Background information
(1+ source reference) Problem: Obesity in Children in the United States.
Causes: The causes range from genetic factors to a lack of physical activity. It is also caused by unhealthy eating patterns (high-calorie, low-nutrient foods and beverages), hormonal problems (this is rare), the environment the child grew up in and the socio-economic background of the family the child is a part of.
https://www.webmd.com/children/guide/obesity-children#1
https://www.cdc.gov/obesity/childhood/causes.html
Effects: Children suffering from obesity suffer from high cholesterol and high blood pressure which can cause cardiovascular disease (CVD). It can cause early heart disease, diabetes, a weakened glucose tolerance, asthma or sleep apnea. Obesity can also result in fatty liver disease, gall stones, bone problems, cancer, heat rash, and fungal infections. Patients may suffer from mental disorders such as anxiety and depression which may be due to effects of obesity such as acne. Sufferers may additionally suffer from low self-esteem and social problems such as bullying and stigma
https://www.webmd.com/children/guide/obesity-children#1
https://www.cdc.gov/obesity/childhood/causes.html
Organization:
Name: Obesity Action Coalition
Link: http://www.obesityaction.org/
About: This is a national non-profit organization. They are dedicated to helping those suffering from obesity for example through treatment. (http://www.obesityaction.org/)
Thesis Statement
This essay will revolve around the topic of 'Obesity in Children in the United States'. By unfolding, evaluating, and suggesting improvements for solutions offered by the Obesity Action Coalition, we will explore how viable 'modifying behaviors' and 'physician-supervised weight-loss' really are in solving the problem of obesity.
II. Solution 1 Behavior Modification and Physical Activity
A. Description
(1+ source reference)
This includes self-monitoring, where the patient keeps track of the number of calories consumed. While lowering your calorie intake alone does not significantly reduce one's weight, monitoring it to keep it in check can contribute to the treatment of the disease. Self-monitoring consists of recording one's eating, drinking and physical activity habits with the help of logs and regular self evaluation.
Behavior modification encourages physical activity and it is proven that regular physical activity reduces the risk of obesity related diseases. The Centre for Disease Control (CDC) recommends around 100 minutes of physical activity each week. Physical activity does not have to be intense, a person new to exercise may start the process by incorporating a few minutes of exercise into their day. This can range from moderate to vigorous kinds of exercise. The first comprises of around 65% increase in heart rate. The latter is categorized by more than 65% of an increase in heart rate.
Examples of this include competitive sports for example soccer, jogging, hiking, cycling, or aerobics.
Being a part of support groups can boost the confidence of patients. There are many options available (gender-based or faith-based) with the benefit of online support groups available for those who are not willing to meet face-to-face.
Setting realistic goals is an aspect that is commonly forgotten. Patients are often left disheartened when they do not see immediate results which is why it is necessary to understand that small factors all contribute to the big picture.
http://www.obesityaction.org/obesity-treatments/behavior-modification-physical-activity
B. Potential Critique Points
(Strengths and weaknesses; 2 source references)
Strengths
It is convenient because the needs of the patient are taken into account. They are not forced to step out of their comfort zones.
"Behavior therapy for obesity can be standardized and used more readily. Furthermore non-face-to-face therapy and computer-assisted therapy have also been developed. We can use these materials conveniently." (Adachi, Y. (2005). Behavior Therapy for Obesity. Retrieved from http://www.med.or.jp/english/pdf/2005_11/539_544.pdf)
It is inclusive and different people of different backgrounds are accepted. The organization takes into account that people may have preferences.
It takes into account people's different comfort zones by having "a wide variety of support groups available (women-only, men-only, faith-based, etc." (http://www.obesityaction.org/obesity-treatments/behavior-modification-physical-activity)
It can be modified to fit the routine of the patient for maximum effectiveness: "…Investigators have examined whether physical activity goals can be met by performing short bouts of activity throughout the day rather than engaging in a single continuous bout. Research has demonstrated that intermittent and continuous activity of the same total duration produce equivalent improvements in cardiovascular health, weight, and fasting or postprandial lipemia." Link (if I put the full link for the pdf it ruins the format of the table so I just linked it to the word)
Weaknesses
It is time-consuming and skill-intensive which may result in limitations: Some may not be able to take out time to carry out activities at a stretch, for example a child may not be able to spend a full hour exercising if they have to go to school and attend extra-curricular activities or tutoring after school.
