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A Literature Review


Eating disorders in children, adolescents and adults Risk factors, causal pathways and outcomes.


Introduction


Eating disorders in children today are reaching epidemic proportions. This assignment will explore the issues surrounding childhood obesity, the psychological effects, social effects, associated health risks, the impact it has on adult life and what we can do combat this problem. To assist in this exploration, references and the results of the field research conducted will be used to highlight these areas.


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The statistics are really quite alarming. According to Peregrin (001), 11%, an incredible 4.7 million children and adolescents in the United States are deemed as ‘seriously overweight’. Numerous theorists believe that eating disorders stem from the “early interactions with caretakers” forming their “foundations for beliefs, attitudes, and expectations about the self” (Rabinor 14, p. 7). Caretakers constituting all those whom maintain regular contact with the children thus would include parents and educators. There is evidence to support childhood obesity being the result of the parent’s genetic makeup, beliefs and attitudes and the increase in sedentary behaviour.


Annotated Bibliography


Abraham, S., & Llewellyn-Jones, D. (001). Eating disorders the facts (5th ed.). United States Oxford University Press.


Obesity itself, is quite difficult to determine however in 15 an Australian “National Health survey found that 1 per cent of men and 18% of women aged 0-6 were obese as defined by a BMI of 0 or more”. (p. )


Chapter eleven of this book thoroughly examines every possible aspect of obesity from a number of perspectives. It begins by defining obesity using the body mass index and waist measurements to calculate it. The authors recognise that in other countries obesity is an indication of prosperity, those whom are well respected and affluent in society whereas our western societies carry a social stigma, obese people being considered not worthy of treatment and targets of discrimination.


Possible genetic and behavioural factors are the primary reasons for obesity. It acknowledges the disadvantages for obese children and the psychological repercussions it could have.


The authors discuss how to manage obesity through exercise and detailed weight loss programs whilst providing case studies of obese people and offering their suggestions for tackling the problem. It also provides graphic details of people that have undergone various treatments. A comprehensive list of drugs are referenced to aid obesity and details of surgical procedures that are available. This however, is focused towards the ‘morbidly obese’ adult population.


Anderson, R. (000) The spread of the childhood obesity epidemic, Canadian Medical Association Journal, 16, 1461. Retrieved April 5, 00, from Proquest Psychology Journals database.


Alarming figures show, “In the United States alone the estimated annual number of deaths attributable to obesity is about 80 000”. (p. 16) Anderson aims to report on the associated psychological problems and health risks concerned with obesity, acknowledging that in most cases obese children mature into obese adults. A sedentary lifestyle is seen to be the major cause in childhood obesity.


Anderson on a couple of occasions uses the term fat or fatter. This was the only article reviewed that made use of such words. For example, “Moreover, the fattest children were those who reported low levels of vigorous activity and high levels of television watching”. (000, p. 16) This article, produced by the Canadian Medical Association Journal, was written relatively recently and came as a shock, the word ‘fat’ deemed as politically incorrect, these days.


Anderson declares childhood obesity a community issue and that all leaders, schools and health care professionals must work together in devising ways to resolve this problem. Emphasis is placed on the need for healthier diets and more physical activity.


Brown, L. (001). Go outside and play! Better Nutrition {Online}, 6, 46-5. Retrieved May, 1, 00, from Proquest Psychology Journals database.


In this article, Brown outlines the trends in childhood obesity and attributes them to both nature and nurture. Brown goes on to discuss a myriad of reasons for why children are becoming obese. These include the replacement of sports and other active tasks with sedentary behaviour, the media targeting children in promoting unhealthy foods, the larger portions of food being served, eating out and convenience food that lack in nutrition and role models being gangster rappers. There is little importance placed on the genetic contributions. She indicates that obese parents do have some bearing on their children’s weight, noting that there are contradicting studies. The previous factors seem more predominant.


Brown indicates that this results in numerous social, psychological and health problems and offers ten preventative tips to assist parents in developing healthy children. Although they are very helpful, there seems to be one problem and that is that the majority of those reading this particular journal, titled Better Nutrition aren’t going to be candidates of this problem. There is a dilemma of conveying this message to the people who aren’t familiar with this information.





Cristol, H. (00) Trends in global obesity, The Futurist, 6, 10. Retrieved April 6, 00, from Proquest Psychology Journals database.


Cristol interviews nutritionist Youfa Wang on her recent studies into childhood obesity and discusses the many attributes to this condition. She has undertaken studies in three countries, America, China and Russia and made comparisons. She claims that “Excessive body fat promotes heart disease and diabetes” and that “obesity is linked to various cancers, congestive heart failure, stroke depression, incontinence and other numerous diseases and ailments” (p. 10).


