Childhood Obesity Status in Australia: A Recent
Perspective
Kamrun Nahar1*, Tanveer A. Khan2,
Md Kamal Hossain1*
1Vetafarm Pty Ltd, Wagga Wagga, NSW, 2650, Australia
2Faculty of
Pharmacy, Al-Jouf University, Al-Jouf,
Saudi Arabia.
*Corresponding Author E-mail: Hossain_238@yahoo.com
*Equally Contributed Authors
ABSTRACT:
Overweight and obesity is an
important public health issue in Australia and around the world. Childhood
obesity is becoming an increasing concern worldwide and Australia
alone recognizes that 1 in 4 children are either overweight or obese.
In Australia, as in many other countries, the community
has become increasingly concerned about the rising
prevalence of childhood
obesity. The raft of health consequences for obese children
now, and particularly when they are adults, has provided impetus for increased interest in the role for government in obesity
prevention strategies.
Children should therefore be considered the priority population for intervention
strategies. Prevention may be achieved through a variety of interventions
targeting built environment, physical activity, and diet. Some of these
potential strategies for intervention in children can be implemented by
targeting preschool institutions, schools or after-school care services as
natural setting for influencing the diet and physical activity. All in all,
there is an urgent need to initiate prevention and treatment of obesity in
children.
KEYWORDS: Childhood, Obesity,
Overweight, Prevention, BMI, economic cost, well being.
1. INTRODUCTION:
The world is undergoing a
rapid epidemiological and nutritional transition characterized by persistent
nutritional deficiencies, as evidenced by the prevalence of stunting, anaemia, and iron and zinc deficiencies. Concomitantly,
there is a progressive rise in the prevalence of obesity, diabetes and other
nutrition related chronic diseases (NRCDs) like obesity, diabetes,
cardiovascular disease, and some forms of cancer. Obesity has reached epidemic
levels in developed countries. The highest prevalence rates of childhood
obesity have been observed in developed countries; however, its prevalence is
increasing in developing countries as well1.
Females are more likely to be obese as compared to males, owing
to inherent hormonal differences2.
There has
been a phenomenal rise in proportions of children having obesity in the last 4
decades, especially in the developed world. Childhood obesity is one of the most
serious public health challenges of the 21st century.
Childhood obesity is a worldwide epidemic that, in 2009, effected 155 million
(1 in 10) 5-17 year olds3. In regards to The International
Association for the Study of Obesity, figures collected in 2013 highlight that Greece
held the highest values for both overweight and obese boys and girls (44% and
38% respectively)4 Twenty four percent of Australian girls,
according to the Organization for Economic Co-operation and Development
(OECD), were considered obese, ranking in at 10th out of 40 countries4,5.
Both Spain
and Canada reported the same
statistical findings of 24%. In regards to obese and overweight boys, Australia
is ranked 18th, showing an identical figure of 22% to that of the United
Kingdom4,5. The lowest ratings of obesity were displayed
by Indonesia
showing values of 11% and 8% respectively for boys and girls6. In
2013, the World Health Organization estimated that over 42 million children
under the age of five were obese with 31 million of these living in developing
countries7.
Childhood obesity has been a
consistent health burden throughout the entirety of Australia’s history with
close regard placed on genetics and an energy imbalance between calorie consumption and
expenditure. Between 1985 and 1995 the number of obese children increased
dramatically from both perspectives of boys (10.7% to 20.5%) and girls (11.8% to 21.1%)
aged 7–15 and 5-17 in the two respective year brackets (Fig 1)4. In
the 10 years that followed, until 2008, figures continued to rise from 21% to
25% resulting in a similar percentile for both males and females8,9.
In the 2011/12 Australian Bureau of Statistics- Australian Health Survey,
statistics reiterated the lack of substantial preventative methods,
highlighting a 1% increase and therefore a total of 26% of children aged
between 5–17 years as being either overweight or obese10.
