Literature Review: Childhood Obesity

Childhood obesity is a global health concern that is affecting many children. World Health
Organization (WHO) has identified childhood obesity as a weighty health issue in the 21 st
century. Incidences of childhood obesity are quite high in both developed and developing
nations. Obesity among children is accepted as an outcome of an obesogenic and complex
system. Levels of obesity among children vary. The variations are mainly associated with many
interdependent and interrelated factors. Obesity in the early years of development is associated
with long-term and short-term health complications such as hypertension, orthopedic problems,
fatty liver disease, low self-esteem, as well as type 2 diabetes. In response, many practitioners,
researchers, communities, organizations, and governments have come together to systemically
address this issue. The purpose of this paper is to explore existing research on childhood obesity,
its causes, effects, and prevention and management while identifying existing research gaps for
further studies.
Background
The definition of childhood obesity has varied over the years but can be defined as having an
excessive amount of fat in the body. There is, however, no agreement on what exactly can be
termed as excess body fat in children. Williams et al. (2017) conducted a study in which he
referred to children as fat or overweight if they had 30% of body fat in females and 25 in males.
According to the Centers for Disease Control and Prevention (CDC), a child is termed as
overweight if they are in the 95 th percentile of body mass index (BMI) and children in or above
the 85 th percentile mark at the verge of being obese (Flegal et al., 2016).

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There exist various methods that can be used to determine the amount of fat in the body in
terms of percentage. The BMI is the most used method mainly because of its availability. Its
results, however, may differ compared to those produced by other methods. Techniques
commonly used in studies include magnetic resonance imaging (MRI) and underwater weighing,
also known as densitometry (Sahoo et al., 2018). BMI is common in clinical settings. Other
techniques used in clinical settings include skin-fold thickness and waist-circumference. These
methods provide satisfactory results that are sufficient to determine whether an individual is at
risk. However, they are less accurate for research purposes. For instance, while BMI is used to
differentiate among obese adults, it is less effective in children as they are usually undergoing
various development changes and their bodies change a lot in shape.
Statistics show that approximately 15 million children across the world are affected by
obesity. 20-30% of children in under-developed and developing countries are either overweight
or obese. 25% of school-going children are obese, and 10% carry additional fat in their bodies
(Angawi & Gaissi, 2021). In the last four decades, the burden of obesity among children has
increased by ten times. This has mainly been attributed to changes in diets and a lack of physical
activity. Remarkably, obesity among children is a multi-factorial issue. It encompasses
multiplicative and additive interactions between genes and other factors within the environment
of a child. The environment could be seen in the eating patterns of a child, acquired behavior,
socio-cultural practices, and inactive lifestyle bodies (Angawi & Gaissi, 2021). Interactions such
as these can have adverse effects on a child’s life, resulting in obesity which has been associated
with comorbidities such as diabetes, cancer, and cardiovascular diseases.
Causes of Obesity

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Scholars have accepted that excess weight results from a lack of balance between the intake
and use of energy. An increase of a balance in positive energy is widely linked to preferences in
dietary intake and lifestyle choices. Recent research has revealed that this is not the only factor
associated with obesity. A person’s genetic background is vital in determining their risk of
becoming obese. According to Davidson et al. (2015), a child’s risk of becoming obese is
determined by factors such as their physical activity, dietary intake, and sedentary behavior. The
impact that these risk factors have depends on gender and age. Additionally, parents’ lifestyles
and parenting styles have a role to play. Environmental factors such as parents’ occupation,
demographics, and school policies influence the activity and eating behaviors of a child.
One of the major factors that cause obesity in children is genetics. Different studies have
shown that 25%-40% of a child’s BMI is inheritable (Anderson & Butcher, 2016). Additionally,
Güngör (2016) notes that the onset of obesity during infancy raises suspicion on the possibility
that such abnormalities could e caused by genetic mutations. Melanocortin-4 receptor defects are
the single gene defect that has been associated with obesity in infants. It comprises 5%-6% of the
total cases of pediatric obesity, specifically early-onset of the condition (Güngör, 2016).
However, existing studies don’t identify the rate at which early infant obesity leads to childhood
obesity and consequently adult obesity.
Even though, genetic susceptibility has to be combined with other behavioral and
environmental factors for it to have a noticeable effect on a child’s weight. Studies have
confirmed that genes are responsible for less than 5% of the total cases of obesity in children
(Sahoo et al., 2018). Thus, while genetics is a risk factor in the development of obesity, it cannot
be the contributing factor in the alarming rise in cases of childhood obesity. Further, metabolism,
also known as the basal metabolic rate, has also been recognized as a possible cause of childhood

