The role of social work in the childhood obesity epidemic.
Subject: Social case work (Analysis)
Obesity in children (Care and treatment)
Obesity in children (Statistics)
Obesity in children (Prevention)
Author: Eliadis, Elizabeth E.
Pub Date: 01/01/2006
Publication: Name: Social Work Publisher: National Association of Social Workers Audience: Academic Format: Magazine/Journal Subject: Sociology and social work Copyright: COPYRIGHT 2006 National Association of Social Workers ISSN: 0037-8046
Issue: Date: Jan, 2006 Source Volume: 51 Source Issue: 1
Topic: Event Code: 680 Labor Distribution by Employer
Geographic: Geographic Scope: United States Geographic Code: 1USA United States
Accession Number: 143163719
Full Text: Childhood obesity is growing at alarming rates in the United States. According to the American Obesity Association (AOA), the prevalence of obese children and adolescents has greatly increased in the past three decades. From 1976 to 1980 the prevalence of obesity in children between ages 6 and 11 was 7 percent, and the prevalence of obesity in adolescents between ages 12 and 19 was 5 percent. Between 1999 and 2000, 15.3 percent of children in the United States were considered obese, and 15.5 percent of adolescents were considered obese (AOA, 2002). It is astonishing that obesity has doubled in children and has tripled in adolescents between 1976 and 2000.

So how is obesity determined? The medical community formulates a person's body mass index (BMI), which takes into account the person's weight and height. The BMI is then charted on standardized growth chart from the Centers for Disease and Control and Prevention (CDC) to determine the percentile of that person's BMI. The AOA (2002) declared that a child or adolescent at the 85th percentile of BMI is considered overweight and a child or adolescent at the 95th percentile of BMI is obese. It should be noted that the CDC refrains from using the word "obese" for children and adolescents. Rather, the CDC suggests two levels of overweight: the 85th percentile is "at-risk" level and the 95th percentile is "severe." (See http://www.cdc.gov/ nccdphp/dnpa/growthcharts/training/modules/ modulel/text/modulelprint.pdf for more information on the BMI and growth charts.)

Deckelbaum and Williams (2001) investigated the health risks associated with childhood obesity. They found that comorbidities associated with obesity and excessive weight in adult populations, including hypertension and dyslipidemia and the higher prevalence of factors associated with insulin resistance and type 2 diabetes, can also be found in children. In fact, type 2 diabetes is now the dominant form of diabetes in certain populations of children and adolescents because of obesity (Deckelbaum &Williams). The causes of this surge in the prevalence of childhood obesity can stem from a variety of reasons. Children are consuming more calories and decreasing their level of physical activity. It is becoming a cultural issue in the United States regarding family lifestyles that cater to obesity. Families are busier, and there is less time for parents to make their children healthy, scheduled meals. Children are running out the door without breakfast. Lunches consist of high-fat food items from the school cafeteria. Often, dinner is served in the car, in front of the television, or at a restaurant. High-calorie, high-fat foods such as chips, sweets, fast food, and other "junk foods" are staples in U.S. homes. Instead of playing outside with friends after school or on the weekends, more children are resorting to watching television, playing on the computer, or playing video games. These types of lifestyle choices are some of the major contributors to the childhood obesity epidemic.

Some might say that with the medical health risks associated with childhood obesity and the known methods to combat it, treatment and prevention should be left to physicians, dieticians, and others in the medical field, right? Wrong! Treating childhood obesity needs to be a much more comprehensive intervention than strictly nutritional counseling and treatment of comorbidities. It is crucial to address the behavioral and lifestyle changes of the child and the family. Many fundamental principles of social work are essential when working to treat childhood obesity, including family systems theory, advocacy, cultural competence, and strengths-based perspective.

SYSTEMS THEORY

Systems theory is an important part of trying to understand how to deal with childhood obesity. When working with an obese or overweight child, it is important to remember that the child is part of a family system. Consideration of this system is essential for successful, healthy lifestyle intervention. A system can be defined as a whole made up of many parts. These parts (or, in this case, family members) are simultaneously independent from and interdependent with each other. What affects the child affects the rest of the family, and, conversely, what affects the family affects the child. When working with an obese or overweight child, it may be necessary to teach the parents about healthy eating and increasing activity levels. If the social worker is teaching a child about the importance of eating more vegetables and cutting back on chips, the change most likely will not be put into action unless the parent buys more vegetables and fewer chips. Many of the unhealthy eating habits stem from the parents' unhealthy eating habits. It is important to spend as much time with the parents about the importance of three meals per day, cutting back on high-fat and high-calorie foods, increasing activity levels, and decreasing television and computer time so that the learned behaviors can be enforced and encouraged at home.