Fig: 1 Number of obese children
between 1985 to 1996
For Australians
aged between 4 and 17 years, obesity is a very concerning condition as once
gained it is favorably harder to be liberated from. Short-term effects on
children can mean a decrease in their psychological well-being 11
as well as physical deteriorations such as sleep apnea,
breathlessness
and cardiovascular disease11,12. With an increase risk of adult obesity
being associated with childhood obesity there are numerous long-term effects
that can ultimately hinder the life
expectancy of individuals including the development of serious
diseases 13. In order to combat the worldwide epidemic of
childhood obesity it is imperative that the issue is addressed in its early
stages. The main preventative measures to be implemented include increasing physical
exercise, dietary knowledge and decreasing sedentary behaviours12. In this
review article emphasis was given to give a brief overview on its causes,
socioeconomic impact, effect of obesity and its management.
2. CAUSES OF CHILD OBESITY:
It is widely accepted that
increase in obesity results from an imbalance between energy intake and
expenditure, with an increase in positive energy balance being closely
associated with the lifestyle adopted and the dietary intake preferences.
However, there is increasing evidence indicating that an individual’s genetic
background is important in determining obesity risk. Research has made
important contributions to our understanding of the factors associated with
obesity. The ecological model, as described by Davison et al., suggests
that child risk factors for obesity include dietary intake, physical activity
and sedentary behaviour14. The impact of such
risk factors is moderated by factors such as age, gender. Family
characteristics parenting style, parents’ lifestyles also play a role.
Environmental factors such as school policies, demographics, and parents’ work
related demands further influence eating and activity behaviors.
A strong genetic
basis exists for the development of obesity. Numerous genes have been linked
with a predisposition to excess fat. At least six very rare mutations of
single-genes causing severe early-onset obesity have been identified. In
addition, there are also a number of rare syndromes that cause obesity, among
other conditions, such as Prader–Willi syndrome and Bardet–Biedl syndrome15. In addition, an
international review of twin and adoption studies found that genetics had a
strong effect on Body Mass Index (BMI) variation at all ages, and the effect
was stronger than that of environmental influences16. However,
biological factors alone, including genetic composition, are unlikely to
account for the rise in obesity that has occurred since the 1970s, as it has
occurred too quickly to be explained in evolutionary terms17,18. It
is more likely that the rise is due to changes in the social and Genetics,
according to the Australian Health Survey plays a primary role in determining
obesity19. In 2011/2012 it was recorded that 90% of the Australian
population had inherited their obese tendencies due to the epigenetic
modifications of their mothers during pregnancy19.
Interchanging closely with the genetic factor, the environment and individual temptations
are also highlighted as contributing causes to the worldwide epidemic. The
genetic configuration influences the tendencies to become overweight, and diet
and physical activity determines to what extent those tendencies are elaborated20.
Parents,
guardians and teachers all play a key role in the mentality that children have
towards certain types of foods as they develop. The first five years of a child’s life,
when developing a familiarization with solids, can ultimately have a negative
influence on the foods that they give preference to in the future21.
“Treat” food consumption, which is a well- intentioned technique used by
parents to reward their children, contributes to between 23- 24% of an
individual’s total daily energy intake (aged between 2–16 years old)22.
With no more than 20% being recommended daily it is visibly clear that adults
may not be allowing their children to develop an intrinsic motivation for
healthy foods, ‘rewarding’ them with energy dense snacks such as potato chips,
muffins and lollies22. According to the Australian Dietary
Guidelines 2013 a child aged between 4–8 years old should consume 1 ½ serves of
fruit and 4 ½ serves of vegetable daily with individuals aged 9 and above
recommended to consume “2 and 5”4, 23. Parents can help to
positively influence their child’s diet by being an active role model
and eating a wide variety of fruits and vegetables themselves. Encouraging children to eat a variety
of different nutritional snacks and making fruits and vegetables visually
appealing through changing their shapes can also help to entice and excite
children about fruit and vegetable consumption15.
In order for an
individual (children) to remain healthy, there must be a balance between the amount of
calories consumed and the amount of calories expend (through physical
activity). Socio-environmental factors that disrupt this energy
consumption/ expenditure balance include changes to the economy (food costs),
an increased dependency on cars and sedentary behaviors and an increased marketing
of poor nutritional foods3.
