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Childhood Obesity in the Caribbean: Weighty
Challenges & Opportunities
Fitzroy J. Henry*
College of Health Sciences, University of Technology, Jamaica
*Corresponding author: Fitzroy J. Henry, College of Health Sciences, University of Technology, 237 Old Hope Road Kingston, Jamaica; E-mail:
@
Received: September19, 2016; Accepted: October12, 2016; Published: October15, 2016
Citation: Henry FJ (2016) Childhood Obesity in the Caribbean: Weighty Challenges & Opportunities. Obes Control Ther 3(1): 1-4. DOI: http://dx.doi.org/10.15226/2374-8354/3/1/00122
Abstract
Childhood obesity rates in the Caribbean are higher than
the global average, and are increasing rapidly. The trends reflect
economically and culturally driven shifts in dietary practices towards
over consumption of energy coupled with shifts towards lower levels
of physical activity. Because the causes of these shifts are multifactorial,
the preventive intervention actions are not singular and not
always clear cut. Although various programs are in place they are far
from what is required to make major inroads into halting this obesity
epidemic. Bold, creative and sustained policies are required if the
region is to strengthen children's learning potential and decrease the
risk of nutrition-related chronic diseases later in life. But Caribbean
countries are not powerless in developing strategies and activities
that can make a substantial impact. This paper outlines some specific
actions within various settings that can help stem the increase in
childhood obesity in the region.
Key words: Childhood obesity; Diet; Physical activity; Policies; Caribbean
Key words: Childhood obesity; Diet; Physical activity; Policies; Caribbean
The Challenge
Prevalence
The obesity tsunami impacting the Caribbean is prominent
in childhood. During one decade overweight and obesity rates in
pre-school children changed from 6% to 14% [1]. This is indeed a
weighty challenge because Caribbean children have much higher
rates than the global average of 5% [2-3]. At the older age of 6 to
10 years studies in Jamaica show rates of 17%. Within this narrow
age range there was still a significant increase in prevalence as
children got older. Significantly higher percentages were also
found in girls and in urban areas [4]. The gender difference
persisted in early adolescence (11-13 years) with 33% of girls
overweight or obese compared to 27% among boys across the
Caribbean [1]. Even more frightening is the observation that the
risk of adult obesity is several times greater in obese children than
those non-obese [5-7]. And the spiral continues because children
of overweight and obese parents are more likely to be overweight
and obese. Parents and the child share the same environment,
and parents often feed their children the same fattening foods
that they eat and expose them to the same inactive lifestyle. So while physiologic and genetic factors are important [8] it is clear
that the critical influences are the obesogenic environment and
the adverse behaviors within it [9].
Health risks
Despite the dramatic fall in under-nutrition in recent decades
Caribbean countries still experience significant levels in some
regions of these countries. With obesity widespread, some
communities show substantial amounts of under-nutrition and
also obesity [1]. Obese children are likely to suffer from sleep apnea
and those suffering from asthma tend to have worse symptoms
than their non-obese counterparts. The major concern, however,
is that obese children can develop high blood pressure, and high
cholesterol in adults - conditions which increase the risk of heart
disease, stroke, osteoarthritis and some cancers [10]. Children at
a healthy weight are free of these weight-related conditions and
less at risk of developing these diseases in adulthood.
Causes
Several factors are believed to be contributing to this high
prevalence of childhood obesity in the Caribbean and the key
influences are outlined. The evidence is clear that breastfeeding
protects against childhood overweight and obesity [11,12]. In the
Caribbean although the vast majority of mothers breastfeed at
birth the rate falls of dramatically by 3 months and at 6 months
only 15% of mothers exclusively breast feed in Jamaica [13].
Between 6 and 11 months among those who breastfeed and
introduce complementary foods 85% do not follow the guidelines
[13]. Inappropriate young child feeding practices often lead to
overweight infants. Further, much financial savings can result
if the recommended child feeding guidelines are followed.
