Introduction
Obesity has become a serious problem in the modern society. Gradually more evidence surfaces regarding the social nature of the issue. Some researchers argue that in modern society, urbanisation plays a major role in the increase of obese people. This view, known as the sick city hypothesis, highlights a number of effects resulting from urbanisation which contribute to the matter. The issue demands utmost attention as the obesity, in addition to physical complications, is associated with a number of serious health conditions, such as asthma, cardiovascular disease, and type-2 diabetes, both among adults who were obese in childhood and among kids as young as five. In addition, obesity often results in adverse psychological effects, such as low self-esteem.
The following report presents the evidence of the obesity rates in Southwark borough of London as an urban issue. The metrics and statistical data are compared to the determinants to find the primary cause of the problem. A brief overview of the health conditions connected to the condition is given to capitalise the significance of the problem. Finally, a review is conducted of the policies suggested by various committees in the recent years to battle the issue, along with the assessment of results and the gaps in the strategies. Based on the review, a set of recommendations is suggested to complement the current policies, raise the awareness and enhance the understanding of the issue, and possibly offer the solutions to obese adolescents and their parents.
Rationale
The London borough of Southwark has a population of people under the age of 19 of 22.6%, which is slightly lower than the London’s overall 24.6% (Public Health England, 2015a). The percentage of children is expected to stay within these limits in the nearest future.
Several researchers pointed to the fact of a growing tendency for obese children. In 2001, increased obesity and overweight rate were 29.5% in boys and 22% in girls (Public Health England, 2015a). The 2006 data show 27% (4950) overweight and obese children in Southwark (Whincup et al., 2015). Among boys, the prevalence of overweight was highest at the age of 10 with 34% and dropped to 15.4% at the age of 14, whereas in girls the prevalence of overweight was highest around 23.4% at the age of 6 and down to 12% at the age of 14 (O’Neil, Nicklas, & Kleinman, 2010).
As of 2015, the level of obesity among children of Southwark is the worst among London’s boroughs, with more than 26% of children aged 0-19 years being classified as obese, compared to 22% of London’s overall number (Public Health England, 2015a). The tendency of an increase in percentage is thus clearly visible. The general health profile of Southwark children is more diverse. At the same time, the borough displays high levels of poverty.
The level of child poverty rate puts the Southwark’s performance at the twelfth position among London boroughs, as the percentage of children under 16 living in poverty is one of the highest in the region, being 28.6%, which is also significantly higher than London’s average of 23.7% (New Policy Institute, 2015). Taking into account the established correlation between poverty and obesity and the fact that Southwark is within the 20% most deprived boroughs of England (Department for Communities and Local Government, 2015), it is logical to apply the sick city hypothesis to prove that obesity, in this case, is an urban health issue.
In our case, the already mentioned poverty rate is an urban health penalty: the lower-income leads to a multitude of barriers to good health, including financial inability to buy medical insurance and gain access to medical services (Rodwin & Gusmano, 2002). Besides, communities with high poverty rates are usually characterized by poor education. This is also true for Southwark, where 42% of 19 year-olds lack the level 3 GCSE qualifications (New Policy Institute, 2015), one of the eight worst results among London boroughs.
The lack of proper education is usually associated with poor communication with a health provider and the lack of understanding of health issues such as obesity. Another urban health penalty commonly associated with obesity in England is ethnic group diversity. 79% of Southwark’s children of the school-age are from minority groups. At the same time, it is known that children of such groups as well as of mixed race are more likely to be obese (Nolan-Bertuol, 2012).
According to the sick city hypothesis, the urban areas also provide better employment opportunities, access to public services, and other benefits. However, the Southwark performs poorly in all of the areas that could potentially balance the situation: the unemployment rate of the borough is 7.7% compared to London’s 6.3% overall, and the percentage of recipients of the out-of-work benefits is 11.1 compared to London’s 9.3, making Southwark sixths and sevenths worst performing borough, respectively (New Policy Institute, 2015).
Previous findings on the subject suggest that urban areas, including London, tend to have poorer health than that of the general population on a national scale (Rodwin & Gusmano, 2002). In other words, in London the urban health penalties override the advantages, making it a “sick city.” By extension, in Southwark, where a number of penalties are below the general level, the effect is even more prominent. Even more troubling is the tendency towards the increase in obesity among children, which is a clear indication of the issue becoming gradually more dangerous.
