Childhood obesity is one of the most serious public health challenges of the 21st century (Sahoo, Choudhury, Sofi, Kumar & Bhadoria, 2017). It affects all aspects of a child’s life; most significantly by contributing to poor health and negative social perceptions by society (Greco,2008). Obesity is caused by a number of factors such as diet, genetics, physical inactivity, environment and poor dietary habits. It is a chronic disease that has been a health issue for both developed and developing countries (Dinsa, Goryakin, Fumagalli, & Suhrcka, 2012). Globally in 2010, the number of overweight children under the ages of five estimated to be over 42 million and 35 million of these children are living in developing countries (Sahoo, Choudhury, Sofi, Kumar & Bhadoria, 2017). Dinsa et al. (2012) have noted that among countries that are regarded as developed, obesity is a condition that is considered to affect people who are of lower socioeconomic status (SES) compared to those with a higher SES. The highest prevalence rates of childhood obesity have been observed in developing countries; however, its prevalence is increasing in developing countries as well (Popkin, 1998).
The Center of Disease Control and Prevention defined obesity as a BMI at or above the 95th percentile for children and teens of the same age and sex. In the United States, the percentage of children and adolescents affected by obesity has more than tripled since the 1970s (Fryar, Carroll, Ogden, 2014). Childhood obesity is a growing epidemic in the United States. The prevalence of childhood obesity continues to increase rapidly. Data from 2015-2016 show that nearly 1 in 5 school age children and young people (6 to 19 years) in the United States has obesity (Center of Disease Control and Prevention, 2017). This health issue has become a public health problem and is linked to multiple long-term health conditions such as type-2 diabetes, heart disease, high blood pressure, high cholesterol, and several specific cancers (Hojjat, 2015). Their obesity disease and risks factors in adulthood are likely to be more severe (Bass, 2015, pg.91), which means that obese children are more likely to stay obese into adulthood.
Recent studies have supported evidence that children and adolescents are becoming more obese at a younger age. Data has shown evidence that obesity has become a true epidemic in the United States. Almost 15 percent of children and adolescents are obese, approximately 8 million youth” (U.S. Department of Health and Human Services [HHS], 2007a, p. 5). According to Goel (2006), “This problem has increased to an extent that it is being labeled an epidemic and a leading cause of preventable deaths, second only to smoking” (p.317). Obesity in American has reached an epidemic level with health care cost escalating as a direct result of overeating. It is estimated that in 2008 the annual medical cost of obesity was $147 billion (Centers for Disease Control and Prevention, 2014). Obesity is a major health concern not only because it is costly, but also because it greatly reduces quality of life for the individual. Childhood obesity affects all aspects of a child’s life; most significantly by contributing to poor health (Greco,2008).
Many factors contribute to childhood obesity. Environmental factors such as food, walking routes, law enforcement and safety plays an important role in the high obesity risk among children. Children in low-income communities have higher risk of obesity due to the environmental factors. Environmental factors have condensed the time for physical activity. There are many reasons why children become obese. Genetics can play a role too, but childhood obesity is generally caused by a lack of physical activity, unhealthy eating patterns resulting in excess energy intake, or a combination of the two. (U.S. Department of Health and Human Resource). A study conducted by Butcher (2006), found that 53 % of parents drove their children to school. Children who live in unsafe neighborhoods or do not have access to safe walking routes have less chance to be physically active. Other factors such as socio-cultural have also been associated with the development of childhood obesity. The use of unhealthy food choices increases the risk of developing obesity. Portion sizes and sugary drinks has been found to contribute to obesity. Uncontrolled large portions of highly caloric food contribute to an excessive caloric intake (Butcher, 2006). Dietary factors such as fast food consumption, sugary beverages, snack food and portion sizes contributes to rising rates of obesity (Sahoo, Choudhury, Sofi, Kumar & Bhadoria, 2017). Many low-income neighborhoods are less likely to access to healthy food where residents can buy a variety of high-quality fruits, vegetables and low-fat dairy products. Instead, residents are limited to shop at small neighborhood corner stores, where fresh produce and low-fat items are limited and not always available.
Research focused on children by Katz et al. (2005), found that “overall, the prevalence of childhood overweight has tripled over the previous 2 decades and the prevalence of overweight among certain ethnic minority groups is even higher.” Poor nutrition, which could be a result of low family income among Hispanic and African Americans in comparison with other races/ethnicities, contributes to obesity (Samani-Radia & McCarthy, 2011). Berkman and Kawachi (2000) likewise noted that low educational status among African Americans leads to low family income, which leads to obesity. The amount of money a family gets contributes to what type of food they eat and the type of lifestyle they will live. Acheampong and Halderman (2013) have noted that one of the most notable barriers to consuming healthy diets by African Americans is the cost of healthy foods. Not everyone in low-income communities can afford buying food that are fresh and less unhealthy.