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obesity. It refers to the body’s use of energy for functions when one is in normal resting
positions. Metabolism is accountable for approximately 60% of the total energy used in inactive
adults (Anderson & Butcher, 2016). However, in children, metabolism is not likely to be the
cause of obesity.
Intake of poor diet is one of the parental factors associated with obesity among children.
Children learn a lot by modeling behavior from their peers, parents, and the larger society. Their
food preferences, consumption, and willingness to try out new foods are widely affected by their
parents. Repeated exposure to and availability of unhealthy foods impacts a child’s liking and
intake of these foods (Vidhyashree et al., 2015). If a parent avails a lot of junk foods, then that is
what the child will consume, and this is likely to lead to obesity. Authoritarian restriction of
unhealthy foods has been found to lead to a decrease in desire and craving for such foods. Thus,
the constant availability of unhealthy foods increases children’s cravings for such foods,
consequently exposing them to obesity.
Another factor that studies have identified as a possible cause of childhood obesity is
snacking. Snacking foods such as candy and chips has been identified as a factor that leads to an
increase in overall calories taken (Sahoo et al., 2018). However, existing studies do not show any
link between being overweight or obese and intake of snacks. A study is necessary to identify
possible instances when snacking can lead to obesity. For instance, consumption of many snacks
which are considered unhealthy may lead to obesity since this increases caloric intake. However,
such a claim needs to be supported by evidence for it to hold.
Additionally, intake of sugary beverages has been linked to an increase in BMI. Sahoo et al.
(2018) analyzed the findings of a study conducted in 1998, which shows that the consumption of
sugary beverages over a long period accounts for a small increase in BMI. Thus, consumption of

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sugary beverages in the form of juice, sodas, and other sweetened drinks is a contributing factor
to obesity in children. Many studies have confirmed that the intake of sugary beverages
contributes to obesity. Also, sugary drinks are less filling; they are thus consumed faster and in
huge amounts leading to increased caloric intake (Center for Disease Control and Prevention,
2021).
Covid-19 and Obesity in Children
Covid-19 was first reported in 2019 in one region, and within months, it spread to other
countries. Today, Covid-19 is a global pandemic, having caused the deaths of very many people.
The disease affected life in many ways. Obese and overweight children are affected by
environmental factors. A study revealed that children were removed from their structured school
schedules and activities as most countries went into lockdown and consequently quarantined to
help contain the disease (Ferruzzi et al., 2021). Children’s lifestyles changed as most engaged in
undesirable trends such as watching TV for prolonged periods, eating unhealthy foods, and
reducing to zero physical activity. According to Petriobelli et al. (2020), an increase in glycemic
index and a decrease in physical activity was evident during quarantine. Excessive time spent
watching TV and reduced sleep are contributors to childhood obesity.
Covid-19 infections were reported to have an indirect effect on the mental as well as physical
health of children. Further, most children were inactive during quarantine, and this resulted in an
increase in weight and reduced fitness, especially cardio-respiratory in most children. On the
other hand, scholars agree that children who are overweight are more prone to psychiatric
disorders compared to their peers with a normal weight range (Sahoo et al., 2018; Topcu et al.,
2016). Stressors related to social isolation and prolonged lockdown could have had long-term
effects on the mental health of obese children. Covid-19 is still a threat. Many people are still

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getting infected, and this is a developing issue that has attracted a lot of attention from scholars
and researchers.
Health Effects of Obesity
Evidence shows that obesity has significant health impacts on the psychological and physical
health of children. Some of the serious consequences of obesity among children include
menstrual disorders, metabolic, neurological, cardiovascular, hepatic, orthopedic, and pulmonary
disorders (Sanyaolu et al., 2019). Some of these disorders are more prevalent than others. For
example, sleep apnea, cardiovascular and diabetes are very common diseases among children
with diabetes. Many studies have not focused on these health impacts but have mainly
concentrated on the psychological impacts of obesity among children.
Obese children go through weight-related bullying. This mostly happens in schools and is a
serious problem that tends to even affect a child’s academic performance. Psychological distress
related to weight bullying is also common (Sanyaolu et al., 2019). Children may develop a
dislike and even disengage from school activities due to bullying while in school.
Obese children are at risk of developing asthma and asthma-related complications. The
severity of asthma among children is directly correlated with obesity. There is also a high
likelihood of low response to corticosteroids. Studies have revealed that children with obesity
encounter very challenging asthma attacks, which prove very hard to control and engage
(Sanyaolu et al., 2019). This is also linked to poor life quality. Asthmatic children are less likely
to take part in certain physical exercises that may worsen their conditions. Inability to engage in
physical activities may make their obesity levels even worse. It is, therefore, a cyclic challenge
that is likely to affect the wellbeing of a child for prolonged periods.