The major challenges among older children and adolescents
are unhealthy eating and lack of physical activity. These stem
from ineffective Caribbean policies related to food supply, food
processing, food marketing and transport, among others. Even
those children who wish to engage in healthy lifestyle behaviors
face weighty challenges from the increasingly obesogenic
environment in the region. For example, the World Health
Organization (WHO) recommends that children between 5 and
17 years should accumulate at least 60 minutes of moderate to vigorous-intensive physical activity daily [10]. In the Caribbean
children are more likely to be driven to schools in both urban and
rural areas. This may be due to an increasing number of persons
having access to motor vehicles. In many countries the school
system is so structured that children often go to school far away
from home. Children therefore use motorized transport because
of the distance and also for security concerns. In addition, children
today have fewer opportunities to be involved in recreational
sporting activities. The increased emphasis on academics has
cut out or drastically reduced sporting programmes in schools.
In some systems these academic activities persist after school
hours which further limit the amount of time a child has available
to participate in sporting events. Further, children today play
less active games which are usually restricted to indoor activities
like board and computer games. This move to the indoors for
children's play may be due both to security concerns and also a
lack of space. With more and more children moving to crowded
cities and urban areas very many children do not have the space to
play. With the availability of dozens of cable television channels,
children can sit and watch cartoons and other programs all day,
every day. The challenge to meet the WHO recommendations is
indeed weighty given these constraining environmental factors.
The national dietary guidelines of Caribbean countries as well as WHO recommend that the intake of sugars should be limited and that energy intake from fats should shift from saturated to unsaturated fats [10]. They further recommend that fruits and vegetables, whole grains and legumes should be increased. In the Caribbean, water is being replaced by sweetened juice drinks and syrups which are very common. There is also a multitude of different candies and sweets, chocolates, cookies, cakes and breakfast cereals available with little limitation on their use. These energy-dense foods are marketed directly to children. They taste more exciting, and children more often choose them. Also heavily marketed to children are fast foods which are relatively cheap, attractive and offer a wide variety of items. With increased competition among the fast food outlets, portion sizes have increased. So children today are more aware of what is available and either ask their parents for them or purchase them on their own. In schools children can buy foods throughout the day from tuck shops and vendors at the gate or vending machines rather than just at meal times. The availability and affordability of these addictive high energy-dense foods make it difficult to adhere to the national dietary guidelines. Despite these weighty challenges, equally weighty opportunities exist to meet them. These are outlined below.
The national dietary guidelines of Caribbean countries as well as WHO recommend that the intake of sugars should be limited and that energy intake from fats should shift from saturated to unsaturated fats [10]. They further recommend that fruits and vegetables, whole grains and legumes should be increased. In the Caribbean, water is being replaced by sweetened juice drinks and syrups which are very common. There is also a multitude of different candies and sweets, chocolates, cookies, cakes and breakfast cereals available with little limitation on their use. These energy-dense foods are marketed directly to children. They taste more exciting, and children more often choose them. Also heavily marketed to children are fast foods which are relatively cheap, attractive and offer a wide variety of items. With increased competition among the fast food outlets, portion sizes have increased. So children today are more aware of what is available and either ask their parents for them or purchase them on their own. In schools children can buy foods throughout the day from tuck shops and vendors at the gate or vending machines rather than just at meal times. The availability and affordability of these addictive high energy-dense foods make it difficult to adhere to the national dietary guidelines. Despite these weighty challenges, equally weighty opportunities exist to meet them. These are outlined below.
The Opportunities
The strategies to prevent obesity in the whole population
[14] will also have a major impact on childhood obesity. Many
of the chronic nutrition-related diseases such as hypertension,
heart disease, diabetes and cancers which manifest in adult years
have their roots in childhood obesity. And the obesity rates are
increasing. This trend can be halted and reversed by instilling
positive habits of good nutrition, health and lifestyle through
various settings by parents, communities, schools and the general
public, among others.