Determinants
Before proceeding with addressing the problem, it is important first to determine the reasons for obesity among children. While different studies point to a multitude of causes, they can be grouped into three broad categories: physiological, social, and behavioral. The physiological determinants of obesity consist of genetic information and in utero environment. The research by Loos (2012) has established a positive influence of the mentioned determinants on the obesity levels in children.
However, the 52 genetic loci identified as associated with obesity have been proven to have a small effect on the susceptibility to the condition and thus can not be used to explain the majority of occurrences. While genetic determinants are accounted for in evaluating the risk of obesity in some commercial tests, their effect is negligible compared to behavioral and social ones and can be safely ignored within the scope of this research. The two most noticeable behavioral determinants are dietary habits along with food intake procedures and the factor of physical activity (Affenito et al., 2012). Both are complemented by environmental factors, such as the proximity to the food store or a park.
Finally, social determinants include the poverty levels mentioned above and, by extension, the social class. Besides, several causes of obesity can be determined as a combination of the mentioned factors. For instance, there is an observable connection between smoking and obesity. In particular, the research by Von Kries et al. (2002) has shown that children of mothers who smoked during pregnancy are more likely to be obese and that the percentage tends to increase with more cigarettes smoked a day. Besides, there is preliminary evidence of the overall higher body mass index of children up to ten years of age and their exposure to second-hand smoke (Dallas, 2015).
At the same time, the smoking habits are determined by the social prerequisites (Barbeau, Leavy-Sperounis, & Balbach, 2004), so the determinant is at least in part social. The same can be said about early malnutrition: the children who are inadequately fed at an early age become at higher risk of obesity (Caballero, 2001). While malnutrition is thought to be triggered by the changes in the endocrine system, making it a physiological determinant, the cause of improper nutrition is often based on poverty.
Physical Activity
Currently, the behavioral determinant most commonly associated with obesity among children is the sedentary lifestyle. Such behavior is the result of the urban environment as well as the constantly increasing number of technological advances in household appliances, most notably, television. As urban areas tend to have better access to technology and a well-established media infrastructure, the sedentary lifestyle is among the chief contributors to the “sick city” status.
The children usually are more exposed to risk associated with television, as they are easily attracted to it and, as a result, lack the motivation to engage in other activities. At the same time, the early formation of the habit has been connected to a higher risk of obesity later in life (Parsons, Manor, & Power, 2008). Recently, the advent of video games and the Internet has expanded the range of means of entertainment which contribute to the sedentary lifestyle and was also connected to obesity among children.
Finally, the behavior is induced by parents themselves, as they often invite their kids to spend time in front of the TV or a computer to get some time off without effort. The issue is also often aggravated by environmental factors, such as the absence of the green spaces and parks in the locale that denies the possibility for children to spend more time in the open and engage in physical activities. However, the Southwark borough has more than 245 hectares of public parkland (Southwark Council, n.d.) comprised of more than 130 areas.
Thus, the environmental side plays a relatively minor role in the situation. On the other hand, the social aspect, such as the insufficient involvement of parental care, is likely the primary cause behind the sedentary lifestyle that triggers obesity.
Diet
The availability and growing popularity of unhealthy foods high in sugar and fat are also contributing to the issue. The press release by the Public Health England (2015b) concludes that children in England consume three times the recommended daily intake of sugar. Besides the gastronomic attractiveness, environmental factors, such as the presence of fast-food restaurants and the scarcity of vendors offering healthy foods, also contribute to consumption rates.
There is also a connection between the region’s deprivation level and the availability of fast-food restaurants. The constantly increasing pace of life in urban areas prohibits parents from cooking a meal at home and encourages using fast foods to keep up the pace. This has led to the perception of fast food consumption as a socially induced norm associated with a certain status. Finally, the abundance of consumer electronics mentioned above often prompts the habit of eating in front of a TV, which is also among the causes of obesity.
Media Influences
The influence of commercials and product placement on dietary choice deserves special attention. The food advertisements have been associated with the increased body mass index, as the children are more susceptible to marketing techniques, and the advertised food is more often of high-calorie variety. Britain is currently one of the countries with the mildest regulations of unhealthy food marketing to children. This fact, coupled with the children’s constant interaction with media in their daily lives makes the formation of unhealthy eating habits almost a certainty.