"Physicians often tend to be unwilling to use behavior therapy in clinical practice considering it time-consuming and skill-intensive." (Adachi, Y. (2005). Behavior Therapy for Obesity. Retrieved from http://www.med.or.jp/english/pdf/2005_11/539_544.pdf)
"As noted previously, lack of time is frequently cited as a barrier to meeting physical activity goals. With recommended goals as high as 70-80 minutes per day, it is understandable that this is a challenge." Link (if I put the full link for the pdf it ruins the format of the table, so I just linked it to the word.)
It may cause unrealistic expectations. Patients often start and think that they will immediately see results but that is unlikely, and when they do not they get disappointed: "One of the greatest challenges in the clinical management of obese patients is addressing the significant disparity between actual and expected weight losses" (Foster, G. D., Makris, A. P., & Bailer, B. A. (2005, July 01). Behavioral treatment of obesity | The American Journal of Clinical Nutrition | Oxford Academic. Retrieved March 15, 2018, from https://academic.oup.com/ajcn/article/82/1/230S/4863396). These unrealistic expectations may cause the patient to become disheartened.
Since the patients are children, they may be unmotivated if they are being told what to do by those considered to have authority, a natural reaction among many people: "Parents/guardians reported their child had issues with authority or was unmotivated to engage in healthy behaviors instructed by adults." (Staiano, A. E., Marker, A. M., Comeaux, J., Frelier, J. M., Hsia, D. S., & Broyles, S. T. (2017, Spring). Family-Based Behavioral Treatment for Childhood Obesity: Caretaker-Reported Barriers and Facilitators. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5349643/)
Children's routine may be a contributor to the problem. Their school environment, or as stated before, their juggling between school and extra-curricular activities, may result in them not being able to maintain a healthy lifestyle. "Parents/guardians reported a number of general eating concerns, such as eating too much unhealthy food, not knowing what their child was eating, or not having enough time to prepare healthy meals. Parents/guardians in all focus groups reported school lunches as a major contributor to poor eating habits, specifically, not eating at school and then overeating at home: "By the time he comes home, he's starving, and he wants to eat everything in the cabinet because he doesn't eat at school because it's nasty." (Baños, R. M., Cebolla, A., Botella, C., GarcÃa-Palacios, A., Oliver, E., Zaragoza, I., & Alcaniz, M. (2011, March 4). Improving Childhood Obesity Treatment Using New Technologies: The ETIOBE System. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3089028/)
C. Suggestions for improvement
(1+ source reference)
The clinic intending to carry out behavior therapy for practice could work to receive loans from larger corporations or firms to fund the practices.
Home Support System (HSS): The ETIOBE Mates
The following program can encourage children to be healthy by making the process fun. It includes games and creative ways for children to take initiative and learn a healthier way of life. This tackles the problem of children being unmotivated and them not having the time, because it is a child's nature to make time for something they want to do.
"The ETIOBE platform is an e-therapy system for the treatment of obesity, aimed at improving treatment adherence, promoting the mechanisms of patient self-control facilitating the maintenance of weight loss and preventing relapses by means of the establishment of healthy lifestyle habits."
