Unfortunately, 2.8 million people worldwide suffer from being obese (“World Health Organization,” 2018). In most cases, it starts at infancy followed into adulthood. Obesity is expected to increase worldwide by 2030 even in countries where obesity was historically low. On Guam, about 60% of mortalities are from bad diets lifestyle choices. Obesity rates in the United States were the highest. It is preventable if certain measures are taken such as watching dietary intake and increasing physical activity. Programs on Guam, nationally, and internationally are being implemented to try to combat this disease. Obesity is continuing to increase with more than one-third (34.9% or 78.6 million) of U.S. adults who have obesity.
David L. Katz once said, “Epidemic obesity is arguably the gravest public health crisis we face and inarguably the least controlled.” Obesity rates continue to increase in the United States and westernized countries, including Guam. According to the Centers for Disease Control and Prevention (CDC, 2018), the prevalence of obesity was 39.8% and affected about 93.3 million of US adults in 2015-2016. Leon Guerrero, Paulino, Novotny, and Murphy (2009) states that 41.9% of adults in Guam were ‘normal weight’, while the rest were overweight (36.2%) or obese (21.9%). The annual medical cost of obesity in the United States was $147 billion in 2008, which proves to be a costly epidemic (CDC, 2018). These statistics are stagnant and will continue to increase if preventive measures are not taken. There are numerous programs available, but people need to be serious about making lifestyle changes if they want to see a reduction in the numbers. Obesity is continuing to increase with more than one-third (34.9% or 78.6 million) of U.S. adults who have obesity.
Weight Gain During Infancy
Are chubby babies healthy babies? Frequently, parents, grandparents, and clinicians propagate the belief that a baby’s ability to eat and gain weight is a sign of good health. However, there is increasing evidence that suggests heavier babies have a poorer long-term health trajectory than those who are not. Over the past twenty years, data emerged depicting that early life growth patterns and behaviors play a key role in the etiology of obesity, yet there is little being done to prevent obesity during infancy by the medical and public health communities (Paul, Bartok, Downs, Stifter, Ventura and Burch, 2010). A recent report showed that between the late 1970s and 2000, obesity among infants 6-23 months of age increased by over 60% (NIH, 2010).
The stages of prenatal, infancy and early childhood are the most vulnerable to the development of obesity because this is a unique period for differentiation and development. Numerous studies indicate that overweight infants and toddlers are at a higher risk of remaining overweight as they age into adults. During infancy, growth charts are utilized by healthcare providers to ensure adequate and proportional growth with respect to weight, length, and head circumference. However, this information is communicated to parents without significant explanation; therefore, a disconnect between the parents and healthcare provider occurs regarding the definitions of overweight and obese. Most parents believe heavy infant weight means a healthy infant. Parents perceive their children as picky eaters, and introduce them to solid or table foods at an early age. The association between food and love contributes to an infant gaining weight. Healthcare providers must keep an eye on growth patterns and the way parents interpret it. Providers must communicate this information to parents in a way they understand (National Institute of Health, 2010).
Evidence indicates that breastfeeding offers modest protection against obesity in the long run compared to using formula. The first reason is that breastfeeding promotes the self-regulation of intake by the infant. On the other hand, the regulation of intake by infants who consume formula is directed by the parents, rather than the infant. Common bottle-feeding practices like serving excess volumes of formula at feedings are correlated to more weight gain in the first six months of life. The composition of breast milk is deemed beneficial in which its lactose and cholesterol content supports the growth of the central nervous system; whereas, the formula contains high levels of proteins and minerals, which may contribute to excess physical growth in infancy (National Institute of Health, 2010).
With that said, prenatal, intrapartum, and postpartum education should be implemented to promote breastfeeding practices and enable women to gain knowledge and skills about it. But if families choose formula as their way of feeding then specific education should be given to reduce any problematic feeding behaviors. Parents should feed their infants only when they are hungry, rather than on a set schedule. Also, parents should pay attention to infant cues for satiety, rather than letting the infant finish the entire bottle. Lastly, parents should follow age-specific guidelines for how much formula to use during a feeding and the appropriate portion amount for their infant.
