Childhood Obesity In London Borough Of Enfield: Rationale, Interventions, And Essay.

Rationale

Describe about rationale and critique of the interventions to handle the issue?

The issue of obesity is a major concern in almost all the developed countries across the world, considered as the most serious health challenge for 21st century by WHO (World Health Organization). Studies by National Child Measurement Programme (NCMP) show around 19.2% children of the age group 10-11 years were obese and 14.6% were overweight in 2013/14 in England (Noo.org.uk, 2015). Around 9.6% of children were obese and 13.2% were overweight in age group 4-5 years. The London Borough of Enfield depicts high levels of obese children. Incidence of child poverty, teenage pregnancy and infant mortality makes the childhood obesity a major concern over this place (Apho.org.uk, 2015).

The current essay identifies the urban health issue of childhood obesity with the relevant causes and effects on the society along with the urban health advantages. The essay provides with the information regarding the relevant measures existing in London Borough of Enfield (LBE) to handle the issue of childhood obesity and analyze their effectiveness as per the challenges and outcomes. The essay concludes by shedding light on the ways to a more effective handling of the childhood obesity problem in LBE. The relevant suggestions and identified implications for policies and practices in context of handling the urban health issues intends to provide a sound knowledge of the childhood obesity issues and its better handling measures to control this growing concern in the health system of UK.

In England, around 28% of children in the age group 2 to 15 years reflect overweight or obesity by the reports of Health Survey for England (HSE) (Noo.org.uk, 2015). Studies reveal 27.3% children in the primary schools and 24.7% of children in secondary schools to recieve Free School Meals in 2012 in LBE. The LBE depicts 13.7% reception pupils to be obese, which is nmuch higher than 11.2% in London and 9.6% in England. Several newspapers also identifies the fact that around 1 in 10 children in the age group of 5 years is obese with a third of the primary school children are overweight by the time they reach the end of school (Donnelly, 2014). Research depicts 27% children in the primary school in London Borough of Southwark were obese, which is again higher to the 11% children in Richmond upon Thames. Studies identify a high concentration of fast food outlets in the east of the Borough, where the incidence of obesity is also quiet high.

The south-east of the LBE reveals highest rate of obesity in the reception pupils  (Haringey.gov.uk, 2015). Researches found out that the other 6 wards on eastern side of the LBE border reflects the rise of obesity rates towards 30%. These 6 wards include Lower Edmonton Jubilee, Enfield Highway, Edmonton Green, Ponders End and Enfield Lock. LBE also depicts 21.7% of the population as less than 16 years of age. It is the largest proportion of children prevailing among the boroughs in the North London. The rates of children is forecasted to increase with the increasing birth rate of LBE. As per the view of Singh et al. (2010), childhood poverty has a very close relation to childhood obesity. The LBE showing a high rate of childhood poverty with more than 50% people living in poverty indicates a high-risk area for childhood obesity.

Adverse Effects of Childhood Obesity

As stated by O'Dowd (2009), the development of obesity in children increases the risk of serious health problems in future stages of life. It includes morbid conditions as type 2 diabetes, cancer and heart diseases due to high cholesterol and blood pressure (BP). The health risks also comprise of fatty liver disease, joint problems (osteoarthritis), early puberty, and infertility, breathing problems as obstructive sleep apnoea, asthma, iron deficiency, vitamin D deficiency and gallstones. Puhl and Latner (2007) pinpointed on the psychological effects that obesity has on the children’s health. Since, the childhood is the most essential stage of development both physically and mentally, so the psychological detriments of obesity is evident as low self-esteem, lack of confidence, social seclusion and even depression in some severe cases. This essay provides insights on the eminent adverse effects of childhood obesity identifying the serious detrimental risk to which it exposes the future generation and overall health status.