Public Health Consequences
Obese children are known to become ill more often and, as a result, miss more classes at school. They also require more medical care and experience more difficulties in their everyday lives. Aside from these generalized adverse effects, gradually more serious health conditions are found to be associated with it. Obesity exposes children to a number of risks, both long-term and immediate. Most of the risks are physiological in nature, while some result in psychological disorders.
The condition most often associated with obese people is cardiovascular disease (CVD). A case study by Freedman et al. (2007) has revealed that the majority of obese children aged 5-17 (70%) had at least one risk factor of cardiovascular diseases, such as high blood pressure and high cholesterol level. The study results were confirmed by the research nationwide surveillance study in the Netherlands, where the percentage of the children under twelve demonstrating the risk factors was only slightly lower (62%) (van Emmerik et al., 2012). The obese children are also facing a serious increase in the risk of hypertension (26% against 6% among previously non-overweight) (Watson et al., 2013). Finally, in addition to the long-term risk, obese children sometimes experience cardiovascular damage at an early age.
Type 2 diabetes is another condition that is known to occur among the younger population as a result of excess weight. A surveillance study has revealed that the overwhelming majority of British children diagnosed with the condition, sometimes as young as seven, are obese (83%). Ethnic minorities have been shown to be at higher risk than the white population. Finally, the risk of diabetes among obese adults was higher if excessive weight was onset at a young age (Richardson & Gordon-Larsen, 2013).
The development of asthma has been conclusively associated with the increase in weight. The risk growth varies across studies but mostly stays within a 40 to 50 percent increase (Egan, Ettinger, & Bracken, 2013).
The musculoskeletal system also suffers from the stress resulting from excessive weight. As the system is in the development stage during childhood, the additional stress usually results in such orthopedic problems as slipped capital femoral epiphysis and tibia vara (Daniels, 2009). Besides, obese children have more complaints of pain in joints. Finally, the essential activities such as walking and ascending the stairs may become challenging for them.
A study by Kang et al. (2012) has recently discovered the correlation between sleep disorders, in particular, the obstructive sleep apnoea (OSA) among obese children.
Finally, the psychological condition is impacted heavily by excessive weight. There is no conclusive evidence establishing the causality of obesity on mental health dysfunctions. However, at least one study has concluded that the adults that were obese during childhood are more often experiencing the impaired quality of life and are prone to have lower self-esteem (Griffiths, Parsons, & Hill, 2010). The factors that contribute the most to the matter are body dissatisfaction, being bullied at school, avoidance of physical activity, and eating disorders.
Besides the fact that childhood obesity will likely lead to more severe health issues, there is an inherent risk of retaining the condition for the rest of one’s life.
Strategies and Interventions
National Level
Following the 2007 Foresight report, ‘Tackling Obesities: Future Choices’, the UK government has issued a call to action in 2011, which described the general principles and the course of action for the following years. The outline suggested the involvement of the population in the struggle against the growing problem. The involvement consisted of individual responsibility for personal health as well as finding partners, both in government and in the business sector, that would help the matter.
The document also capitalizes on the distinction between obesity among adults and children and provides a brief explanation of the dangers of each. Most importantly, it specifies the need for the reduction of the daily calorie intake and emphasizes the role that businesses can and should play in the process (Department of Health, 2015). The policy was moderately successful as of 2010, when some authors noted the progress associated with the implementation of the plans and guidelines, but pointed to the slower than desired rate of changes (Whitacre & Burns, 2010).
The call to action was later expanded to the policy paper on obesity and healthy eating, which set a goal of establishing a downward trend in obesity among adults and children. The document suggested empowering people to eat healthy food and engage in physical activities by providing advice on both topics through the Change4Life program and improving the standards of food labeling in stores and restaurants for the better public understanding.
The policy also provides the pledges to the businesses urging them to decrease the sugar and salt content of the foods and offering smaller portions. Finally, the local communities are provided with funding for improving health infrastructure and addressing environmental issues of the region. Currently, little progress is made on any of the fronts outlined in the paper, and some sources suggest the absence of positive results (Campbell, 2015). However, it is important to remember that the policy is multifaceted and is still ongoing, and the effect will become gradually apparent later.
