This brings me to the Epidemiology of Childhood Obesity. One of the Major health problems that plague the United States is Childhood obesity. Since the 1980 the amounts of children who have been considered obesity have been at an alarming rise and the prevalence among children under the age of 12 has more than doubled. “According to the 1999-2002 National Health Association (NHA) survey, 16 percent of children ages 6-19 years are overweight. The major population that seems to be plagued by childhood obesity are minority population. NHA found that African American and Mexican American adolescents ages 12-19 were more likely to be overweight,  than non-Hispanic White adolescents. The disparity of being overweight in the adolescences has been the major contributor to a high risk of developing high cholesterol, hypertension, respiratory ailments, orthopedic problems, depression and Type 2 Diabetes as a youth. One disease of particular concern is Type 2 Diabetes. Due to these increase in negative health behaviors The hospital costs alone associated with childhood obesity were estimated at $127 million during 1997-1999 (in 2001 constant U.S. dollars), up from $35 million during 1979-1981” (Department of Health and Human Services, 2010, p 1)

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The epidemiology triangle long-term consequences of being an overweight adolescent is that there is a 70% chance of them becoming overweight or obese adults and 80% if one or more parent in the home  is overweight or obese. When obesity in childhood falls over into adulthood, it increases the risk of diabetes, high blood pressure, high cholesterol, asthma, arthritis, and a general poor health status. In 2000, the total cost of obesity for children and adults in the United States was estimated to be $117 billion where $61 billion are direct medical costs (The World and I, 2006).
Childhood obesity has many determining factors.  The most prominent factor that causes childhood obesity are  lack of physical activity, Unhealthy eating, genetics and social factors,” socio-economic status, race/ethnicity, media and marketing, and the physical environment are also contributing factors to child hood obesity.” (Kumanyika, 2008).
In general, children and adolescents are eating more foods at fast food restaurants than they are eating at home, drinking more sugary drinks, and snack on more unhealthy foods like fries and chips frequently. This change is contributed to the American need for Convenience. This is leading more people to consume quick service or restaurant meals or to buying microwavable ready-to-eat, low cost, quickly accessible meals to prepare at home.”The nutritional composition of children’s diets as well as the number of calories consumed is of interest to determine the effect of food consumption on childhood obesity. In relation, portion sizes increased between 1977 and 1996. Average portion sizes increased for salty snacks from 1.0 ounces to 1.6 ounces and for soft drinks from 12.2 ounces to 19.9 ounces.  Below shows the major change in food portions, which has contributed to the major factors of obesity” (Department of Health and Human Services, 2010, p 1)
 
 
 
Figure 2: Proportion of Vegetable Servings, 1999-2000
Figure 3: Proportion of Grain Servings, 1999-2000
Note: Children 2-19 years.
Source: National Health and Nutrition Examination Survey, NCHS, CDC.
Note: Children 2-19 years.
Source: National Health and Nutrition Examination Survey, NCHS, CDC.
 “Other studies indicate that children are not eating the recommended servings of foods featured in the USDA food pyramid and that there have been significant changes in the types of beverages that children are consuming.
·         Only 21 percent of young people eat the recommended five or more servings of fruits and vegetables each day. As shown in figure 2, nearly half of all vegetable servings are fried potatoes.
·         Percent total energy from fat actually decreased between 1965 and 1996 for children, from 39 to 32 percent for total fat, and 15 to 12 percent for saturated fat.”
·         In 1994-1996, adolescent girls and boys only consumed 12 and 30 percent, respectively, of the Food Guide Pyramid’s serving recommendations for dairy; and 18 and 14 percent, respectively, of the serving recommendations for fruit.”