According to Langwith (2013), the early detection of the issue of overweight or obesity in childhood enable the reversing and prevention of health challenges in the later stages.  The low rate of breastfeeding in Britain is highlighted as a major reason, giving rise to childhood obesity. Researches reveal that the number of women breastfeeding for six months is less than 1 in 5. The higher levels of proteins in the bottle feeds than in breast milk accounts for the protection of children from weight gain. Not only the adverse health issues but also the nation incurs huge losses in productivity and high expense of medical treatment due to obesity issues (Algazy et al. 2010). However, LBE depicts a high rate of breastfeeding incidence thus preventing a major contributing factor to childhood obesity.

Urbanization is identified as a force driving the transition of energy balance thus underpinning the epidemic of obesity. Reilly (2007) asserted the view that higher rates of urbanization induce higher obesogenic pressure on the population. Urbanization leads to the prevalence of an obesogenic environment affecting the energy intake and expenditure by the individuals. Availability and access to food on the go that increases with urbanization lead to an increase in overconsumption. The poor availability of high quality healthy food at affordable price in the low-income neighborhoods of LBE depicts high association with poor diet and obesity (Currie-McGhee, 2012). It is an indication that the childhood obesity is a major urban health problem in LBE.  

In the research conducted by Rice and Rice (2009), the urban health penalty takes place due to the rapid growth of cities with diverse population, high density of transport network due to globalisation, division of socio-economic groups resulting in high density socio-economic activities and low concentration of socio-ecnomic families adds to the rise of urban health penalty. Evidences of unhealthy conditions of larger cities in compare to the rural areas in Europe provides support to the concept of higher health issue experienced by urban populations (Goodfellow and Northstone, 2008). The poor urban dwellers in LBE are at a higher risk of health issues. It is evidenced in studies by Freudenberg (2015) that the larger cities emerging due to globalization and urbanization, concentrate the poor people and raises their exposure to the unhealthy social and physical environments. Lack of adequate healthy food at affordable prices, social conception of accessing the processed foods, parental failure to maintain the child’s healthy weight, etc evident in the LBE acts as the factors leading to increasing incidence of childhood obesity.

Urbanization and Childhood Obesity

The urban environment leads to development of health inequalities. In addition to it, the low socio-economic status, deprivation, marginalization and urban vulnerability contributes to the negative health outcomes. It leads to unhealthy lifestyles, inappropriate food consumption habits, inaccessibility to healthy foods, that causes obesity in children (White, 2009). As seen in the LBE, increasing interest to acquire fincial strength drives the adults towards a major focus on financial gains as highering the income by working more. This leads to a decreased focus on the children detrimenting their health. Thus, the low socio-economic status acts as a major factor in contributing to development of childhood obesity in the urban areas as LBE. It is seen that mainly the children in the age group of 5 to 11 years depicts the maximum incdence of obesity in LBE.

As per the view of Tzou and Chu (2012), one of the main reasons for development of childhood obesity is the parental negligence to the child’s food consumption. With majority of parents in LBE working and leading an unhealthy lifestyle themselves, they unconciously drives the child towards an unhealthy lifestyle. It is evident from the increasing number of fast food outlets in the east of LBE. The children are drawn towards consumption of sugary foods with high calories. It leads to the issue of childhood obesity among the children in this group. This is also responsible for development serious co-morbid conditions as type 2 diabetes and higher level of cardiovascular diseases (Uusitupa et al. 2011).

As per the reports of the study conducted by NCMP (National Child Measurement Programme) measuring the height and weight of the school children identifies a 3rd of the 10-11 years old children depicting obesity and overweight. In London Borough of Enfiled (LBE), studies reveal 13.7% obese children in reception, which is quite high compared to 11.2% across London and 9.6% across England. It is the 3rd highest rate of childhood obesity in London following Hackney and Barking & Dagenham (Enfield.gov.uk, 2015). Other studies indicate a rapid and huge rise in obesity in the age group of 7 and 11 years. UK is identified as the place with the highest obesity prevalnece level in Europe (Harding, 2015).