Local Level
In September 2011 a steering committee comprised of members of local organizations and members of local communities conducted a review of child obesity in Southwark. The review concluded that while the energy imbalance is the core reason behind the issue, several inter-related factors, such as individual psychological issues, societal influences, and food environment contribute to the situation. The review also concluded that the community has successfully utilized the readily available nationwide child obesity programs, such as Carnegie Weight Management, COCO, WATCH IT, MEND, SCOTT, HENRY, EMPOWER, and ALIVE N KICKING, and produced observable positive outcomes on a limited scale of small children groups (Nolan-Bertuol, 2012).
At the same time, some of the areas were either of limited effectiveness or were not developed at all. Thus, the commission has compiled a list of recommendations with a number of actions that will help its facilitation. The recommendations included developing a strong vision of healthy weight backed up by consistent evidence, the need for further monitoring, an emphasis on collective and community work, taking into account the diversity of the region, the disadvantage and deprivation factors, and, most importantly, the insights into environmental shortcomings, such as the concentration of fast food vendors in the more deprived locales of Eg Walworth Road, Camberwell, Peckham and Queen’s Road, the absence of safe traveling routes for walking and cycling.
Some of the recommendations also account for the inadequate dietary conditions of local schools and the insufficient attention to maternal obesity. There is no published concise research conclusively evaluating the progress made thanks to the implementation of recommendations. However, a draft of an updated version of the policy lists the child and adult obesity rates which show no improvement over the previous situation. Thus, the results are either absent or are slow enough to be undetectable at this point in time.
Barriers to Interventions
The lack of observable improvement may be credited at least in part to the barriers which are present in the locale. The first such complication is the interdependence of the causes of the urban issue in question, covered in detail in the Determinants section. Raising awareness is not possible without an improvement in school attendance which, in turn, is connected to the deprivation level of the community. The behavioral aspect is equally multifaceted, with the sedentary lifestyle being caused by the lack of motivation among children, the absence of a proper environment for physical exercise, and parental negligence.
Finally, the acceptance of government pledges by local and national businesses is complicated by the factor of business interests. The presence of these barriers does not render the goal of the government policy unachievable – in fact, the guidelines effectively address each of the mentioned difficulties. Rather, it severely decreases the pace of progress towards the goal.
Recommendations
The report on Southwark child obesity provides decent and concise recommendations on battling the urban issue. The recommendations are mostly aimed at local authorities, businesses, and educational establishments. To complete the list of involved stakeholders, the following list of recommendations is suggested for parents’ and children’s consideration:
The parents need to control the time their kids spend in front of the TV or a computer screen. Several studies have shown that once the exposure is decreased, the improvements in BMI are noticeable (Parsons, Manor, & Power, 2008). As soon as the process of educating parents on the matter is launched, this recommendation will become easier to implement.
As the removal of the fast-food outlets will likely be a lengthy process, schools and parents need to educate children on the importance of a healthy diet. Again, the planned educational events for parents may be a good start for this, but a significant individual effort is also expected.
The reconstruction of parks and green zone into a more activity-friendly environment is an equally time-consuming task. In the meantime, the Southwark population needs to take advantage of the existing green areas. The amount and dispersion of currently available parks already give the residents an advantage in terms of opportunity for exercise and outdoor activities. This is also within the capabilities of parents, so they are advised to facilitate and support the child’s initiative.
The report also notably lacks the recommendation on the stigmatisation of the obese children. Stigmatized individuals tend to develop psychological issues that restrict them from effectively overcoming the problem (Obesity Society, n.d.). The destigmatization campaign is recommended in schools across Southwark. Alternatively, the psychological aspects can be incorporated into educational events on health topics.
Conclusion
Obesity among children is a real threat to the health of society. It has been conclusively associated with both immediate and long-term risks for health and proven to increased risk of asthma, type 2 diabetes, musculoskeletal damage, and a range of psychological complications. While physiological factors play a certain role in its occurrence, in the case of Southwark the primary reasons are of the social and behavioral kind. A number of policies have been suggested and implemented on the national and local levels to address the issue.
The policies are mostly aimed at local authorities, businesses, and educational establishments, and have not yet shown significant progress. A set of recommendations has been suggested in the paper as an attempt to enhance the effect of policies and reverse the process in the shortest time possible. With the proper execution of the reviewed policies and recommendations, the issue is expected to be successfully overcome.
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