Parents
Perhaps the most important contribution Caribbean parents
can make to control childhood obesity is to provide appropriate
nutritional support, including breast feeding, during the first 1000
days of a child's life. Regarding behaviour, parents can provide
the most powerful influence on childhood lifestyle practices.
This influence is critical in navigating children through an
increasingly obesogenic environment. Parents should therefore
help and encourage children to evaluate their food preferences
and physical activity habits.
Expected Outcome 1
Wise and healthy lifestyle choices made by children
Activities: Send a positive message to children by being a role
model. Try to eat right and get physically active regularly.
Ensure that healthy foods are always available in the home and use them for breakfast, school snacks and dinner.
Avoid rewarding good deeds with candy, television watching and video games. Celebrate success with creative and realistic incentives for desirable behaviours which can develop a good self-image.
Gradually influence lifestyle behaviour change by looking for opportunities where the family can have fun together.
Identify physical activities that an individual child loves and seek every opportunity to promote them in place of a sedentary lifestyle habits such as video games and television watching which can also lead to excessive snacking.
Ensure that healthy foods are always available in the home and use them for breakfast, school snacks and dinner.
Avoid rewarding good deeds with candy, television watching and video games. Celebrate success with creative and realistic incentives for desirable behaviours which can develop a good self-image.
Gradually influence lifestyle behaviour change by looking for opportunities where the family can have fun together.
Identify physical activities that an individual child loves and seek every opportunity to promote them in place of a sedentary lifestyle habits such as video games and television watching which can also lead to excessive snacking.
Schools
Obesity, a major risk factor for chronic nutritional diseases,
is increasing among school children. Apart from parents, schools
provide the longest daily interaction with children and hence a
weighty opportunity for positive lifestyle influence.
Expected Outcome 1
Principles, concepts and skills training about healthy
eating and regular physical exercise made mandatory in
all levels of school, from pre-school to tertiary institutions.
Activities: Create awareness among policy makers, teachers and
curriculum planners about healthy diet, physical activities and
disease relationships, particularly how these relate to health
risks in children.
Design a model curriculum for teaching about food, nutrition, health and healthy eating skills as well as regular physical exercise gradually and sequentially to all students.
Ensure that all children participate in a minimum of 30 minutes of moderate to vigorous physical activity during the school day.
Ensure that all children participate in a minimum of 30 minutes of moderate to vigorous physical activity during the school day.
Design a model curriculum for teaching about food, nutrition, health and healthy eating skills as well as regular physical exercise gradually and sequentially to all students.
Ensure that all children participate in a minimum of 30 minutes of moderate to vigorous physical activity during the school day.
Ensure that all children participate in a minimum of 30 minutes of moderate to vigorous physical activity during the school day.
Expected Outcome 2
Nutrition education and physical activity incorporated
into a healthy lifestyle programme in schools. Activities:
Conduct nutritional assessment of schoolchildren to (1) determine the trends in nutritional status and (2) provide information for counseling.
Plan and implement healthy lifestyle programmes to enable children to make informed decisions.
Conduct nutritional assessment of schoolchildren to (1) determine the trends in nutritional status and (2) provide information for counseling.
Plan and implement healthy lifestyle programmes to enable children to make informed decisions.
Expected Outcome 3
Policies to support healthy diet and lifestyle choices
developed by school management. Activities: Evaluate current
foods offered at the school cafeteria and modify them in keeping
with national dietary recommendations, whilst also discouraging
the excessive use of salt, sugar- and fat-containing foods.
Develop incentives for students to make healthy dietary choices.
Introduce competitions as incentives to promote physical activity for all categories of students, not only the athletically gifted.
Involve school health services and parents in childhood obesity prevention efforts
Develop incentives for students to make healthy dietary choices.
Introduce competitions as incentives to promote physical activity for all categories of students, not only the athletically gifted.
Involve school health services and parents in childhood obesity prevention efforts
Communities
Community action is critical to reinforce actions in schools
to control obesity. The community has formal institutions such
as church, youth clubs and community centres from which
individual and group initiatives can be spawned to improve
dietary and other lifestyle habits.