Advertising
is a common aspect of today's society and is strategically conducted and
presented and conducted to persuade consumers to respond in a particular way.
Approximately 30% of advertisements conducted during children's television
viewing hours in Australia are directed on food intending to influence children
towards unhealthy food products24. Companies such as “McDonalds”,
in particular, have specifically created and designed their advertisements and
commercials so that they are appealing and enticing to children. Through the
use of bright alluring colors, the introduction of the ‘happy meal’, the
strategic use of playgrounds and the Ronald McDonald character it is evident
that children are the main target audience25. In a similar way,
Australian sporting teams are often sponsored by companies who market unhealthy
food products to children and young adults. Recent reports show that during a
high- profile cricket
match, the KFC
(Kentucky Fried Chicken) logo was clearly visible for 61% of playing time and
XXXX beer
logo clearly visible for 75% of playing time in a similar event26.
As a country dominated by sporting heroes, with a strong child based audience
during televised times, the inclusion of unhealthy foods and alcohol
sponsorship may indicate to children that even their most idolized sporting
heroes support such unhealthy products.
Some children
find it hard to grasp the concept of unhealthy products in the same way they
have internalized the negative effects of smoking. Advertisements in Australia
for tobacco smoking reflect the negative outcomes
associated, through the use of graphic and gruesome images. Unhealthy food, in
comparison, is not portrayed in the same light, despite the equality of
consequences. Instead, commercials, billboards and television advertisements
portray fast food and energy dense products with attractive colors and happy/
energetic staff members, persuading children to believe that high calorie junk
food promotes a positive and rewarding experience27.
In this same
manner, to entice children, the value of energy dense products has also
decreased making these products cheaper and more available to younger adults.
Despite the prices of these items being reduced, the portion sizes coincidently
have also risen, allowing individuals to pay less for more12,25.
Australians have developed a
reliance on cars as a means of transport instead of walking or cycling. As a
result of the radical development of technology over the past 30 years,
individuals have adapted a less active mentality becoming increasingly more
reliant on cars as a means of transport and succumbing to more sedentary
behaviors. Individuals are more inclined to use a vehicle, bus or train as transportation as
a pose to physically walking or riding a bike. This idle perspective that Australians are
adopting is a clear contributor to the obesity epidemic. A study carried out in
2008 showing the relationship between walking
and obesity in Europe,
North America
and Australia
highlights that the countries with the highest levels of active transportation
generally had the lowest obesity rates 27. The lowest rate of active
transportation
was seen in the United States (only 8%) and they also, coincidently, had the
highest rate of obesity
(34.3%)28.
Another contributor to the epidemic of childhood obesity has been the increase in sedentary pursuits. Sedentary behaviour includes the time spent using electronic media as a means of entertainment. Examples include: television, seated electronic games (iPad
) and computer use, including educational or non educational pursuits. The Australian Governments Department of Health recommends that children aged between 5– 12 years should not be sedentary for more than two hours a day29.The
socio-economic status of individual families has also been said to be a related
cause for overweight and obese individuals. Children who grow up in families
who have a lower income
are more likely to be obese compared to those who have a higher income
and are therefore brought up in higher socio-economic environments30.
Lack of playground equipment, dangerous roads, and unsafe neighborhoods are all
factors that contribute to a lower level of physical activity27. The
financial status of a family has also been reported to be a key influence in
the physical well being of children, as parents may not have the funds to
support children in participating in extracurricular activities and physical
activity in general26. As a result of this, children are more
inclined to spend their time partaking in sedentary
activities such as watching television31. Economic status is also
shown to be a major contributor to obesity, as families tend to buy more
affordable foods, those of which are usually higher in fat and energy density26.
Researchers
suggest that individuals with a low income
are more likely to becoming obese and those who are more financially stable, less likely.