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Further, a study conducted by Lumeng and Saltiel (2017) revealed that children who are
obese also have multiple organ systems affected, and this directly makes them more susceptible
to illnesses. Obesity affects tissues and has been found to lead to insulin-resistant type 2 diabetes.
Children also are at the risk of developing pulmonary diseases and face a high risk of developing
cancer. Additionally, the body’s inflammatory response to excess weight leads to acute-phase
reactants, which cause tissue inflammations. Researchers have found that obese children face a
high risk of meta-inflammation.
Remarkably, obesity has long-term as well as short-term effects on the physical and
psychological wellbeing of a child. The problem is that most of these consequences occur
concurrently, or one is a risk factor of another. For example, an obese child is likely to
experience weight-related bullying. This is likely to cause distress and even depression which
may lead to the development of eating disorders. If a child has eating disorders, they are at the
risk of eating more or less, both of which will have negative consequences on their physical
health (Sanyaolu et al., 2019). All these may cause learning and behavior problems. A child is
disposed to other physical conditions such as asthma. It seems like a never-ending cycle. This
makes it necessary to prevent obesity and help manage the condition before a child experiences
all the adverse effects. Children who are already obese need support and close monitoring to help
them overcome the challenges associated with the condition.
Prevention and Management
Childhood obesity is a complex issue to tackle. However, concerted efforts from all
stakeholders can help alleviate the effects of the problems. Social and government policies have
the potential to promote healthy behavior. According to research, taste is the most significant
factor in children’s snack choices (Sahoo et al., 2018). Hunger and price follow closely.

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Additionally, children associate unhealthy food with convenience, pleasure, and freedom, and
healthy food choices are perceived as odd. The implication then is that the social perceptions of
eating patterns and meanings of food can be changed. This would require an investment in terms
of financial and non-financial resources.
The National Taskforce on Obesity recommends that the government can make an impact by
providing incentives to distributors of healthy foods so that they can reach the consumer at an
affordable price (Keane et al., 2014). Additionally, fiscal policies such as having options where
unhealthy foods are taxed more compared to healthy foods would be effective in encouraging
healthy eating (Keane et al., 2014). Also, if the government was to invest in more leisure
facilities or the establishment of the esthetic quality of localities, this would help encourage
children and the larger society to be more active in physical activity.
There are preventive measures that have proven effective in controlling childhood obesity.
However, when a child is already overweight or obese, then management techniques can help
control the weight and even help the child reduce to what s considered normal weight based on
their age and height. For instance, children spend a lot of their time in learning institutions. Thus,
interventions implemented at school are likely to be more successful (Ijaz et al., 2021). They are
also likely to target a high number of people hence increasing the overall impact. School-based
interventions such as creating awareness on the importance of healthy diets, physical activity
programs, and provision of healthy foods at school are important in helping children maintain a
healthy weight and those already overweight reduce their weight to a normal range.
Research shows that physiotherapists are important in helping control weight among
childhood. Evidence supports the claim that childhood obesity can be controlled through
fundamental movement skills, physical activity, and motor coordination (Truong et al., 2021).