·         Soda consumption increased radically in the early to mid-1990s. Thirty-two percent of adolescent girls and 52% of adolescent boys consume three or more eight ounce servings of soda per day. Soft drink consumption for adolescent boys has nearly tripled, from seven to 22 ounces per day (1977-1978 to 1994). Children as young as seven months old are consuming soda
·        Milk consumption has declined during the same period. In 1977-78, children age 6-11 drank four times as much milk as any other beverage. In 1994-1996 that decreased to 1.5 times as much milk as sugar sweetened beverages. In 1977-1978, adolescents drank 1.5 times as much milk as any other beverage and in 1996 they consumed twice as much sugar sweetened beverages as milk. Milk consumption decreased for adolescent boys and girls 37 and 30% respectively, between 1965, and 1996.” (Department of Health and Human Services, 2010).
This research shows that the decrease in actual physical activity and the increase in food intake is the major contributor to childhood obesity. Physical activity trend data for children are limited, but cross sectional data indicates that one third of adolescents are not receiving recommended levels of moderate or vigorous activity, 10% are completely inactive, and physical activity levels fall as adolescent’s age (Booth, Murphy, Phongsavan, Salmon & Timperio, 2007).
          Americans need for watching television, using the computer, and playing video games occupy a large percentage of children’s leisure time, which are influencing their physical activity levels. “It is estimated that children in the United States are spending 25% of their waking hours watching television and statistically, children who watch the most hours of television have the highest incidence of obesity (Department of Health and Human Services, 2010, p1). This trend is apparent and a major risk factor to child hood obesity because while the sedentary activity of watching TV and video games usually involves the composition of meals high in fat.
Along with the dietary changes that affects child hood obesity schools are also contributing to the problem by decreasing the amount of free play or physical activity that children receive during school hours. There are only a 3rd of American elementary schools, allow children to have daily physical education, and only a 5th of the elementary schools have extracurricular actives for the children to participate in. “Daily enrollment in physical education classes among high school students decreased from 42% in 1991 to 25% in 1995, subsequently increasing slightly to 28% in 2003” (Department of Health and Human Services, 2010, p 1).
“Experts have looked increasingly to the physical environment as a driver in the rapid increase of obesity in the United States. In urban areas, space for outdoor recreation can be scarce, preventing children from possessing a protected place to play. Neighborhood crime, unattended dogs, or lack of street lighting may also inhibit children from being able to walk safely outdoors; and busy traffic can impede commuters from walking or biking to work as a means of daily exercise. Though few studies are available on the direct effects of the physical environment on physical activity, there are signs of the potential for improvement, evidenced by Toronto’s 23% increase in bicycle use after the addition of bike lanes, and London’s footpath use increase within the range of 34-101% (depending on location) as a result of improved lighting there has been less research on the relationship between the physical environment and physical activity for children than for adults; however the findings for children appear to be consistent with those of the adult population. The percentage of trips to school that children walked declined from 20% in 1977 to 12% in 2001. Because children spend a substantial amount of time traveling to and from school, this may be an area in which to incorporate and increase physical activity into children’s daily habits” (Department of Health and Human Services, 2010, p 1)
Studies suggest that parental food preferences directly influence and shape those of their children. In a study by Oliveria and colleagues, they reported that parents who ate diets high in saturated fats also had children who ate diets high in saturated fats (Birch & Fisher, 1998). “It is suspected that this observation is not merely due to the foods parents feed their children, but rather due to the preferences children develop through exposure to foods that their parents choose to eat in their lives. Birch and Fisher posit that exposure to fruits and vegetables and foods high in energy, sugar and fat may play an important role in establishing a hierarchy of food preferences and selection in kids. Other studies have showed that when parents eat fruits and vegetables and they are readily available the preferences for children to want such an item as a choice of snack are increased” (Department of Health and Human Services, 2010, p1)
Researchers also indicate that the social context in which a child is introduced to or has experiences with food is instrumental in shaping food preferences the eating environment that a child is involved in will determined the eating pattern the child will make in his or her lifetime (Birch, 2006). “For many children, eating is a social event that often times occurs in the presence of parents, other adults, older siblings and peers. Children typically observe the behaviors and preferences of others in their surroundings. This becomes the role models. Children observation in unhealthy eating habits and behaviors have brought a rise in childhood weight problems” (Department of Health and Human Services, 2010, p1). “Several potential mechanisms have been proposed to explain this phenomenon including the following:
·         Constraints on parent’s time potentially contribute to children’s weight problems, as working parents probably rely more heavily than non-working parents on prepared, processed, and fast foods, which generally have high calorie, high fat, and low nutritional content.