Causation behind this issue is founded on the prices of nutritional based foods
being more expensive thus directing funds towards cheaper and more calorie
dense options such as fast food and take away. The minority of the costs of
healthy eating, however, firmly outweigh the economical burden that is placed
on both the individual and society caused by diet-related chronic disease 4.
In order to
decrease the prevalence of childhood obesity in Australia both parents and
teachers must together develop techniques that best encourage healthy eating.
In association to this, parents must also develop stronger understandings of
the specific foods that will either benefit or prove unfavorable to their
children’s health. The establishment of in school programs that urge children
to participate in physical activity is also imperative, introducing children to
fun methods of exercising such as interactive games26.
Short-term
prospects for children in Australia suffering from a Body Mass
Index (BMI) of more than 25 kg/m2include
deteriorations in their physical health as well as a decreased psychological
well-being3. Children who are obese or overweight by the time they
reach their schooling careers are likely to become victims of discrimination,
bullying and teasing in the playground 32. Individuals
who are made to feel inferior for their physical appearance develop a
self-conscious attitude towards their body image, leading them to foster
feelings of depression, anxiety and incompetence12,29. Psychological
detriments of this sort can also have a negative effect on children’s ability
to form relationships and make friends with peers. The social stigma
surrounding the “perfect body image” can also be extremely degrading to
adolescents who feel they are unable to meet the expectations of such
situations causing further damage mentally and physically (anorexia
and bulimia)33. From a long- term
perspective obesity can also cause negative psychological effects on
individuals who are discriminated and victimized in the work place. Food is
also used as a psychological coping mechanism for overweight adults who indulge
when they are feeling stressed, lonely and sad. The guilt felt as a result of this
"mindless eating" can, in turn, cause people to feel anxious and
distressed34.
The physical
implications of obesity in children include sleep apnoea, breathlessness,
a reduced tolerance to exercise and orthopedic and gastrointestinal problems
including non-alcoholic fatty liver disease4.
Children who reciprocate these physical health disadvantages tend to struggle
to concentrate more in- school and find it harder to fit in, being marginalized
due to the inability to partake in physical exercise. According to the
Dieticians Association of Australia 25-50% of overweight or obese children with
turn out to be obese as adults 35. Long-term effects of obesity,
therefore, include cardiovascular disease (hypertension
and high blood pressure) and particular types of cancers
in particular colon, kidney
and breast cancer4,8.
Non-alcoholic fatty liver disease
(NAFLD) is one of the most common risk factors associated with obesity being
characterized as a buildup of fat within the liver cells36. Musculoskeletal defects such as osteoarthritis
are also said to have a strong link with obesity due to excessive amounts of weight
being exerted on the joints4.
Individuals who have a Body Mass Index (BMI) that is equal to or
greater than 25 kg/m2 are also said to have an increased chance of premature morality8.
As a result of
the alarming statistics involving the number of obese children in Australia the
consequences have also been extensive to the economy. Between the ages of 4–5
years the costs of childhood obesity, according to the Longitudinal Study of
Australian Children, has incurred significantly higher medical
and pharmaceutical bills4. The health system
comprised direct health care, indirect health care, and burden of disease costs
was estimated at $58.2 billion in 20088. Direct costs included 4
main medical conditions: cardiovascular disease, type 2 diabetes, osteoarthritis
and specific forms of cancer with in-direct costs referring to productivity loss (premature morality and
sick days) and burden of disease, financial and social costs. In particular cardiovascular accounted for $34.6
billion, cancer,
$9.7 billion, type 2 diabetes $8.3 billion and osteoarthritis
$5.7 billion8. The access economic has estimated the cost of obesity
under two main categories as “Loss of wellbeing and financial costs”. Details
of the cost structure have been explained in box 1.