Expected Outcome 1
Community-oriented nutrition and lifestyle programmes
developed. Activities: Involve community development
workers in health, sports and other sectors to promote healthy
eating habits.
Involve community action groups in designing and implementing programmes for the prevention of obesity particularly in high-risk low-income groups.
Identify and train resource persons in the community to obtain skills in food preparation and healthy eating.
Identify or provide safe and inexpensive exercise facilities in communities. For example: after school use of school facilities; use of school as a community centre to promote physical activity.
Promote daily physical exercise for healthy living through community organizations (e.g. youth clubs, service clubs) and to avoid weight gain, for persons who are not physically active.
Encourage the initiation of community projects that will increase availability and affordability of fruits, vegetables, legumes and ground provisions for the community.
Involve community action groups in designing and implementing programmes for the prevention of obesity particularly in high-risk low-income groups.
Identify and train resource persons in the community to obtain skills in food preparation and healthy eating.
Identify or provide safe and inexpensive exercise facilities in communities. For example: after school use of school facilities; use of school as a community centre to promote physical activity.
Promote daily physical exercise for healthy living through community organizations (e.g. youth clubs, service clubs) and to avoid weight gain, for persons who are not physically active.
Encourage the initiation of community projects that will increase availability and affordability of fruits, vegetables, legumes and ground provisions for the community.
General Public
Childhood obesity must be tackled from within families and
schools, but reinforcement is also critical from the general public.
Many Caribbean countries have developed national dietary
guidelines which are meant to reduce obesity and the devastating
diseases such as diabetes, high blood pressure, heart attack, stroke and cancer. The challenge is to utilize these guidelines to
improve the chances of a healthier life.
Expected Outcome 1
The public is aware of, and convinced of, the need to
develop and maintain healthy lifestyle habits. Activities:
Launch and maintain massive public education campaigns to
inform the public about the dietary guidelines using the mass
media – radio, television, newspaper, posters and leaflets. This
should be done on the basis of audience segmentation.
Provide support, incentives, and introduce competitions, which challenge the public to seek and obtain information on healthy eating and physical activity.
Provide support, incentives, and introduce competitions, which challenge the public to seek and obtain information on healthy eating and physical activity.
Expected Outcome 2
The public is provided with consistent educational
messages and dietary recommendations. Activities: Develop
applications for computers and smart phones that can provide
the public with information on food, nutrition, exercise regimes
and health.
Develop and disseminate scientific-based nutrition and lifestyle education materials to all audiences.
Review and monitor educational messages that reach the public to ensure consistency and conformity to the national guidelines.
Develop and disseminate scientific-based nutrition and lifestyle education materials to all audiences.
Review and monitor educational messages that reach the public to ensure consistency and conformity to the national guidelines.
Conclusion
The rapid rise in childhood obesity in the Caribbean will not
be halted with feeble and ineffective policies and programs. To
harness the superior learning capacity of non-obese children
and to decrease the risk of nutrition-related chronic diseases
countries of the Caribbean must give priority attention to
addressing these weighty childhood challenges. Clearly, the need
is for major investments in the protective factors at the family,
school and community level to attain substantial advances in
healthy lifestyles in childhood. It is not expected that every
country will implement all of these activities outlined here but
the aim was to present options that policy makers can implement
based on political, practical and financial feasibility.
To address these weighty challenges Caribbean countries need to implement bold and appropriate policies which can shape environments that will enable children to access healthy, affordable meals and also safe, attractive settings for increased physical activity. A multi-sectoral, multi-level, evidence-driven approach is therefore essential to halt childhood obesity in the region.
To address these weighty challenges Caribbean countries need to implement bold and appropriate policies which can shape environments that will enable children to access healthy, affordable meals and also safe, attractive settings for increased physical activity. A multi-sectoral, multi-level, evidence-driven approach is therefore essential to halt childhood obesity in the region.
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