The Childhood Obesity Epidemic
According to the World
Health Organization (WHO), childhood obesity is increasing worldwide at an
alarming rate with the countries of Latin America and the Caribbean among the
most affected. In many of the countries of the region stunting and
micronutrient deficiencies are also common, giving rise to a dual nutrition
agenda. Countries need to prevent the new problems of obesity and related
chronic diseases while eliminating yesterday’s unsolved problems of nutritional
deficiencies. This is a difficult challenge for countries with limited
resources.
The consequences of obesity for adults are well known. Obesity contributes to the development of many diseases, including diabetes, hypertension, stroke, cardiovascular disease, and some cancers while increasing the mortality rate from all causes. Childhood obesity is a serious problem because it is an important predictor of adult obesity and its negative health impact. One third of obese preschool children and one half of obese school-age children become obese adults. A recent collaborative study by the National Institutes of Health found that children who were overweight from ages 2 to 4.5 years were 5 times more likely to be overweight at age 12 when compared to children who were not overweight during the same age span.
Obesity also affects child health. The risk of hyperlipidemia, hypertension, and abnormal glucose tolerance is somewhat higher among obese children. Type II diabetes, formerly observed only among adults, is increasingly being diagnosed among children, in association with obesity. There are also important psychosocial consequences: obese children frequently are targets of systematic discrimination and, by adolescence, many suffer from low self-esteem.
The causes of the obesity epidemic are complex and linked to economic development and the nutrition transition. The absence of breastfeeding, the consumption of energy dense foods and snacks and beverages containing sugar, reductions in physical activity and the rise of sedentary recreation, are among the causes cited. It is also possible that malnutrition in utero and in infancy may increase the risk of obesity among adolescents and adults, but this mechanism is likely to be less important than the changes in diet and physical activity that accompany the nutrition transition.
The need for action
Countries need to take a number of
actions to prevent obesity and related chronic diseases. Examples of actions
include information systems to collect data about chronic diseases to help
define policies and programs and support advocacy activities. Professionals must
be trained to design, monitor, and evaluate programs aimed at preventing chronic
diseases. Nutrition and healthy lifestyles should be addressed in the school
curriculum and physical activity should be promoted in schools and in the
general population. Urban planners can support increased physical activity by
building recreational facilities, such as parks and playgrounds. Public
education must be aggressive and effective in promoting healthy diets and
lifestyles. Food and agricultural policies can stimulate greater availability
and affordability of fruits, vegetables, unrefined cereals and grains, and fish.
Industry can also help developing healthier processed foods with lower salt, fat
and sugar content.
The call for proposals about childhood obesity
PAHEF
wishes to contribute to the development of policies and programs to combat
childhood obesity in Latin America and the Caribbean and invites proposals in
the area of childhood obesity and nutrition. Successful proposals will be linked
to corrective actions and can refer to preschool children, school-age children
and adolescents. PAHEF will not fund studies that seek solely to assess the
extent of obesity in populations and/or to investigate its predictors. Examples
of topics of interest to PAHEF include the following:
• Addressing nutrition and healthy lifestyles in the school curriculum. There is agreement that physical activity should be promoted in schools and in the general population and that the quality of foods and beverages offered in schools should be improved. However, how best to do this and in ways that can be scaled up?
• Promoting food and agricultural policies that stimulate consumption of healthy diets. Governments need to implement policies that increase the affordability of healthy foods, such as fruits and vegetables. Industry’s role in developing healthier food products and in promoting public health and nutrition should be recognized and encouraged;
• Evaluating the effectiveness of existing policies and nutrition programs, such as feeding programs, and assessing their impact on child health and efforts to prevent obesity;
• Developing information systems to collect data about obesity or nutrition related chronic diseases in order to better support advocacy activities and to help define policies and programs;
• Educating the public and particularly health care providers in the area of nutrition and how to improve the diets of children; and
• Social marketing in support of childhood obesity prevention.
The list above is intended to be illustrative. PAHEF is looking for novel approaches to address the problem of childhood obesity and does not wish to restrict the call for proposals beyond insisting that a link to programs and action be very clear. Since the level of funding is capped at to $25,000 per year for up to two years, PAHEF recognizes that successful proposals may not complete the progression from designing an intervention to fully testing its impact. This may take years. PAHEF expects to support the initial steps in such a plan, provide an opportunity to launch a pilot intervention or serve to evaluate and/or existing actions.
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http://www.pahef.org/grants/smallgrants/healthy_aging/
We have moved from living only to the end of reproduction and dying of acute illnesses to much greater life spans, with attendant chronic illnesses. In the Americas there are approximately 94 million persons 60 years of age or older. 44% live in Latin America and the Caribbean. By 2025, the total number of persons 60 years and older in the Americas is expected to reach 194 million; 98 million (1 out of every 7 people) will live in Latin America and the Caribbean. With the exception of pockets of unrelenting poverty and/or inaccessibility, the Most of the population will survive infections and parasitic diseases only to develop chronic ailments.