·         Children left unsupervised after school may make poor nutritional choices and engage in more sedentary activities.
·         Childcare providers may not offer as many opportunities for physical activity and may offer less nutritious food alternatives.
·         Unsupervised children may spend a great deal of time indoors, perhaps because of safety concerns, watching TV or playing video games rather than engaging in more active outdoor pursuits. “(Department of Health and Human Services, 2010).
In short, the recent social and economic changes in American society have encouraged unhealthy habits of excess consumption. “These changes have [influenced] the foods available in the homes, the degree of influence parents have when children make food selections and has led to increases in sedentary behaviors among youth” (Department of Health and Human Services, 2010, p1)
 Finally there has been a large debate over whether or not overexposure to food advertising has increased the incidence rates of childhood obesity. Although there has been a positive correlation between “the hours of television viewed, body mass index, and obesity incidence has been documented, the exact mechanisms through which this occurs are still being investigated. It has been estimated that the average child currently views more than 40,000 commercials on television each year, a sharp increase from 20,000 in the 1970s” (Department of Health and Human Services, 2010, p1). Moreover, an “accumulated body of research reveals that more than 50 percent of television advertisements directed at children promote foods and beverages such as candy, convenience foods, snack foods, sugar sweetened beverages and sweetened breakfast cereals that are high in calories and fat and low in fiber and nutrient density. The statistics on food advertising to children indicate that:
·         Annual sales of foods and beverages to young consumers exceeded $27 billion in 2002.
·         Food and beverage advertisers collectively spend $10 to $12 billion annually to reach children and youth: more than $1 billion is spent on media advertising to children (primarily on television); more than $4.5 billion is spent on youth-targeted public relations; and $3 billion is spent on packaging designed for children.
·         Fast food outlets spend $3 billion in television ads targeted to children” (Department of Health and Human Services, 2010, p1).
Available research shows that there are a number of root causes of obesity in children. Selecting one or two main causes or essential factors is next to impossible given the current data because the potential influences of obesity have many interlocking factors. There are large gaps in knowledge and research, which is limiting the ability to pinpoint a particular cause and determine the most effective ways to combat childhood obesity. ” Another research gap stems from lack of a perspective longitudinal study that links dietary and other behavior patterns to development of obesity. Another complication of current data is that there is a need for more precise and reliable measures of dietary intake and activity levels, as individual recall of events and diet are not the most dependable sources for information” (Department of Health and Human Services, 2010, p1).
When thinking about early prevention of obesity, it is essential that more is understood about how genetics is involved and how the genes are triggered or react to environmental changes and stimuli.”Research is only beginning to explain how taste preferences develop, their biochemical underpinnings and how this information may be useful in curbing childhood weight gain” (Department of Health and Human Services, 2010, p 1).
Primary prevention is not an option for many children who are already overweight. Research on successful interventions for children who are overweight or at risk of becoming overweight is extremely important to reduce effectively childhood obesity in this country (Maternal and Child Health Library, 2008). Generally, research has just begun to scratch the surface in elucidating the causes of obesity in children. Filling in the knowledge gaps will take time, as implementing some of the study designs that will best illuminate the complex interactions are time consuming and costly. However, the fundamentals are clear, to stay healthy, eat a balanced diet and devote adequate time to physical activity (Department of Health and Human Services, 2010). This will help epidemiologists and keep down the cost of becoming healthy.