The imbalance between the amount of input energy and expenditure of energy is the major cause of obesity. Of the various contributing factors adding to the incidence of obesity in children, dietary habits is the prime one. White (2007) identified a growing cohort of children with development of unfavorable eating habits. Foods containing high amount of fats and carbohydrate content adds to the obesity. The failure of restrictive measures to the fast food location outlets in LBE by the public health interventions adds to the development of this unhealthy food habit. It thus fails to decrease the fast food consumption among people and children in the surroundings (2014).

In addition to the absence of dietary modifications, the lack of adequate level of physical exercise adds to the development of obesity in children. Schobersberger (2013) criticises the decline in the level of compulsory sports. The activity programme in school implemented with the intension of promoting physical exercise depicts very little influence on the BMIs (Body Mass Index) of the children that indicates the level of overweight or obesity. Another prime factor leading to obesity is the deprivation of sleep. It is associated with the low level of physical exercise. Youngstedt (2007) asserted that lower level or absence of physical activities or exercise leads to poor sleep. The importance of the hormones leptin and ghrelin are of vital significance in this respect. Leptin hormone secreated by the fat cells informs the brain about the filled up state of the fat stores in body. On the other hand, stomach release the ghrelin hormone that act as a signal for hunger. A higher level of ghrelin and lower level of leptin is evident in individuals with little sleep. It encouarges the person towards overconsumption of food leading to obesity or overweight.

Development of Health Inequalities in Childhood Obesity

Genetic contribution acts as a prime factor leading to obesity. Obesity in parents increases the risk of obesity in children due to genetic predisposition to obesity. Studies conducted on the LBE reveals a close link between childhood obesity and the prevailing socio-economic situation. “Public Health England Child Obesity factsheets” indicate a linear relationship among deprivation and prevalence of obesity (McLoone and Morrison, 2012). The education of the parents also emerge as an important factor adding to the increase in obesity of the children. The reports of the Millenium Cohort Study identifies 25% children obese and 14% overweight in houses with both parents lacking education. The houses with at least one educated parent depicts 15% children obese and 15% overweight. Another study highlighted the children residing in middle-affluent regions revealing highest probability of obesity due to activities like snacking between meals (Pearlman Hougie, 2010).

Donnelly (2014) identified the children in the age group of 11-15 years at the maximum risk of obesity, espeially those living in obesogenic environment due to extreme urbanisation. It is seen to increase the child moratlity rate as well as the adult mortality rate in LBE due to morbid health conditions that arise due to obesity as diabetes and heart diseases (Walter et al. 2009). It not only affects the children and people but also the overall health cost of the UK government because in England the NHS (National Health Service) executes the maintenance of health system across the country (Chinitz, 2011).

A better status of the health indicators in urban areas of LBE compared to that in the rural areas and a better faring of the urban poor than the rural poor indicates the providence of urban health advantages in cities. Kasper et al. (2014) believed that the socio-economic heterogeneity benefits the disadvantaged urban residents by bringing in health care and education at a higher accessibility level. The high level of social support with greater social cohesion in association with positive health outcomes is another urban health advantage. The wealthier individuals in the urban society of LBE are seen to provide support to the neighbours in need of healthcare. The dense social networks in urban areas provide with a wider option of supports. Freudenberg et al. (2010) put forward the view that the cities are capable of providing more access to the life’s necessities as nutritional and healthy foods, more opportunities for physical activities as fitness centres and better health awareness programmes. It enable rhe effective handling and control of the health issue of childhood obesity. It is evident through the studies revealing a higher consumption in the levels of fruits and fresh vegetables in urban areas of LBE, which is an indicator of a good eating habit that restricts obesity and overweight in the population.

Chinitz (2011) opined the presence of a conducive environment to health in cities. A higher encouragement of activities as walking is productive towards the handling of the issue of obesity in adults that indirectly decreases the chances of exposing children to the risk of obesity due to parental obesity development and ill habits. The large numbers of open spacesb and parks established in LBE are clear evidences proving the health advantage by providing and encouraging the children towards participating in higher level of physical activities. From the results derived by the surveys, it is evident that a major urban health advantage is the achievement of support for the low-income residents of the urban neighbourhoods for overcoming the concerning health burdens. Through political mobilisation and more social movements, urbanisation enables the attraction of higher amount of resources for healthcare. According to Dilani and Sia (2014), in terms of housing standards, public health infrastructure establishment and public education improvement, the cities as London Borough of Enfield seems to precede the non-urban areas. It can be conceptualised that the disadvantaged population in urban areas are acore area of concern depicting high incidences of childhood obesity. However, the urban health advantages contributes adequately towards achievement of the goal for better health improvement.

