The history of the childhood obesity epidemic in the United States is complex as there are many causative factors that have contributed to this growing health crisis. Several of these factors have evolved over time leading to the growth in prevalence of childhood obesity. Childhood obesity was not considered a public health issue until recent history. Rates of obesity in children were between 5%-7% and stable until the 1980’s, at which point several cultural shifts occurred causing the epidemic we see today (Johnson 2012).
The first major shift that occurred for families is that mothers were starting to work at higher rates. According to the Bureau of Labor Statistics, from 1975 to 2000, the rate of mothers with children under 18 years of age rose 26% (Bureau of Labor Statistics, 2009). This limited the amount of time that families were willing to spend on food preparation, leaving families reaching for the convenience of more processed packaged foods and also dining out more frequently. Between 1972 and 1997, the number of fast food restaurants per capita doubled to answer this growing demand (Johnson, 2012).
Fast food consumption among children has increased 500% since 1970 and by 2004, about one third of American children were eating fast food every day. Fast food options tend to be served in unnecessarily large portion sizes and contain excessive amount of sugar and fat which leads to excessive consumption of calories contributing to weight gain. Consumption of fast food tends to be more prevalent among children ages 14-19, males, children living in low income families, non-Hispanic Blacks, and those residing in the South (Bowman, Gortmaker, Ebbeling, Pereira, Ludwig, 2004).
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Another shift that occurred in the late 1960’s was that the government increased subsidies for farmers growing corn. This lead to a high national yield of corn that was very inexpensive, leading to mass production and advertisement of foods with high fructose corn syrup, specifically sugar sweetened beverages like soda (Fields, 2004). The annual production of soda has increased by over 600% per capita from 1942 to 2000 (Johnson, 2012).
According to the Center for Disease Control, from 2011 to 2014, 63% of children drank a sugar-sweetened beverage such as soda or a sweetened sports drink on a given day. Currently, an average American child consumes 143 calories per day from sugar sweetened beverages. Consumption of sugar sweetened beverages in children is higher in males, non-Hispanic Blacks, and those living in low-income families (CDC, 2017).
As these cultural shifts impacted caloric consumption of America’s youth, it simultaneously became more common to be less physically active. In the 1940’s following WWII, there was an emphasis put on physical education in schools due to a large percentage of drafted men failing their military physicals (Murray). In the 1950’s and 1960’s there was continued emphasis on physical education, but in the 1970’s the number of schools providing daily physical education began to drop. In the 1990’s, schools began to be required to administer standardized testing to students. This caused schools to reconsider the importance of physical education time compared to instructional time. By 1995, only 25% of schools offered daily physical activity (Boyce, 2019). By 2006, only 3.6 % of elementary schools, 7.9% of middle schools, and 2.1% of high schools required daily physical education (CDC, 2006).
As schools dialed back on opportunities to be physically active during the school day, sedentary hobbies became increasingly more available through a variety of mediums including television, computers, video games, and cell phones. In 2014, it was found that children ages 8-18 consumed an average of over 7 hours of screen media per day (Campaign for a Commercial-Free Childhood, 2014). In 1988-1994 the National Health and Nutritional Examination Survey (NHANES) indicated that Hispanic and Non-Hispanic Black children watched more television than their White peers and were less likely to participate in vigorous physical activity each day.
The Center for Disease Control and Prevention indicated that girls are twice as likely to be inactive than boys, and the rate of inactivity among Black girls is twice the rate of inactivity in their White female peers (American Academy of Pediatrics, 2006). Children living in low income families are also at a greater risk for lower levels of physical activity as are children residing in the Southern and Western regions of the United States (Nader, et al, 2008).
Considering the risk factors that contribute to overconsumption of calories and levels of inactivity among youth, it is clear to see how the most susceptible populations to these risk factors are more likely to be obese. While 14.1% of White children are obese, 25.8% of Latino children and 22% of Black children have obesity. Older children are more likely to be obese than their younger counterparts (Robert Wood Johnson Foundation, 2018). Although overall, a household income at or below 130% of the poverty level increases the risk for a child living in that house to have obesity, household income level appears to affect childhood obesity differently depending upon race. For White children, households with an income below 130% of the poverty level are more likely to be obese but for non-Hispanic Black children and Hispanic children, there is not a significant correlation (CDC, 2010).
According to the U.S. Department of Health and Human Services, children ages 10-17 living in rural areas have a higher prevalence of overweight/obesity than their urban dwelling peers across all races and ethnicities (HRSA, 2015). The risk factors for caloric overconsumption and inadequate levels of physical activity indicate similar social determinants as those with higher rates of childhood obesity, specifically Hispanic and Non-Hispanic Black males, children between 12 and 19 years of age, children living in rural communities, and children living in households at or below 130% of the poverty level.
One of the most significant public health interventions to combat the crisis of childhood obesity is the Healthy Hunger Free Kids Act of 2010. This piece of legislation sought to take a multi-faceted approach to combat the poor quality of child nutrition contributing to obesity. This bill requires Congress to reauthorize funding periodically with the plan that this will cause the interventions within it to be re-examined and change as the epidemic evolves.