Access Economics’ estimates of the costs of obesity, 2008 Access Economics estimated the total cost of obesity in Australia was $58 billion in 2008. This estimate encompassed two types of costs — the ‘loss of wellbeing’ and financial costs. The cost of the loss of wellbeing was measured as the dollar value of the burden of disease arising from disability, loss of wellbeing and premature death — and was estimated to be approximately $50 billion in 2008. This accounted for 86 per cent of the total estimated costs of obesity. This estimate was derived by multiplying the burden of disease attributable to obesity (in terms of disability adjusted life years) by an estimate of the value of a statistical life. These costs are borne by obese individuals themselves. The financial costs of obesity were estimated to be $8 billion in 2008, and included: · health system costs (such as hospital and nursing home costs, GP and specialist services, and pharmaceuticals) · productivity losses · carer costs · transfer costs (that is, the deadweight loss from the higher level of taxation) · other indirect costs (such as aids, modifications and travel). · Financial costs are borne, to differing extents, by obese individuals, their families and friends, governments, employers and society
|
The two most
common forms of treatment that are crucial for individuals to carry out to
combat obesity include changing to a healthier
diet and increasing their physical
exercise8. In extreme cases, if children are morbidly
obese bariatric surgery may be carried out.
It is important for parents
and teachers to encourage children to consume more fruits and vegetables. In
Australia, the “2 Fruit and 5 Veg” campaign is
advertised to educate and encourage young children and adults of the necessary
nutrients that are needed in a daily diet37. For adults who are
entirely responsible for the foods that their children consume, it is important
that they are aware of the key strategies of a healthy regime. Adults should
provide their children with a moderate to low fat diet by limiting the amount
of energy dense meals they feed them, reiterate the importance of eating breakfast
and encourage children to eat their vegetables29. For young
adolescents who have a BMI percentile of 80 or above, there are
certain weight loss
programs available that offer services specified in dietary advice
and fitness coaching8.
It is also
imperative that parents and guardians are well informed regarding healthy
eating for their children. Developing strategies on how to encourage their
children to eat more healthy foods and grasping the knowledge on how to
distinguish between high and low calorie
based pre-packaged snacks is crucial26.
The food industry
also plays a huge part in promoting healthy foods as management from a dietary
point of view. Methods include making wholesome foods widely available and
affordable for their customers. Closely monitoring and managing the amount of
fat, sugar and salt content that is in the foods that are sold is also
important 3.
A key method of preventing
obesity is physical exercise. The "Find 30" campaign reiterates the
importance of exercising for at least 30 minutes a day in order to maintain a healthy
lifestyle. Physical exercise, in order for a child to
maintain a healthy lifestyle, must be considered a fundamental aspect of their
daily regimen5. The environment including both school and local
neighborhoods where children grow up are an important stimulus of physical
activity. Sporting facilities, playgrounds and bike tracks are all encouraging
features that influence the length of time a day that a child is physically
active. The “Healthy Together Victoria” campaign run by St Pauls Primary in Mildura
is a state government funded program that, according to World Health Organisation worker Timthoy
Armstrong, is recognized worldwide with New Zealand,
the United Kingdom and Canada
all participating in similar exercises. The program in Victoria focuses on the health of its
students by walking laps every morning and encouraging children to attend the
healthy breakfast following, three times a week 13.
Another campaign
that is run in Australia to educate and encourage individuals to regularly
exercise is the “Find 30” initiative. Initially developed in 2008, the “find 30
every day” campaign encourages Australian candidates to participate in at least
thirty minutes of moderate-intense physical activity as a bench mark for
maintaining a healthy lifestyle 38.
Although there
are many short- term preventative methods in place to combat childhood, there
are some individuals who return to their initial base weight and therefore
might turn to surgical measures to achieve a more lasting effect 8. Bariatric
surgery is an effective procedure used to restrict the patient’s
food intake and decrease absorption of food in the stomach and
intestines 36. Procedures of this type are said to be
able to reduce excess body weight of obese or overweight individuals by 50-75%,
ultimately maintaining this weight loss for 16 years following 8.
5. AUSTRALIAN SUCCESSFUL
INTERVENTIONS:
Australian interventions addressing childhood obesity are primarily of a targeted kind, focusing on providing
information, increasing education and influencing physical activity37,38. Few interventions list reducing or preventing obesity in children among their stated objectives, although many seek to influence physical activity
or dietary awareness or both. Given that some of these have measured body composition (such as BMI or waist circumference), they provide
some insights into how
well they work in terms of reducing or preventing obesity.