Measures to Handle Childhood Obesity in LBE

Simple methods as changes in lifestyle like inclusion of a healthier diet, encouraging children towards physical activities and involvement of the family to support the children in tackling the issue of obesity are quiet effective interventions to handle the childhood obesity issue. Public health interventions as policies restricting the locations of the fast food outlets seems to fail in moving the presence of the large number of fast food centres in the East Borough of London.

As per the view of Goodfellow and Northstone (2008), long-term actions executed by a range of partners is effective in obesity handling. The council in the London Borough of Enfield (LBE) devised the strategy of ‘Health Weight Strategy’ in 2009, updated in 2011 as per need of the corresponding situation. It aims at directing the children of LBE towards a healthy diet and suitable lifestyle (Enfield.gov.uk, 2015). However, even after implementation of the strategy, the rates of childhood obesity in LBE depicts a high level. Therefore, it can be said that the strategy is not quiet effective in lowering the obesity rate. Keegan (2011) highlighted the lack of adequate resources as a major challenge in implementing the strategy. Addressing the needs of the people in the LBE appropriately requiring a close collaboration of the communities and local organisations is a major challenge as well due to the varying needs of the people across the Borough.

The childhood obesity prevention interventions of government as promoting healthy eating and active lifestye culture encouraging the children at a young age in schools with improvemets in physical activity facilities are expected to improve the issue of obesity in children. However, it involves quiet a considerable amount of expense. The childhood obesity programmes as “Eat Better Move More” by the charity The Gifted works in the primary schools in LBE is found to efficiently aware the children about health benefits of healthy eating and encourage them towards appropriate dietary habits (Creativetraininghub.co.uk, 2015).

The working with the Renown Care, Mencap in Redbridge and Oasis Academy in the LBE is effective enough to deliver a healthy eating programme. The programme involves a 6-week schedule including 4 workshops for healthy eating promotion among children and parents/carers, a cook school on Saturdays and a creative workshop for events as interactive performing arts and crafts encouraging the participants for engaging in these events (Creativetraininghub.co.uk, 2015). It is found that Fun with Food is efficient in promoting healthy eating activities among children and people at the LBE in 2013-13.

Other than these the gvernment policies as “Healthy Lives, Healthy People: Our strategy for public health in England (2010)” are effective in responding to the eminent challenges of health inequality tackling in LBE and across England (Lho.org.uk, 2015). Through a national wellness service the government shifts power to the local communities thus enabling the better understanding and relevant execution of the necessary activities to handle health inequalities in the locality. As asserted by Chinitz (2011), it enables a better handling of the objective to prevent childhood obesity as the health inequalities are closely related to inidence of obesity in the children.

Effectiveness of Measures in LBE

Recommendations and Conclusions:

The study thus highlights the major urban health problems as correct understanding of the causes for childhood obesity and ways to eradicate them in the area. The local authority can conduct an extensive survey of the community at LBE. It will identify the reasons for the emergence of the problem of childhood obesity. This enable the strategizing of the most appropriate measures to prevent the reasons thus avoiding the health isuue from the core. The city cuncil needs to participate actively in enabling the enforcement of these measures.

Although the currently prevailing child obesity prevention programmes possess adequate number of activities to promote the spreading of health awareness among parents, carers and children regarding obesity, yet a higher focus on the children can prove beneficial. A genral dietary plan can be attractive to one child while another may resist it strongly. Same is true for the encouraging activities to involve children in the programmes. Therefore individual focus on the children to provide them with a diet relevant to their preferences can be more effective in driving the children towards a healthier diet and lifestyle. This can be done by combining the child’s parents, school ad carers’ opinion while framing the healthy physical activities and diet routine for the child.