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The research is based on the assumption that a child who has fundamental motor skills that are
well-formed is more likely to engage in physical activity compared to one whose functional
motor skills are not well developed. Obese and overweight children have poor motor skills,
lower coordination, agility, speed, and balance. They also have reduced fine and gross motor
skills, but this is not the case with their counterparts within normal weight. These children are
usually unable to reap the benefits that body movements of different kinds provide to the body,
and this is why physiotherapists would come in handy to assist such children.
Physiotherapists have a unique set of skills that is appropriate to care for overweight and
obese children. However, most physiotherapists do not adequately cater to the unique needs of
this specific population (Milne et al., 2016; Truong et al., 2021). Research shows that most
physiotherapists lack the resources necessary to provide adequate care and services to obese
children (Truong et al., 2021). Some do not prioritize this population. As such, there has been a
gap in the appropriate interventions that can be used by physiotherapists and their overall
effectiveness. Existing research recommends that evidence-based guidelines should be developed
to assist physiotherapists in coming up with the appropriate intervention techniques (Milne et al.,
2016). There are limited studies on the use of physiotherapy in the management of childhood
obesity. Additionally, gaps exist on the universal and appropriate protocols to be followed in
managing obesity among children.
Summary
Scholars seem to have reached a consensus that obesity among children is a global concern.
Countries are struggling with childhood obesity. In most cases, children who are obese develop
into obese children. There are many factors that contribute to obesity in children. These include
sedentary lifestyles, social norms, and easy access to unhealthy foods. Childhood obesity is a

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complex multi-component health issue. No single factor single-handedly leads to obesity in
children. Studies show that genetic factors also lead to obesity. However, only 5% of cases of
obesity among children can be attributed to genes. Even when genes are to blame, there are also
other factors such as a sedentary lifestyle and unhealthy eating patterns that combined lead to
obesity. It then implies that even when a child is susceptible to obesity due to their genetic
makeup, it is possible for them to still maintain a normal weight if they engage in healthy
behaviors such as healthy diets and regular physical exercises.
Further, gene mutation can be attributed to obesity cases in infants. This occurs when an
infant becomes obese, yet he or she is only feeding on breast milk. Breast milk was not found to
cause obesity, and the only explanation for such anomalies is gene mutation. Covid-19 also has
been found to increase the risk of obesity. During lockdown and quarantine, children spent most
of the time at home watching TV and consuming junk food. Some were even infected, and this
affected their physical health. Since overweight has a higher susceptibility to psychiatric
disorders, their mental health was also affected during this period.
A healthy diet, regular physical activity, and parental modeling are useful in preventing
obesity. When parents avail healthy foods and engage in physical activity, their children are also
encouraged to do so. Besides, children imitate a lot of behavior from their environment. When
parents engage in healthy behavior patterns, their children are likely to do the same (Truong et
al., 2021). Additionally, the government has a role to play in the prevention of obesity.
Government policies such as the elimination of tax on healthy foods and the provision of
recreational facilities can encourage people to engage in healthy behavior patterns (Keane et al.,
2014). Additionally, although research is limited, physiotherapists too can help manage obesity
by enhancing motor skills among children and enabling them to engage in physical activities.

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Conclusion
Overall, the growing rate of obesity among children can be slowed down through concerted
efforts focused on the causes. Many factors interrelate, leading to the development of childhood
obesity; some of these components are more important than others. Interventions that combine
physical activity and a healthy diet are effective at preventing and managing childhood obesity.
Moreover, implementation of interventions at school and enforcement of healthy lifestyles by
parents would be effective in preventing obesity among children. Although evidence exists
supporting the effectiveness of these interventions, obesity among children is still an issue across
the world. As such, more studies are needed to explore the effectiveness of additional strategies
such as the use of physiotherapy skills to manage obesity.
Part 2
Reflection
Overall, the course has polished my writing skills a lot. Over the years as a scholar, there are
certain writing practices and formatting skills that I have always used which were incorrect.
However, through this course and in writing this literature review, I have corrected some of the
mistakes and learned quite a lot. Specifically, I have learned a lot about the new APA formatting
guidelines. For instance, when citing two articles in one sentence, I learned that I should use
semicolons to separate the different articles. For example, if I am citing Truong et al., 2021 and
Keane et al. (20140, then the correct way of writing this is ‘Keane et al., 2014; Truong et al.,
2021). Also, I did not know that the citations had to appear in alphabetical order. I used to just
write them and separate them with a comma, and this was not correct according to the new
guidelines. Now I know how these should appear.