ADVOCACY

The family is a part of a larger system called the community. The community consists of the neighborhood, schools, churches, community agencies, parents' employment, extended family, and friends and affects the family's ability to make healthy lifestyle changes. Woodside and McClam (1998) said that advocacy "involves educating clients about their rights, teaching advocacy skills to clients, and applying pressure to make agencies and resources respond to client needs" (p. 192). Social workers can play an active role in advocating for their clients, for example, by helping the family advocate at schools for healthy lunch meals. They can also help the parents and child advocate for themselves at community functions (that is, barbecues, church picnics, and school bake sales) by encouraging the family to bring a healthy dish, to talk to the cooks and make sure there are healthy foods to eat, and to organize fun, active games for the children. Social workers can encourage the child and parents to educate others in their community about the importance of healthy eating and exercise. This is a classic example of spreading the word by example.

CULTURAL COMPETENCE

When a social worker works with a child and his or her family regarding a healthy lifestyle, it is extremely important for that social worker to take into consideration the family's cultural background. Food is such an important part of a person's heritage, culture, and family life. Many of us gather together around food to enhance relationships. Holidays and ceremonies often revolve around specific types of food that are as important as the event itself. It is important when working with a family who is trying to eat healthy for the benefit of their obese or overweight child to take the cultural aspect of food into consideration. We do not want an obese child to feel like an outcast because he or she is unable to participate in the food aspect of the event. A social worker can address this issue by teaching the family how to alter traditional foods so they have a lower caloric and fat content. The social worker can also encourage strict portion control and the increase of exercise to help burn off calories. This strategy allows the obese child to continue to participate in special events and holidays while keeping with weight loss goals.

STRENGTHS-BASED PERSPECTIVE

The strengths-based perspective in social work takes into account the positive aspects in the child's life and builds on those aspects to help the child or adolescent make the necessary lifestyle changes. Poulin (2000) said that with the strengths-based perspective the social worker can help children and adolescents be their own problem solver by helping them "recognize, strengthen, and marshal their inherent strengths and abilities" (p. 4). They can then take successful, positive steps toward change, and in this case, create better eating habits and increase physical activity.

Many people struggle with some sort of weight issue. I am sure most of us have gone on a diet or joined a gym in an attempt to lose weight. Most adults can understand how difficult it is to make these lifestyle changes of healthy eating and exercising. Think of how hard it must be for a child. Children do not fully understand the health risk to their body that obesity can cause or the potential restriction on what they can do because they are obese. Children want to do what their friends can do. A social worker can work with a child and help him or her see the positive aspects in their lives on which they can build. Examples of strengths are a child's motivation to play basketball without becoming out of breath, a grandmother who decides to make a low-fat pumpkin pie for the holidays, a school cafeteria that has a salad bar, or a neighborhood that has a park in which children can ride their bikes. A social worker can help the child build on these positive experiences to make even the hardest choices feel good and seem less difficult.

CONCLUSION

It is essential that social workers work with physicians, nurses, dieticians, physical therapists, schools, communities, and families in treating childhood obesity. Social workers understand that a child is part of a system called the family and that family lifestyles also need to be addressed for treatment. Social workers understand that the family is part of a bigger community that needs to change, and advocating on behalf of the child can help with successful weight loss. Social workers understand that a level of cultural sensitivity is needed when addressing food issues. Finally, social workers understand that focusing on the strengths of a child and his or her family helps to empower them all to create a successful atmosphere for behavioral and lifestyle change. When all these things come together with the rest of the medical team's intervention, a child can successfully combat obesity.

Original manuscript received January 10, 2005

Accepted April 11, 2005

REFERENCES

American Obesity Association. (2002). Childhood obesity: Prevalence and identification. Retrieved August 10, 2004, from http://obesity.org/subs/childhood/ prevalence.shtml

Deckelbaum, R.J., & Williams, C. L. (2001). Childhood obesity: The health issue. Obesity Research, 9(Suppl. 4), 239S-243S.

Poulin, J. (2000). Collaborative social work: Strengths-based generalist practice. Itasca, IL: F. E. Peacock.

Woodside, M., & McClam, T. (1998). Generalist case management: A method of human science delivery. Pacific Grove, CA: Brooks/Cole.

Elizabeth E. Eliadis, MSW, LCSW, is a social worker, La Rabida Children's Hospital, East 65th Street at Lake Michigan, Chicago, IL 60649; e-mail: eeliadis@larabida. org.
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