The Healthy Hunger Free Kids Act gives the USDA the authority to determine standards for all foods sold in schools during the school day, supports schools with the funding required to meet those nutritional standards and improves commodity foods that schools are able to get through the USDA. It also helps schools and communities to increase and build upon school gardens and farm to school programs. It helps ensure availability of water to all students, especially during meal times. It dictates requirements for what schools should include in their district wellness policies and ensures USDA will follow up with evaluations of these policies and their implementation.
It also addresses improving nutrition and wellness in day care centers and homes through the Child and Adult Care Food Program, a nutritional reimbursement program. It helps improve access to low income students by making it easier for these children to qualify for free and reduce priced meal programs. It allows USDA to support meals for after school programs. It also requires schools and daycare settings to be more communicative with parents about the nutritional content of meals they serve (Child Nutrition Reauthorization Fact Sheet, 2010).
Prior First Lady, Michelle Obama promoted this law as part of her “Let’s Move” campaign that focused on the obesity epidemic, although it was created by the Senate Agriculture, Nutrition, and Forestry Committee (Library of Congress, 2010). To make a maximum impact on the childhood obesity epidemic, it takes all levels of public health collaborating with outside partners. It takes governmental organizations such as the USDA, school districts to buy in and implement programming properly, local health departments to incorporate support via local grants and facilitation of projects such as community gardens, and not-for-profit agencies such as Alliance for a Healthier Generation to provide technical assistance. Only when all these levels work to create a culture of wellness for the Nation’s youth, focusing on those most at risk, will we see the childhood obesity epidemic reduce in impact on the current and future generations of American children.
References
- Johnson, S.B., (2012) The Nation’s Childhood Obesity Epidemic: Health Disparities in the Making. CYF News. Retrieved from https://www.apa.org/pi/families/resources/newsletter/2012/07/childhood-obesity.aspx
- Bureau of Labor Statistics (2009). Labor Force Participation of Women and Mothers, 2008. Retrieved from https://www.bls.gov/opub/ted/2009/ted_20091009.htm
- Holguin, J., (2014) Fast Food Linked to Child Obesity. Retrieved from: https://www.cbsnews.com/news/fast-food-linked-to-child-obesity/
- Bowman, S.A., Gortmaker, S.L., Ebbeling, C.B., Pereira, M.A., Ludwig, D.S. (2004). Effects of Fast-Food Consumption on Energy Intake and Diet Quality Among Children in a National Household Survey. Pediatrics, 113; 112-118. Doi: 10.1542/peds.113.1.112
- Fields, S. (2004). The Fat of the Land: Do Agriculture Subsidies Foster Poor Health? Environmental Health Perspectives, 112(14); A820-A823. Doi: 10.1289/ehp.112-a820
- Center for Disease Control and Prevention. (2017). Get the Facts: Sugar-Sweetened Beverages and Consumption. Retrieved from: https://www.cdc.gov/nutrition/data-statistics/sugar-sweetened-beverages-intake.html
- Murray, Emma. (n.d.). History of Physical Education in Schools. Synonym. Retrieved from https://classroom.synonym.com/history-physical-education-schools-6521673.html
- Boyce, A.B. (n.d.). Physical Education- Overview, Preparation of Teachers. Retrieved from http://education.stateuniversity.com/pages/2324/Physical-Education.html
- Center for Disease Control and Prevention (2006). School Health Policies and Programs Study: Physical Education Fact Sheet. Retrieved from: https://www.cdc.gov/healthyyouth/shpps/2006/factsheets/pdf/FS_PhysicalEducation_SHPPS2006.pdf
- American Academy of Pediatrics. (2006) Active Healthy Living: Prevention of Childhood Obesity Through Increased Physical Activity. Pediatrics. 117;1834. Doi 10.1542/peds.2006-0472
- Nader PR, Bradley RH, Houts RM, McRitchie SL, O’Brien M. Moderate-to-Vigorous Physical Activity From Ages 9 to 15 Years. JAMA. 2008;300(3):295–305. doi:10.1001/jama.300.3.295
- Robert Wood Johnson Foundation. (2018). National Obesity Rates and Trends. Retrieved from https://stateofobesity.org/obesity-rates-trends-overview/
- Center for Disease Control and Prevention. (2010). Obesity and Socioeconomic Status in Children and Adolescents: United States, 2005-2008. Retrieved from: https://www.cdc.gov/nchs/products/databriefs/db51.htm
- Lutfiyya, M.N., Garcia, R., Dankwa, C.M., Young, T., Lipsky, M.S. (2008). Overweight and Obese Prevalence Rates in African American and Hispanic Children: An Analysis of Data from the 2003-2004 National Survey of Children’s Health. Journal of the American Board of Family Medicine. 21(3); 191-199. DOI https://doi.org/10.3122/jabfm.2008.03.070207
- U.S. Department of Health and Human Services, Health Resources and Services Administration, Maternal and Child Health Bureau, The Health and Well-Being of Children in Rural Areas: A Portrait of the Nation, 2011-2012. Rockville, Maryland: U.S. Department of Health and Human Services, 2015.
- Child Nutrition Reauthorization Healthy, Hunger-Free Kids Act of 2010. (2010). Obama White House Archives. Retrieved from: https://obamawhitehouse.archives.gov/sites/default/files/Child_Nutrition_Fact_Sheet_12_10_10.pdf
- Library of Congress. (2010). S.3307- Healthy, Hunger-Free Kids Act of 2010. Retrieved from: https://www.congress.gov/bill/111th-congress/senate-bill/3307/committees