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Additionally, I am a scholarly writer who is now better at complying with APA guidelines. I
have learned that when citing two or more authors inside a sentence, I should use the conjunction
‘and’ and not the ampersand ‘&.’ For example, if I want to write, according to Anderson &
Butcher (2016), childhood obesity is a prevalent health issue affecting many children, the correct
way of writing this is, ‘According to Anderson and Butcher (2016), childhood obesity is a
prevalent health issue affecting many children the & ampersand is not used in the middle of
sentences but appears in the end and in the reference list as well. I have been doing this wrong
for a long time, but now I have the correct format.
Remarkably, there are areas in that I still need some improvement. For instance, I found
myself struggling with including only current resources say that is only ten years old and below.
This is because sometimes I found relatively old sources written within the last two decades that
had very useful information. I find this requirement limiting because some information never
grows old. For instance, when looking at obesity trends. I looked back in the last twenty years.
Original sources that recorded obesity among children in 2000 are unfortunately too old to use
for my research. Sometimes the recent sources gave information that contradicted the old
sources. I just found myself struggling in this area. I will seek more guidance on this as it can
sometimes be tempting to add one or two older sources when compiling research. This is more
likely to happen when looking at how an issue has progressed and trends over the years.
There are various resources available for y use at NCU. For instance, there is the Dissertation
Center. As a Ph.D. student, this is a very useful resource. I will be working on my dissertation
very soon and have already started consulting the center for guidance on how I should go about
as well as resources that would help me in gathering information. The center also has a collection
of resources that will come in handy when writing the literature review of my dissertation. A

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similar resource is the Applied Doctoral Center which gives me access to a collection of
resources that will be useful when writing my research. It has useful resources that are arranged
in categories. For instance, if I need assistance in the methodology section of my dissertation,
then I just go straight to where related guidance is provided. I have found the center very useful
and will be engaging more with the information provided therein.
There is also the Academic Success Center. This provides various services for students at
NCU. One of the services that I will take advantage of as a student at NCU is the individualized
coaching sessions. I think that these sessions are necessary to address some of the areas that I
feel I still need to work on when it comes to scholarly writing. I will seek tailored guidance as I
work on myself to become a better scholarly writer. Additionally, individualized coaching will
help me address the challenges that I might encounter in the process of writing y dissertation. I
feel that I will really benefit from the individualized coaching sessions.
Another useful resource available for me as a student in the library. The NCU library has a
collection of credible sources that I will use for my research. The library is also user-friendly. It
is easy to navigate and helps generate citations in different writing styles. I find this very useful
for beginner students. I have already acquired APA formatting skills, and I may not require the
automatic generation of citations. However, this option is very useful for anyone beginning their
scholarly writing journey. It is also easy to search for articles by topic. I do not have to go
through many articles before finding the ones that are useful for y research. I find this very useful
for scholars.
NCU has a very supportive faculty. My professors have been very helpful throughout y
scholarly journey. I have received timely feedback, and this has helped me make improvements
in subsequent papers. I have learned a lot from each of the professors that I have interacted with,

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and even when writing my dissertation, I can count on them to provide me with support
whenever I require any.

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References

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Future of children, 19-45.
Angawi, K., & Gaissi, A. (2021). Systematic Review of Setting-Based Interventions for
Preventing Childhood Obesity. BioMed Research International, 2021.
Center for Disease Control and Prevention. Contributing factors. 2021. [Last accessed on 2022
Feb 05]. Available
from: http://www.cdc.gov//obesity/childhood/contributing_factors.html .
Davison, K. K., & Birch, L. L. (2015). Childhood overweight: a contextual model and
recommendations for future research. Obesity reviews, 2(3), 159-171.
Ferruzzi, A., Gasparini, L., Pietrobelli, A., Denina, M., Rigotti, E., & Piacentini, G. (2021).
Childhood obesity and SARS-CoV2: dangerous liaisons. Child and Adolescent
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Flegal, K. M., Wei, R., & Ogden, C. (2016). Weight-for-stature compared with body mass
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Güngör, N. K. (2016). Overweight and obesity in children and adolescents. Journal of clinical
research in pediatric endocrinology, 6(3), 129.
Ijaz, S., Nobles, J., Johnson, L., Moore, T., Savović, J., & Jago, R. (2021). Preventing Childhood
Obesity in Primary Schools: A Realist Review from UK Perspective. International
journal of environmental research and public health, 18(24), 13395.

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Keane, E., Kearney, P. M., Perry, I. J., Kelleher, C. C., & Harrington, J. M. (2014). Trends and
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Topçu S, FŞ O, Tayfun M, Uçaktürk SA, Demirel F. 2016. Anxiety, depression and self- esteem
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