The issue of low educational level of parents and poor access to healthy food options for the children by the people of low socio-economic status can be resolved by arranging mass awareness campaigns involving the local community services with the support of the wealthy and concerned population in the LBE area. It involves the utilisation of the urban health advantage as the urban people depicts more interest towards better socio-environment welfare as it will improve their social health as well. It will attract more businesses and organisations to come to the area and conduct business as a greater number of affordable crowd is present in those areas. The government and the local authorities can establish a joint collaborative project to provide access to healthy foods by the urban disadvantaged people. If the business stakeholders and organisations are asked to sell the quality healthy food products at a lower price to the disadvantaged people and in return they will get the license to operate their business by opening stores in the urban area where the wealthier massess can buy from these stores, it will be beneficial for everyone. It will also enable the addressing of the issue of financial overload on the urban disadvantaged population thus preventing the negligence to their children’s health.

Thus it can be concluded from the study that the issue of childhood obesity is gaining momentum rapidly in the current times. The LBE depicted to possess one of the highest rate of childhood obesity due to factors as low parental eductaion, health inequalities, high concentration of fast food stores and policies failing to change their locations. Several interventions as childhood obesity prevention programes, strategies and plans and frmaeworks are implemented to tackle this issue. Although some programs seem to act effectively but more focus on considering  the exact needs of the people with correct identification of the reasons for the issues is highy essential.

Ways to Handle Childhood Obesity Problem

References

Annunziato, R., Calogero, R. and Sysko, R. (2014). Addressing Obesity in Special Populations. Journal of Obesity, 2014, pp.1-2.

Apho.org.uk, (2015). Public Health Observatories - Area: Enfield LB. [online] Available at: https://www.apho.org.uk/resource/item.aspx?RID=50273 [Accessed 16 May 2015]

Chinitz, D. (2011). Health Care in World Cities: New York, Paris, and London. JAMA, 305(9), p.942.

Creativetraininghub.co.uk, (2015). Projects. [online] Available at: https://www.creativetraininghub.co.uk/project/ [Accessed 14 May 2015].

Currie-McGhee, L. (2012). Childhood obesity. Detroit, MI: Lucent Books.

Dilani, A. and Sia, A. (2014). Designing the Urban Physical Environment for Better Health: New Understandings of Health. CITYGREEN:Nature & Health in Cities, 01(09), p.134.

Donnelly, L. (2014). Warning over rising child obesity. [online] Telegraph.co.uk. Available at: https://www.telegraph.co.uk/news/health/news/11271032/Warning-over-rising-child-obesity.html [Accessed 13 May 2015].

Enfield.gov.uk, (2015). Childhood Obesity  - Enfield Health and Wellbeing. [online] Available at: https://www.enfield.gov.uk/healthandwellbeing/childhoodobesity [Accessed 14 May 2015].

Freudenberg N, e. (2015). Beyond urban penalty and urban sprawl: back to living conditions as the focus of urban health.  - PubMed - NCBI. [online] Ncbi.nlm.nih.gov. Available at: https://www.ncbi.nlm.nih.gov/pubmed/15751595 [Accessed 13 May 2015].

Freudenberg, N., Libman, K. and O’Keefe, E. (2010). A Tale of Two ObesCities: The Role of Municipal Governance in Reducing Childhood Obesity in New York City and London. J Urban Health, 87(5), pp.755-770.

Goodfellow, S. and Northstone, K. (2008). Childhood overweight and obesity in the UK – a comparison of two environmentally distinct populations of 7-year-old children. International Journal of Pediatric Obesity, 3(2), pp.117-119.

Harding, D. (2015). Obesity in Children. Obesity and Overweight children.  | Patient.co.uk. [online] Patient.co.uk. Available at: https://www.patient.co.uk/doctor/obesity-in-children [Accessed 13 May 2015].

