Philadelphia is one of the major U.S. cities located in southeastern Pennsylvania. Founded in 1682 by an English Quaker leader William Penn, the city of “brotherly love” is famous as the cradle of American democracy and a pioneer in healthcare services (Encyclopedia Britannica, 2021). Today, Philadelphia boasts a developed economy, technologically advanced medical system, and rich multicultural population. However, the problem of health equity is critical here because ethnic and economic diversity contributes to the uneven distribution of healthcare and educational resources. I work as a nurse at the Hospital of the University of Pennsylvania, and I regularly encounter patients with obesity and related complications, such as chronic kidney disease, diabetes, and cardiovascular disease. The goal of this presentation is to educate our community on the issue of childhood obesity in populations at risk and discuss its health consequences, causes, and possible prevention strategies.
Population at Risk
Childhood obesity is a national problem, as the statistics show that 13.7 million Americans aged 2-19 are obese or overweight (CDC, 2021). The project developed by the State of Childhood Obesity (2021) suggests that Pennsylvania is the 26th in the rank of youth obesity states, and our population has a moderate percentage (14.5%) of obese/overweight children. However, the main issue with childhood obesity in our diverse community is health inequity because ethnic minorities are disproportionately affected. In 2019, 26% of African American and 22% of Hispanic youth were obese or overweight as opposed to 14% of their White peers (Kumanyika, 2019). The problem is critical in North Philadelphia due to its Black and Hispanic demographics, as 70% of children and adolescents there are overweight or obese (CDC, 2021).
Windshield Study Findings
In order to understand the causes of obesity in school children, I conducted the Windshield Study. I examined local schools with considerable ethnic minority representation and tested my hypothesis of contributing inequity factors. The findings demonstrate that multiple advertisements for fast food, soft drinks, alcohol, and tobacco were strategically installed around schools and low-income areas of our community. The research by Fischer et al. (2020) confirms my idea since the advertisement of unhealthy products aimed at Black and Hispanic children leads to health disparities and obesity complications. Additionally, Kumanyika (2019) claims that current policies limit healthy lifestyle choices and marginalize minorities through inadequate access to resources and education.
Causes of Childhood Obesity
Public health determinants in our community are Access to Healthcare Services, Social Determinants of Health, and Nutrition and Weight Status (Office of Disease Prevention and Health Promotion, 2020). Microenvironments (behavioral settings) impact children’s weight via physical (limited healthy food options), economic (vendor pricing strategies), political (school nutrition policies), and sociocultural (advertisements) factors (Kumanyika, 2017). Macroenvironmental (societal) elements impact food production, trends, pricing, and national legislation. Moreover, inadequate access to primary care and education among African American and Hispanic children can exacerbate the issue of obesity in our community.
During my Windshield Survey, I talked to the parents of local ethnic minority students and discovered that their children prefer sedentary behaviors to physical activities and replace their meals with fast food or snacks. The term ‘oblivobesity’ describes misconceptions of ethnic minority parents who consider obesity normal and do not take action to decrease their child’s weight (Confiac et al., 2019, p. 10). The research on Hispanic school children conducted by Gu et al. (2020) shows that a sedentary lifestyle is associated with obesity and cardiovascular diseases. Trauma or adverse childhood experience can also lead to unhealthy eating habits and obesity that manifest 2-5 years after the event (Schroeder et al., 2021). Finally, some researchers suggest genetic obesity predisposition (AMY1A/AMY2A genes) due to starch metabolism peculiarities in Hispanic populations (Vasquez-Moreno et al., 2020).
Obesity Prevention and Management
Obesity prevention should start with healthy nutrition available at schools and at home. Salad Bars to School initiative offering vegetable-based diet plans and water instead of soda drinks at schools can help reduce obesity rates and establish healthy eating behavior in children. Obesity education and community activities dedicated to nutritional diets (low-fat/sugar/starch), regular eating (no breakfast skipping and snacks), and physical exercise may promote a healthy lifestyle for ethnic minority children. Culturally-sensitive interventions are also required to stop discrimination and targeted advertising of nutritionally poor products to low-income minority populations. Digital (emails) and printed (posters, banners) materials might be distributed in schools, supermarkets, and public spaces to replace unhealthy advertisements and educate community members on obesity prevention and weight management options. Natural produce sold at farmers’ markets should be affordable for all members of our community regardless of their economic or social status.
In our community, social determinants of health increase the risk of obesity in school children and include inadequate access to primary healthcare, limited opportunities for education, discrimination, and the absence of affordable nutritional food choices. The primary expected outcome of interventions is the adoption of a healthy low-fat, and fiber-rich diet consisting of vegetables and healthy proteins (fish or lean meat). Another outcome is community awareness (teachers, parents, students, policymakers) of obesity causes, health consequences, and preventive measures. The outcomes following the interventions might be measured via the assessment of students’ body mass index (BMI). Surveys conducted at schools can help evaluate food shopping choices, eating habits, and obesity awareness of students and their families.
CDC. (2021). Prevalence of childhood obesity in the United States. CDC. Web.
Confiac, N., Turk, M. T., Zoucha, R., & McFarland, M. (2019). Mexican American parental knowledge and perceptions of childhood obesity: An integrative review. Hispanic Health Care International, 18(2), 1–14. Web.
Encyclopedia Britannica. (2021, January 14). History of Philadelphia. Britannica. Web.
Fischer, N. M., Duffy, E. Y., & Michos, E. D. (2020). Protecting our youth: Support policy to combat health disparities fueled by targeted food advertising. Journal of the American Heart Association, 10(1). Web.
Gu, X., Zhang, T., Chen, S., Keller, M. J., & Zhang, X. (2020). School-based sedentary behavior, physical activity, and health-related outcomes among Hispanic children in the United States: A cross-sectional study. International Journal of Environmental Research and Public Health, 17(4). Web.
Kumanyika, S. (2019). A framework for increasing equity impact in obesity prevention. American Journal of Public Health, 109(10). Web.
Kumanyika, S. (2017). Getting to equity in obesity prevention: A new framework. NAM Perspectives. Web.
Office of Disease Prevention and Health Promotion. (2020). Topics and objectives. HealthyPeople.gov. Web.
Schroeder, K., Schuler, B. R., Kobulsky, J. M., & Sarwer, D. B. (2021). The association between adverse childhood experiences and childhood obesity: A systematic review. Obesity Reviews. Web.
The State of Childhood Obesity. (2021). Pennsylvania. The State of Childhood Obesity. Web.
Vazquez-Moreno, M., Mejia-Benitez, A., Sharma, T., Peralta-Romero J., Locia-Morales, D., Klunder-Klunder, M., National Obesity Network Mexico, Cruz, M., & Meyre, D. (2020). Association of AMY1A/AMY2A copy numbers and AMY1/AMY2 serum enzymatic activity with obesity in Mexican children. Pediatric Obesity, 15(8). Web.