ETIOBE Mates: "It is used by patients at home, over a PC platform connected to Internet. Children can log on and contact their therapist, other users and also get access to the tasks and the activities that the clinician has programmed for them, as well as other functions (physiological measures, self-report diaries, educational games, etc.). This application also includes some amusing activities which they can participate in, such as cooking healthy recipes, or playing games. This application allows children to design a virtual agent or avatar, who guides them and recommends the tasks the clinician has proposed for them to carry out. This avatar also provides children with rewards. Children win points as they complete the suggested tasks, and these points allow them to pass from one level to the next (moving from 'beginners' to 'experts'). Patients know how many points that they can win by carrying out each task, playing educational games, completing self-report diaries, and so on." (Baños, R. M., Cebolla, A., Botella, C., GarcÃa-Palacios, A., Oliver, E., Zaragoza, I., & Alcaniz, M. (2011, March 4). Improving Childhood Obesity Treatment Using New Technologies: The ETIOBE System. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3089028/)
The information I have found so far is not sufficient enough. I will try to find ACTIONABLE ways through which the time-intensive aspect can be improved. I believe the funding point may improve the skill-intensive problem however I need to find a source and example supporting this. Moreover, I want to find evidence supporting ways to improving the unrealistic expectations points keeping in mind that the patients are children.
III. Solution 2 Physician-supervised Weight-loss
A. Description
(1+ source reference)
These programs usually offer services led by licensed healthcare professionals, such as medical doctors or nurses, in a clinical setting. (Obesity Action Coalition " Physician-supervised Weight-loss. (n.d.). Retrieved from http://www.obesityaction.org/obesity-treatments/physician-supervised-programs)
The first step is a consultation with a healthcare professional. Patients often arrive undiagnosed with diseases such as diabetes and thyroid disorders. The initial consult focuses on a medical evaluation of diseases related to diabetes followed by a physical examination. The physician management of obesity includes Pre-packaged Meal Replacement Plans and Pharmacotherapy. (Obesity Action Coalition " Physician-supervised Weight-loss. (n.d.). Retrieved from http://www.obesityaction.org/obesity-treatments/physician-supervised-programs)
Pre-packaged Meal Replacement Plans are medically monitored programs that help patients achieve their weight-loss goals with the help of meal replacements and counseling. This program helps train the patients for long term weight-loss by preparing them to be independent. This program provides respectable results within 18-24 weeks since its start.
(Obesity Action Coalition " Physician-supervised Weight-loss. (n.d.). Retrieved from http://www.obesityaction.org/obesity-treatments/physician-supervised-programs)
B. Potential Critique Points
(Strengths and weaknesses; 2 source references)
Strengths
It sets a routine, making it easier for the patient. "These programs work to help patients transition to self-prepared meals" so that they can get accustomed to a way of life that they should continue even after the program ends. (Obesity Action Coalition " Physician-supervised Weight-loss. (n.d.). Retrieved from http://www.obesityaction.org/obesity-treatments/physician-supervised-programs)
It is custom made for the patient. Patients do not feel as if they did not get their 'worth' because the weight loss plan they receive is specifically designed for them, ensuring optimal results. "A medically supervised weight management program consists of various phases individualized to the needs of the person seeking weight-loss."
(Obesity Action Coalition " Physician-supervised Weight-loss. (n.d.). Retrieved from http://www.obesityaction.org/obesity-treatments/physician-supervised-programs)
It is long term. The patient gets used to a healthier way of life and as a result that becomes their regular way of life, making it more likely for patients to continue this way of life even after the programs end. "The phases include some type of a meal replacement phase to achieve initial weight-loss and eventually transitions to a phase of self-prepared foods for long term weight management. (Obesity Action Coalition " Physician-supervised Weight-loss. (n.d.). Retrieved from http://www.obesityaction.org/obesity-treatments/physician-supervised-programs)
Patients are supported. It is proven that weight-loss can cause emotional changes such as mood swings or even depression. Therefore, it is extremely beneficial, or even necessary in some cases, for the patients to have different ways of getting support available to them. "In addition, patients have the guidance of a team of healthcare professionals, access to group or individual counseling, as well as other support options." (Obesity Action Coalition " Physician-supervised Weight-loss. (n.d.). Retrieved from http://www.obesityaction.org/obesity-treatments/physician-supervised-programs)
Weaknesses
