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Article Excerpt
Adolescent obesity is on the rise and is associated in the literature with adverse health effects and with demographic factors that could help focus preventive efforts in the community. The literature suggests that rural and southern populations may be at special risk with respect to obesity (Centers for Disease Control and Prevention (CDC) (2007).
There has been a staggering increase in the prevalence of obesity over the last 25 years. The obesity rates of children up to 5 years of age are estimated to have increased from 5.0% to 13.9% between 1980 and 2004. Children, ages 6 to 11 have increased from 6.5% to 18.8%, and ages 12 to 19 years of age have increased from 5.0% to 17.4% (Ogden et al., 2006). In addition, Healthy People 2010 has identified overweight/obesity as one of the top 10 health indicators affecting individuals and communities (CDC, 2006). These statistics hold major implications for our children and adolescents. Becoming obese during childhood and adolescence can predispose children to a number of health problems, such as hypertension, insulin resistance, and dyslipidemia (CDC, 2006). Resulting adult obesity is another problem that has been identified for children having a body mass index (BMI) greater than or equal to the 99th percentile (Freedman, Mei, Srinivasan, Berenson, & Dietz, 2007). This study was conducted to assess the trend and magnitude of the adolescent obesity epidemic in a small, rural southern community, to study associated health status, and to assess demographic association.
Literature Review
A literature review was completed to document the importance of adolescent obesity as a target for prevention efforts and to understand the associated adverse health conditions and predictive demographic factors. Cited references were selected based on their apparent support for the concepts to be studied in this research project.
Childhood and adolescent obesity. BMI has been found to be a reliable indicator of body fat and an effective screening tool for children, and has been used to screen children for being overweight and obese. According to the CDC (2006), BMI-for-age is used to evaluate weight status according to a child's age and gender. It is plotted on a growth chart to obtain a percentile. Percentile ranking is important because the amount of body fat changes with age and differs between genders. Children at risk for being overweight are ranked between the 85th to 95th percentile, while children at risk for being obese are greater than or equal to the 95th percentile (CDC, 2006). In this study, the term "overweight" is used for BMI between the 85th and 95th percentiles, and "obesity" is used for BMI at or above the 95th percentile for age.
Adverse health conditions associated with adolescent obesity. Cardiovascular risks have a well-supported association with adolescent obesity. As the prevalence of obesity has risen in children and adolescents, a similar increase in cardiovascular risk factors has been noted. Obesity is associated with an increased risk for hypertension, hyperlipidemia, and a higher rate of cardiovascular disease mortality (Kim et al., 2005). Until recently, most hypertension in children could be attributed to secondary causes, including renal disease, endocrine disease, or vascular conditions (such as coarctation of the aorta). However, as childhood obesity rates have increased, the diagnosis of primary hypertension has become more prevalent, especially as the obese child approaches adolescence. Veug-elers and Fitzgerald (2005) reported up to 30% of obese children are hypertensive. However, Flynn and Alderman (2005) reported that approximately half of the patients seen in a pediatric hypertension referral clinic were diagnosed with primary hypertension. Two-thirds of these patients were teenagers, and approximately half of them were obese.
Ribeiro et al. (2003) found a significant increase in both systolic and diastolic blood pressure with childhood obesity. King, Meadows, Engelke, and Swanson (2006) reported that the incidence of obesity and related risk factors, such as elevated blood pressure, was higher in rural children than national averages, and Thorpe et al. (2004) reported similar findings for children residing in inner city areas. The relationship between increased BMI and hypertension is stronger for Caucasians; African Americans are more likely to exhibit elevated blood pressures even with normal BMI (King et al., 2006). Female children have greater rates of obesity than males, and therefore, greater risk for cardiovascular risk factors (Burke et al., 2005).
While the risk for obesity associated with hypertension increases as a child approaches adolescence (Flynn & Alderman, 2005; King et al., 2006), the increase in cardiovascular risk factors actually begins in infancy (Burke et al., 2005). Young-Hyman, Schlundt, Herman, DeLuca, and Counts (2001) reported the presence of metabolic syndrome...
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