According to Paul et al. (2010), short sleep durations may be a contributor to obesity. The first two months after birth is a critical period in an infant’s sleeping patterns because infants tend to wake up every 2-4 hours, typically to eat. The first few months are crucial for the development of normal circadian rhythms. Inadequate sleep during infancy are linked to parental practices associated with sleeping and feeding patterns with consequences for getting obese in the future. Interventions to increase nocturnal sleep include swaddling, diapering, and rocking. A study showed that by doing this the infant showed longer sleep episodes at night with a larger consumption of feeding in the morning to make up from less feeding at nighttime (National Institute of Health, 2010).
Parental Regulation of Emotion
The inability of self-regulation of emotion may have implications in physical health, specifically in gaining weight. A difficult infant whom is temperamental and difficult to pacify is correlated to rapid weight gain. Negative emotions in a child is linked to adult body mass. Similarly, parents utilize feeding as a way to soothe a distressed infant, which may have negative implications on weight gain. Several developmental theorists believe that a soothing milieu helps to alleviate distress and establishes self-regulation of the infant. Hence, the ability to regulate self-emotion may prevent obesity. Using food to reward or punish an infant may lead them to believe that food has reward like qualities. Infants may learn to eat in response to seeing food or when they’re in emotional distress rather than when they’re hungry. This may potentially put infants at risk for obesity due to their inability to self-regulate their food.
According to the World Health Organization (2018), approximately 2.8 million people worldwide die every year from being overweight or obese. Being obese or overweight leads to metabolic effects on blood pressure, cholesterol, triglycerides, and insulin resistance. Individuals with an increasing body mass index are susceptible to risks of coronary heart disease, ischemic stroke, and type 2 diabetes mellitus. An increased BMI raises the risk for various types of cancer in the breast, colon, prostate, endometrium, kidney, and gallbladder. Individuals whom are considered obese have a BMI greater than or equal to 30. Data shows in 2008, 10% of men and 14% of women worldwide were obese. Approximately 205 million men and 297 million women over the age of 20 were obese, which is more than half a billion adults worldwide (World Health Organization, 2018).
Table 1 shows the prevalence of obesity in men, women, and both sexes as well as in the level of income in individuals twenty years and older. Obesity in the WHO Regions of the Americas was the highest (26% in both sexes being obese, 29% in women, and 23% in men). Obesity in the WHO Regions of South East Asia was the lowest (3% in both sexes, 4% in women, and 2% in men). Based on these statistics in Table 1, women were more likely to be obese than men in all WHO regions (World Health Organization, 2018).
Similarly, Table 1 shows that obesity tripled from 7% in both sexes in lower-middle-income countries to 24% in upper-middle-income countries. In low and lower-middle-income countries obesity in women was double that amongst men. Again, obesity in women was higher than men, but similar in high-level income (World Health Organization, 2018).
Another root cause of obesity is depression. According to the article, Obesity Action Coalition, written by David Engstrom (2018), depression and obesity go hand in hand. From the beginning, childhood obesity often leads to ridicule and exclusion from peers. This is followed by problematic behaviors such as body image, social isolation, and self-esteem. Essentially, being overweight or obese at any age causes a sense of dissatisfaction, frustration, and sadness. Accumulating excess weight causes joint pain, which may make the individual not want to exercise, enjoy life, or maneuver around. People who are obese or overweight are most likely to be discriminated against by numerous types of people, which leads to insecurity and depression.
Minati Singh (2014) states that highly palatable foods activate the same regions of the brain associated with reward and pleasure that are active in drug addiction. This suggests a neuronal mechanism of food addiction that leads to obesity. Mood disorders are found to be associated with abnormal feeding behaviors.
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