According to her studies, childhood obesity seems to be most serious in the United States. Interestingly, obesity seems to be more common in American families of a low socio-economic background whereas in China, childhood obesity seems to arise in affluent families.


As these children become adults ‘their quality of life is threatened by myriad health risks, economic loss, and physical limitations’. (00, p. 10) Cristol discusses a new treatment breakthrough oleylethanolamide, commonly referred to as OEA. The substance was trialled on rats and the results were pleasing. The intake of OEA was found to reduce the rat’s dietary intake as well as substantially limit weight gain whilst not affecting the nervous systems like most dieting treatments on the market do.


Gable, S., & Lutz, S. (000). Household, parent and child contributions to childhood obesity. Family Relations, 4, -00.


Gable & Lutz discuss the need for improved nutritional knowledge in parents and for them to restrict sedentary behaviour in their children to target the problem of childhood obesity.


Because of the very little success medical professionals are having treating adult obesity, they claim that the emphasis needs to be placed on preventing obesity in children. This will aspire to lower levels of obesity in adults. According to the article, obesity results from a multitude of factors. These include family demographics, type of household, parenting beliefs and practices, television viewing and physical activity.


A study was conducted whereby there were two primary objectives. The first was to establish the interrelationships between indirect factors and direct factors to indicate those factors that may attribute to children’s obesity in later life. The second was to make a comparison on obese and their more slender counterparts in terms of parenting values and attitudes, demographics, availability of food, child’s consumption of food and activities.


The results lead to the conclusion that environmental and behavioural factors have an enormous bearing on childhood obesity and that the best approach to tackle the issue is via reduction of sedentary activity, watching television and playing videogames and an educating the parents and caretakers on child nutrition and how to approach meals.


Peregrin, T. (001). Take 10! Classroom based program fights obesity by getting kids out of their seats. Journal of American Dietetic Association, 101, 140. Retrieved April 0, 001, from Proquest Psychology Journals database.


This article examines the Take 10! Program, which commenced in 8 American schools across 16 states in late 001. Designed especially for primary children, it includes studies of nutrition and food safety and aims to incorporate physical activity in all areas of learning. This includes reading, mathematics, music and creative writing. Teachers are provided with all the training, guidance and necessary materials.


The Take 10! Program is realistic in their expectations. They by no means believe that it will solve the childhood obesity epidemic but they believe it is a starting point that will hopefully modify children’s behaviour.


A review of the implemented program found that children really enjoyed it, that they were participative and looked forward to the Take 10! Program activities. The response from the parents was also of a positive nature. Because of the success, the creators, The International Life Sciences Institute are developing a program to be played out at home that will accompany the homework provided and also a program that could possibly be incorporated into the workplace to attack adult obesity.


Synthesis


While various studies in regards to childhood obesity have focused on different aspects, all authors reviewed for the purpose of this report recognised sedentary behaviour as one of the major attributes to childhood obesity. Sedentary behaviour is becoming extremely common in children today. Previous generations of children weren’t equipped with these technological advances such as video games, computers and perhaps even television instead relying solely on forms of active play for entertainment. This behaviour could be the result of parents working longer hours and not having the time to schedule outings at the park and encourage exercise. Safety and laziness are definitely key issues. It is quite common for people to drive the shortest of distances or to order take-out to save time in travel and meal preparation. (Brown, 001)


The term obesity is often misused in context; it may just be that the person is slightly overweight. The general definition for obesity is that of a dangerous health problem occurring in people whose body mass index (BMI) is 0 or more. It is however, difficult to determine what portion of the community is obese due to the assorted definitions of ‘overweight’ and ‘obese’. (Abraham, Llewellyn-Jones 001)


Cristol gives rise to the numerous health and psychological implications for obese children. These include, diabetes, high blood pressure, heart disease and strokes.


The truth is, children can be cruel. Children who are teased at school because of their weight can be left with deep emotional scars, something that perhaps encourage them to eat more (relying on food for comfort) and resulting in depression. (Cristol, 00)


Another common observation is the raised question of genetic contributions. It appears that the authors rate this of minor contribution to childhood obesity because there is very little reference in the material dedicated to it; there is more of a focus steered to parental attitudes to eating. Parents are the people who form the basis of the children’s lifestyle. If the parent’s lead a healthy active life, than that will have a positive effect on the children’s eating behaviour and activities. Education and prevention starts at home. (Rabinor, 7-7)


Edmunds, Waters & Elliot links childhood obesity to societal and environmental factors; that encourage weight gain. They declare that adult obesity treatment programmes have not proven successful and that we must develop a strategy to eradicate this problem. Evidence suggests that the family need to provide a suitable environment for treatment and prevention of weight gain. Schools present an opportunity for prevention strategies and programs need to take effect. This by no means should single out the overweight children. Studies show that these programs have proven to be successful. (Peregrin, 140)


We all have to take some responsibility for the obesity epidemic. It needs to be approached as a community, with all parties involved. We need to set an example for the children and actively promotes exercise and nutritional value in foods. Parents need to be made aware of the risks associated with obesity and the importance of early prevention. (Anderson, p. 1461)


Methodology


This fieldwork activity involved a process study interviewing a number of mothers in regards to their children’s eating behaviour. The objective was to review and compare children’s eating behaviour in order to determine the main contributions to eating disorders and the possible effects.