Haringey.gov.uk, (2015). Childhood Obesity | Haringey Council. [online] Available at: https://www.haringey.gov.uk/social-care-and-health/health/joint-strategic-needs-assessment/health-mothers-children-and-young-people/childhood-obesity [Accessed 13 May 2015].

Janjua, N., Mahmood, B., Islam, M. and Goldenberg, R. (2012). Maternal and Early Childhood Risk Factors for Overweight and Obesity among Low-Income Predominantly Black Children at Age Five Years: A Prospective Cohort Study. Journal of Obesity, 2012, pp.1-9.

Jwa, S., Fujiwara, T. and Kondo, N. (2014). Latent protective effects of breastfeeding on late childhood overweight and obesity: A nationwide prospective study. Obesity, 22(6), pp.1527-1537.

Kasper, N., Herrán, O. and Villamor, E. (2014). Obesity prevalence in Colombian adults is increasing fastest in lower socio-economic status groups and urban residents: results from two nationally representative surveys. Public Health Nutrition, 17(11), pp.2398-2406.

Keegan, F. (2011). Implementing a G3 community-based, childhood obesity prevention—OPAL in local Communities. Obesity Research & Clinical Practice, 5, pp.52-53.

Langwith, J. (2013). Childhood obesity. Detroit: Greenhaven Press.

Lawrence, R. (2010). Does Breastfeeding Protect Against Overweight and Obesity in Children? A Review. Childhood Obesity (Formerly Obesity and Weight Management), 6(4), pp.193-197.

Lho.org.uk, (2015). LHO : Health Inequalities. [online] Available at: https://www.lho.org.uk/LHO_Topics/National_Lead_Areas/HealthInequalitiesOverview.aspx [Accessed 14 May 2015].

McLoone, P. and Morrison, D. (2012). Risk of child obesity from parental obesity: analysis of repeat national cross-sectional surveys. The European Journal of Public Health, 24(2), pp.186-190.

Noo.org.uk, (2015). Child Obesity :: Public Health England Obesity Knowledge and Intelligence team. [online] Available at: https://www.noo.org.uk/NOO_about_obesity/child_obesity [Accessed 13 May 2015].

O'Dowd, A. (2009). Sedentary lifestyle could be masking serious health problems in children. BMJ, 339(dec29 3), pp.b5646-b5646.

Pearlman Hougie, D. (2010). Can Family Outdoor Recreation Help Reconnect Children with the Outdoors? Affluent Middle Childhood Perspectives of Outdoor Recreation in the UK. Journal of Outdoor Recreation, Education, and Leadership, 2(3).

Puhl, R. and Latner, J. (2007). Stigma, obesity, and the health of the nation's children. Psychological Bulletin, 133(4), pp.557-580.

Reilly, J. (2007). Childhood Obesity: An Overview. Children & Society, 21(5), pp.390-396.

Rice, J. and Rice, J. (2009). The Concentration of Disadvantage and the Rise of an Urban Penalty: Urban Slum Prevalence and the Social Production of Health Inequalities in the Developing Countries. International Journal of Health Services, 39(4), pp.749-770.

Satterthwaite, D. (2011). Editorial: Why is urban health so poor even in many successful cities?. Environment and Urbanization, 23(1), pp.5-11.

Schobersberger, W. (2013). Regular physical exercise: evidence for health benefits in OSA patients?. Sleep Breath, 17(3), pp.903-904.

Singh, G. K., Siahpush, M., and Kogan, M. D. (2010). Neighborhood socioeconomic conditions, built environments, and childhood obesity. Health affairs, 29(3), 503-512

Tzou, I. and Chu, N. (2012). Parental influence on childhood obesity: A review. Health, 04(12), pp.1464-1470.

Uusitupa, M., Tuomilehto, J. and Puska, P. (2011). Are we really active in the prevention of obesity and type 2 diabetes at the community level?. Nutrition, Metabolism and Cardiovascular Diseases, 21(5), pp.380-389.

Youngstedt, S. (2007). S20.C Acute and adaptive effects of physical exercise on sleep. Sleep Medicine, 8, p.S25