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Article Excerpt
It is no surprise to pediatric nurses that childhood overweight and obesity have become a national health care concern. Since the 1980s, the number of overweight children in the United States has increased steadily. From 1976 to 1980, only 6% of children ages 6 to 18 were overweight compared with the 1999 to 2000 figure of 15% (Child Stats, 2008). In 2006, the percentage of overweight children increased to 17% of 6 to 11-year-old children, and 17.6% of 12 to 17-year-old children (Centers for Disease Control and Prevention [CDC] National Center for Health Statistics [NCHS], 2008). In addition, the rate of overweight is increasing in the preschool (2 to 5 years of age) population. From 1976 to 1980, 5% of the U.S. preschool population was overweight compared to the 2006 report of 12.6% overweight preschoolers (CDC NCHS, 2008).
An overweight child or adolescent is defined as having a body mass index (BMI) at or above the 85th percentile and lower than the 95th percentile, while obesity is defined as a BMI at or above the 95th percentile for children of the same age and sex (CDC, 2008a). It is common knowledge that physical inactivity and poor nutrition contribute to overweight and the development of chronic diseases, such as diabetes, cancers, and cardiovascular diseases (Hill, Sallis, & Peters, 2004). Recent national estimates indicate that only 34.7% of children and adolescents in the U.S. participate in regular vigorous physical activity (CDC, 2008b), a trend that will have long-term effects on the future health of the nation (Clark & Ferguson, 2000).
Rural areas have been historically perceived as more conducive to physical activity than urban areas. In the past, childhood overweight was indeed more common in urban than rural areas (Dietz & Gortmaker, 1984). Therefore, the overweight epidemic has been identified as an urban problem. More recent data trends reveal that living in a rural setting is related to a 50% increase in the incidence of overweight in children (McMurray, Harrell, Bangdiwala, & Deng, 1999). Rural children overweight rates have been documented higher than national rates in Colorado, Michigan, Iowa, North Carolina, South Carolina, Georgia, and Texas (Tai-Seale & Chandler, 2003b). Rural life may present special challenges to maintaining a healthy weight, possibly due to the unique demographic composition, cultural, and structural challenges (Tai-Seale & Chandler, 2003a). Adult rural dwellers have been shown to have higher dietary fat and calorie intakes, higher amounts of sedentary behavior, a lack of health education, lower exercise rates, and limited access to nutritionists and exercise promotion programs (Tai-Seale & Chandler, 2003a).
Klesges, Klesges, Eck, and Shelton's (1995) longitudinal study of 219 families with children 3 to 5 years of age found family overweight to be a significant, consistent predictor of preschool overweight. However, the strongest predictor of long-term, severe obesity has been found to be childhood overweight (Ferraro, Thorpe, & Wilkinson, 2003). Once a child becomes overweight, he or she is more likely to continue to be overweight. Experts recommend that prevention of overweight for preschoolers focus on increasing physical activity (Haschke, 2003) rather than calorie restriction, and preschool is an ideal age for development of basic motor movements through physically active play (Burdette & Whitaker, 2005). Promotion of physical activity should begin as early as possible to stop the current trend of physical inactivity of children in the U.S. Therefore, this study focused on the physical activity of preschool children.
Trost, Sirard, Dowda, Pfeiffer, and Pate (2003) found overweight 3 to 5-year-old children to be at an increased risk for further weight gain due to low levels of physical activity when compared to the physical activity levels of 245 normal weight and overweight children in South Carolina. Overweight boys participated in significantly less physical activity than boys of normal weight, and overweight children were 3 to 6 times more likely to have one obese parent. Klesges et al. (1995) found over a 3-year period that the most consistent non-modifiable risk factor for overweight preschool children was found to be family history of overweight. They also discovered that preschool children who had lower activity levels overall and decreases in their activity levels over time had higher increases of BMI.
Parents have been found to equate outdoor play with an increase in their child's physical activity level. Burdette, Whitaker, and Daniels (2004) found that parental-report measures of outdoor play significantly correlated with an objective direct measure of physical activity in preschoolers. Parents reported that their children would be more physically active if outdoor play areas were safer, and that more physical activity options and facilities were needed in their communities (Dwyer et al., 2003). Rich et al. (2005) discovered that 48% of Hispanic parents with overweight preschoolers indicated that the only safe place the children had to play was inside the home.
Rural studies investigating childhood overweight and obesity reveal important information regarding the rural environment. Davy, Harrell, Stewart, and King (2004) investigated childhood obesity in rural areas of the Southeast and found 54% of 205 children ages 10 to 12 to be either overweight or at risk for overweight. It was found that these children had high consumption of saturated fat, sodium, and soft drinks, and low consumption of fruits, vegetables, and calcium-rich foods. The children also had lower levels of physical activity when compared to urban populations. These rural children demonstrated poor knowledge of the importance of diet and physical activity for optimal health. Nearly half of children ages 7 to 18 in rural Georgia were found to be overweight and at higher risk for having metabolic syndrome, elevated blood pressure, impaired fasting glucose level, high total cholesterol, and high lipid levels (Davis et al., 2005). It seems that contextual factors in the rural setting may outweigh demographic influences of risk, since this study found no differences in risk by gender or ethnicity (Davis et al., 2005).
Tremblay, Barnes, Copeland, and Esliger (2005) compared health-related physical fitness and physical activity behaviors of Old Order Mennonite children to rural and urban children ages 8 to 13 living a contemporary lifestyle in Canada. The Old Order Mennonite children were more habitually active and had less obesity than modernized children. Results revealed that children living in rural areas were less active, had higher skin-fold thickness, lower aerobic fitness scores, and higher levels of obesity than both the Old Order Mennonite and urban children. McMurray et al. (1999) provided informative research regarding overweight in elementary children from North Carolina. Using randomly selected urban (population over 50,000) and rural (population 2500 or less) sites, 2113 children aged 8 to 9 were compared for cardiovascular disease (CVD) risk and rate of obesity. Mean aerobic power was greater for...
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