problematic eating-related preoccupations and behaviors, greater use of food in response to stress, and reduced physical activity.
A combination of the social ecological and psychosocial models of health create a larger understanding of childhood obesity. It is important that parents, caregivers, teachers and government personnel all advocate for children's health as a whole to prevent obesity. A positive home and school environment with educational resources on healthy living with adult role models must be in place. Mental health issues must be addressed to not cause future issues. Family income may not be changeable, but an effort to minimalize the effect on children should be made. Psychosocial stressors should be minimal. If a child is obese, an active effort to change their lifestyle and understand the reasons why should be made. Parents who are obese and do not wish to change should still advocate for their children's healthy life. It is up to the entire circle of care of each individual child to help prevent and treat childhood obesity before it leads to future health defects. Childhood obesity can be conquered, but it will take a multilevel understanding from all Canadians. Understanding the multiple causes behind childhood obesity will not only improve quality of life for millions of children worldwide, it will also lessen the burden on healthcare systems over time.
References:
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