Dr Linda Gilmore who is currently conducting a research project compiled surveys. With participants consent, the material will contribute to her further studies in younger children’s eating behaviours. The specific requirements of the mothers interviewed were that their children were of -4 or 7- years of age. All mothers that were interviewed had children of -4 years of age and are of middle income families that live on the Southside of Brisbane.


The surveys were completed over a two-week period. The Information for Participants was given to each subject individually and an interview was performed. The mothers were advised of the purpose of the questionnaire, agreed confidentiality and were given the option of their data being used in the larger research. All results were recorded on to the questionnaire and presented to the mother for inspection. Once satisfied, candidates were thanked for their time and participation. The four surveys are provided in Appendix .


Field Research


Results and Discussion


All mothers interviewed confessed to leading a healthy lifestyle and eating a wide range of food. Like most women, the majority of mothers did confess to dieting at some stage, self-image and nutrition having a huge bearing on their lives.


All mothers categorised their children as being “Just right” in terms of their age and height, which was on average -4 years. It seems highly unlikely that mothers would confess to seeing their child as overweight even if that were the case. It is a common that people tend to fabricate the truth in order to gain acceptance and to be viewed as ‘normal’.


Interestingly when it came to mealtimes, the only child that was reluctant to eat their meal, rejecting their meal by pushing it away or complaining about the food offered is the only young boy, the girls seem to have caused no problems at mealtimes. Whether gender has a bearing in this instance, I am not sure, only with larger studies could we conclude such a statement. This could be a result of personality, distaste and experiences.


The majority of the children’s favourite foods were all very nutritional and included chicken, fish, pasta, apples, various vegetables and rice. The only exception to this being ice cream and coco pops. Natural responses, they are children, after all.


However, because of their young age, the children probably haven’t been exposed to take-out and convenience foods, as older children would have. The Eating Diaries verifying this, with all meals being prepared and eaten at home.


The foods that children refuse to eat are mostly from the fruit and vegetable food group with the addition of boiled eggs and occasionally meat. Most mothers indicated that their children were quite happy to try new foods and that they weren’t worried about getting fat from eating. At -4 years of age the media in regards to body image does not have a huge influence on them. They haven’t established any particular role models.


The Food diaries revealed that all but one child had quite healthy eating habits and again it was the male child whose results stood out. On what was considered a typical day he consumed the standard five meals. These included numerous sugary beverages, servings of chocolate biscuits, chicken nuggets, potato gems, a milkshake and a chocolate desert. He did however consume a sandwich, yoghurt, rolled oats and a piece of fruit. This is by no means a healthy diet, dinner comprising mostly of convenience foods. Without any form of exercise taking place, this could contribute to some weight gain. This mother did admit to her son being extremely fussy and offered her child a choice in all meals he eats, with the exception of dinner. He is not forced to eat his dinner and is not offered any alternatives.


She stated that he is not enthusiastic about trying new things and frequently uses the word “yucky” when an attempt is made.


Unfortunately for the purpose of this study, not one of the mothers surveyed had overweight children as such, so it was difficult to relate responses to the information researched in this review.


Conclusion


In summary, the results of this study and many others link childhood obesity to parental eating behaviour, sedentary activities, genetic influences and reflections of the social environment.


Any review of obesity must consider the possible ways to reduce this epidemic but needs to differentiate between those things that can realistically be modified and those that are unlikely to change. It seems apparent that in order for us to fight this war against obesity, we must target the children before they mature into adults. It is imperative that all members of the community are involved and that education accompanies the opportunity for change. (Gable & Lutz, 000)


References


Edmunds, L., Waters, E., & Elliot, E. (001). Evidence based management of childhood obesity. British Medical Journal, , 16-1. Retrieved April 8, 00, from Proquest Psychology Journals.


Rabinor, J. (14). Mothers, daughters and eating disorders Honoring the mother daughter relationship. In P. Fallon, M. Katzman & S. Wooley (Ed.s), Feminist perspectives on eating disorders (pp.7-86). New York The Guilford Press.


Appendix 1


Child Development surveys undertaken.


Appendix


A photocopy of the first page of each reference included in the Annotated Bibliography.





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