In many cases, when a child has working parents or is in a single family they have less access to healthy home prepared meals. Grandparents who are the primary caretakers of their grandchildren because parents are absent (Krueger, Jutte, Franzini, Elo, Hayward, 2015). Having these children home alone for the majority of the time after school due to parents having to work various low paying jobs in low income neighborhoods, children are exposed to eat whatever they want and not being told what not to eat. Children are not being observed by parents about the things they eat and the amount of food they have in a day.
Children are often spending much of their free time on the computer rather than playing outside with friends. Low-income youth are exposed to disproportionately more marketing and advertising for obesity-promoting products that encourage the consumption of unhealthful foods and discourage physical activity (Powell et al., 2014; Yancey et al., 2009). Such advertising has a particularly strong influence on the preferences, diets, and purchases of children, who are the targets of many marketing efforts (Institute of Medicine, 2006; Institute of Medicine, 2013). Lack of exercise is a one of the reasons why children in today’s society are now are more obese than in previous generations. According to the Clinton Foundation they report that in a study of 200 neighborhoods, there were three times as many supermarkets in wealthy neighborhoods as in poor neighborhoods leaving fast food restaurants as the most convenient meal options for low income families. The income earned by individuals or families determines what they eat, where they live, and what services are available to them that might motivate them to perform the required physical activity or engage in other activities that ultimately reduce their obesity (Berkman & Kawachi, 2000; Samani-Radia & McCarthy, 2011). There is emerging evidence that food insecurity is associated with less physical activity and greater perceived barriers to physical activity (e.g., too tired to be physically active) (Fram et al., 2015; To et al., 2014). In a neighborhood, there can be places to play and be physically active but it might not be attractive, safe or the possibility of it having trash and not being in good condition to be in it.
According to Schneider (2011), Americans are getting fatter due to eating unhealthy food and lack of adequate exercise. The failure to eat healthy foods has been attributed to factors such as attitudes, lifestyle, and low family income. Families that earn low income often cannot afford to live in neighborhoods that have physical activities places like safe walking trails, swimming pools, and other type of resources that promote healthy lifestyle. In study by Laraia (2015), shows that Members of low-income families, including children, may face high levels of stress and poor mental health due to the financial and emotional pressures of food insecurity, low-wage work, lack of access to health care, inadequate transportation, poor housing, neighborhood violence, and other factors (Leung et al., 2015; Liu et al., 2014).
The outcomes of income on obesity have been demonstrated in studies that have associated measures of growth and the percentage of body fat in children from two contrasting backgrounds as far as income is concerned (Samani-Radia & McCarthy, 2011). In this study, Samani-Radia and McCarthy (2011) noted that children from families with lower income were significantly shorter and much heavier with a higher 3 body mass index (BMI) compared to those of the same age, but from families with higher family income. The study shows that the prevalence of being obesity was greater among children from lower income families based on percent body fat (overweight/obese). The results from the study by Samani-Radia and McCarthy (2011) proved the influence of income on obesity prevalence.
In a qualitative study performed by Bragg, Tucker, Kaye, and Desmond (2009), they found that being overweight and obesity among adolescents has increased significantly in the United States. According to the researchers, since 2006, more than 17.1% of adolescents between 12 – 19 years were considered overweight and more than 33% were considered obese (Bragg et al., 2009). African Americans and Hispanics are disproportionately affected as minority populations with obesity and these racial groups have shown higher rates of obesity (Bragg et al., 2009). The study noted that low-income African American and Hispanic youth are affected disproportionately by most of the 4 health problems that can possibly be prevented through the engagement of health promotions (Bragg et al., 2009).
The disparity in income and obesity assumes unpredictability as related in a study by Gordon-Larsen, Adair, and Popkin (2003), who asserted that maintaining adolescents in the same environments and moving only family income and parental education produced a limited effect on the disparities in the prevalence of obesity. Therefore, increasing family income without substantial difference in the environment or residential location did not improve or narrow the disparity. Other factors that should be considered are contextual, biological, environmental, and socio-economic factors (Gordon-Larsen et 5 al., 2003). Interestingly, increased family income helps to control some of these factors and could lead to decreased obesity (Gordon-Larsen et al., 2003).