Experiences with longer life spans. Increased life expectancy is one of the major gains achieved by public health; however, longer life does not necessary coincide with higher quality of life. Disabling conditions and decreased health status plague many people as they grow older. In some urban areas of Latin American and the Caribbean, an average of 70% of women 60 years and older have at least one disability such as low vision, arthritis, or urinary incontinence. In a survey of self-reported health status, only 42% of older women and 49% of older men reported having very good or excellent health. Despite their pervasiveness, these diseases and disabilities are not an inevitable result of aging. Modifiable risk factors such as poor nutrition, physical activity, smoking, and failure to use preventive and screening services cause almost 70% of physical decline in older people including hypertension, cancer, blindness, cardiovascular disease, chronic pain, and mental health issues (National Center for Chronic Disease Prevention and Health Promotion, 1999).
Solutions for the future; the transition from treatment to prevention. Evolution of the healthcare sector is needed to meet the changing needs of its clients. In the Region, the public health community has focused the majority of resources on infants, youth, and women of childbearing age, and some progress has been made in the areas of maternal/child health and reduction of infant mortality. These efforts are still necessary and important, but the campaigns and consideration must now extend to the healthcare needs of older adults.
The current generation of older adults enjoyed the benefit of antibiotics, vaccines, and access to healthcare services throughout life, and they survived in part through reliance on the public health system for modern medicine and treatment. As they age and stop working, many can no longer pay for healthcare services, life-saving medications, or treatment regimens that increase quality of life. Moreover, the healthcare infrastructure is not built to accommodate their needs, and health professionals are not trained in the diseases or chronic conditions that predominate in older populations. These realities further compromise the quality of care that older adults receive.
Older adults require and deserve a health system adapted to their needs, and
actions can be taken that are both cost-effective and of high quality. We need
to ensure that the continuum of care begins at infancy and continues through old
age without large gaps in service between the end of child-bearing years and the
last years of life. To create an equitable and high quality healthcare system
for older adults, the public health community must act now to develop, test, and
refine healthcare systems and programs.
As the number of older
persons increases, the healthcare system must evolve to meet the changing needs
of its clients. Action must be taken now to adapt the healthcare sector and
train health care providers to ensure that older adults are able to access
health promotion, risk assessment, screening, preventive advice and services
plus quality treatment needed as they age. They must also include
gender-specific strategies. This describes the transition from predominance of
the Treatment Model of Healthcare to the Prevention Model. PAHEF
wishes to foster this transition.
Building the Foundations for Quality of Care for Older Adults: What
is needed?
There is still limited data from developing countries
about risk factors for disability and diseases, and there are few interventions
on which to build. We must create evidence and disseminate lessons learned
for adaptation and replication in the near future. Best Practices in developing
countries for care of the elderly must be discovered and developed, and
operations research on effective and appropriate interventions must be well
documented and disseminated.
Work is needed in three specific areas:
1) Education and training of service providers, families and older
adults;
2) Tools and methodology to ‘adapt’ the environment and
procedures of the health center in order to meet the health needs of older
adults; and
3) Research on how to conduct successful health promotion
and screening activities with older adults in order to obtain behavioral changes
leading to active aging.
While we recognize that chronic disease have their antecedents in younger years, the program seeks proposals that focus on innovative prevention programs, the development of public health protocols, and/or operations research focused on individuals 50 plus. Grants will not be made to launch new or to broaden existing service operations.
Examples of possible problems/topics in enhancing quality of health care for older adults that might be addressed:
• Cigarette smoking is not discouraged sufficiently;
• Health
Centers do not do a periodic health exam of older adults using gender and
age-specific, evidence-based screening protocols, for example, post-menopausal
women do not receive gynecological screenings and mammograms and men do not
receive prostate-specific antigen tests. Screening endoscopies are
reserved for the wealthy;
• Stool guaiac and rectal exams are not often
done for screening purposes;
• There is a general ignorance of the
impact of small increases of blood pressure on cardiovascular morbidity and
mortality, and a failure to act to maintain low systolic
pressures.
• Older adults with co-morbidities are treated with
disease-specific protocols;
• Health promoters fail to take
responsibility for the health of older persons in their geographical area;
• Low coverage of mental health treatment and high rates of depression
and suicide
• The incidence of diabetes and hypertension increases with
old age yet behavior changes related to these conditions are not consistent with
need;
• Health Centers fail to educate families on the proper
care of persons with dementia;
• Older men and women do not use health
services in a timely manner;
• The health system does not have quality
indicators of care from an older person perspective.
Some examples:
A project may focus on increasing the number of older
adults who receive an annual health exam at the Health Center using a protocol
based on models of preventive medicine for older adults.
A project may focus on developing a self-care group for older persons designed on a behavior change model that is age and gender appropriate.
A project may focus on chronic disease management targeting older adults with multiple chronic conditions.
These projects will promote changes in life-style designed to improve health and wellbeing as well as adherence to treatments.