It relies on the dedication of the patient. Since the patient is essentially 'spoon fed' during the program, they may not know how to be independent when they leave the program. They may not be able to adjust to the different lifestyle, where there are other unhealthier options and different ingredients. "There are concerns regarding the ability of participants to be able to re-adjust to eating healthy outside the program once completed." (Obesity Action Coalition " Physician-supervised Weight-loss. (n.d.). Retrieved from http://www.obesityaction.org/obesity-treatments/physician-supervised-programs)
Patients become dependent. The program builds a reliance on the foods that are provided. The child may not be able to know how to substitute, which is important, after the program. For example, shakes are a form of meal replacements. The following quote is an example that demonstrates the ability to not adapt. "You know you'll stay on course for breakfast and lunch, because all you have to do is drink a shake. But what happens if you forget to pack your shake one day? What happens if you're meeting a friend for lunch? Becoming overly reliant on shakes can leave you not knowing how to make the right choices." (BAUER NUTRITION. (2017, July 05). The Pros and Cons of Meal Replacement Shakes. Retrieved March 16, 2018, from https://bauernutrition.com/blog/pros-cons-meal-replacement-shakes/)
It is expensive. Meeting with licensed healthcare professionals and having consultations with them can end up costing a lot. This may not include extra fees or the cost of the meal replacements, further increasing the cost. "Individuals may consider it expensive if it is not covered by insurance." (Obesity Action Coalition " Physician-supervised Weight-loss. (n.d.). Retrieved from http://www.obesityaction.org/obesity-treatments/physician-supervised-programs)
It is not effective: Proven by the study below.
"The present study examined the use of meal replacements in the treatment of obese adolescents. All adolescents and their parents (guardians) received a family-based lifestyle modification program…However, the potential benefit of MR in maintaining weight loss in adolescents was not supported. All groups gained weight from months 5-12. Although the CD participants lost the least amount of weight at month 4, this group did not gain as much weight during months 5-12 as participants in the two original MR conditions. Moreover, there was no evidence that long-term use of MR facilitated the maintenance of lost weight, as revealed by comparing the group that remained on MR from months 5 to 12 with the one that was switched to a CD." (Berkowitz, R. I., Wadden, T. A., Gehrman, C. A., Bishop-Gilyard, C. T., Moore, R. H., Womble, L. G., . . . Xanthopoulos, M. S. (2010, December 9). Meal Replacements in the Treatment of Adolescent Obesity: A Randomized Controlled Trial. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3102147/)
MR = Meal Replacements.
CD = Conventional Diet.
C. Suggestions for improvement
(1+ source reference) Patient's/families should opt for a better insurance plan or make adjustments for it to be affordable. "Additionally, insurance coverage varies depending on provider; therefore, individuals interested in the program should contact their provider to understand whether all or a portion of the program fees are covered." (Obesity Action Coalition " Physician-supervised Weight-loss. (n.d.). Retrieved from http://www.obesityaction.org/obesity-treatments/physician-supervised-programs)
The organization can work towards the child learning how to manage his diet, increasing the chance of the effects being long-term, even if it includes older methods. "Although traditional diets are more complicated, they do help you learn more about portion control and nutrition." (BAUER NUTRITION. (2017, July 05). The Pros and Cons of Meal Replacement Shakes. Retrieved March 16, 2018, from https://bauernutrition.com/blog/pros-cons-meal-replacement-shakes/)
Furthermore, the organization could have a cheaper option for those patient's families who cannot afford it. For example, they could partner up with charity organizations or have a section of the program where they treat less fortunate patients free of charge. (I plan to look for companies already providing free services such as free meal replacements, or charity companies providing free obesity healthcare)
IV. Conclusion
The problem of child obesity is a very prevalent one, however, with the combined efforts of the patient, the patient's family and professionals, it can be eliminated. Amongst the very many organizations already working towards treating obesity in children, the Obesity Action Coalition provides many different treatments that can prove to be very effective. Behavior Modification along with Physician-supervised Weight-loss methods ensure children a healthier future, and a lower risk of them suffering from adult obesity. Self-monitoring and physical exercise grooms the patient for a healthier way of life, with a constant source of motivation through face-to-face or online support groups. Furthermore, meal replacements serve as an easy way for a patient to get used to a low-calorie diet. Working with children suffering from obesity will gradually lower the rate of adult obesity in the United States.