In general, the interventions
studied have had mixed success in improving
body composition. But in some cases they were successful in promoting
other desirable outcomes, such as increasing the level of physical
activity. The results from some other
interventions were less positive.
Further, long-term follow up
to assess the sustainability of outcomes has not been undertaken for many Australian interventions.
5.1 Be Active Eat Well:
Be Active Eat Well was one of the
first community-based interventions in Australia with an evaluation. Key strategies of the intervention included changing canteen menus,
introducing daily fruit, reducing television
watching and increasing
activities after school. Be Active Eat Well delivered positive
(short-term) results for most of the body composition measures
(for example, waist circumference), though not Body Mass Index (BMI). Long-term results are yet to be reported.
5.2 Switch–Play:
Switch–Play focused on physical
activity through two components — behaviour modification (delivered
in classrooms) and/or fundamental movement
skills (delivered in physical
activity facilities).
Switch–Play had a significant effect on BMI for the children participating in a combined behavioral modification and fundamental movement
skills program, directly
after the intervention and at the 6- and 12-month follow-ups. This group was also less likely to be overweight
or obese between baseline and post intervention and at the 12-month follow-up. No significant change was reported in BMI for the other
two intervention groups (one undertaking only behaviour modification and the other undertaking only fundamental movement
skills).
5.3 Engaging Adolescent Girls in School
Sport:
Engaging Adolescent Girls in School
Sport aimed to increase physical
activity by increasing enjoyment
of physical activity,
perceived competence and physical self-perception. The intervention (which
did not measure body composition) succeeded in increasing the target group’s
enjoyment of physical
activity and body image,
yet levels of physical activity reportedly declined.
6. EXPERT OPINION IN CHILD
OBESITY:
The results of the global
study into obesity rates, published in the medical journal The Lancet, show
almost a quarter of the country's children and 63 per cent of the adult
population is overweight. Australia's obesity levels are now on par with the
United States, but slightly less than New Zealand.
The study has prompted health
experts to call on the Federal Government of Australia to commit to a national
anti-obesity strategy 35. (Childhood obesity exaggerated: expert).
Childhood obesity rates in Australia, as well as in New Zealand, the US, China
and many European counties, have barely budged in the past decade.
Many experts
attribute much of the alarm surrounding the issue today to a sharp rise in
childhood obesity in the 1980s and '90s, which was forecast to continue but had
not materialised. In Australia, for example, just one
per cent of boys and 0.8 per cent of girls were obese in 1985 and this
increased to 5.4 per cent and 5.7 per cent respectively in 1996.More than a
decade later, in 2008, obesity in Australian children was found to be 5.3 per
cent for boys - a slight decrease - and 5.9 per cent for girls.
Expert explained
"Because childhood obesity increased in the 1980s doesn't mean that it
will continue, and in fact it hasn't, noting the childhood obesity rate
appeared to have "levelled off" and a new
balance had been reached 38. An obese person is generally considered
to have a body mass index (BMI) calculation of 30 or above. Taking in those
children near but not at this level, Australia's rate of overweight and obesity
roughly doubled from 1985 to 1996 (from about 11 per cent to 23 per cent) but
there was almost no movement to 2008 (24 per cent) (Fig 2).
Fig: 2 Rate of obesity between 1985 and 2008
While the evidence
pointed to a plateau, it should be noted the data was not as clear cut as it
seemed. Children went through periods of rapid growth, and those with more
advanced muscle development could be deemed to be overweight. This
often-included children from a Pacific Islander or Maori background and for
many kids "overweight" was not the same as "unfitness".
"Our children have got taller for generations. The multi cultural society
in Australia is going to produce lots of children that are different and
diverse. Dr O’Dea et al pointed in their research in 2000 that, in a nationwide
study of nearly 5000 children and teens, found nine per cent of lower
socioeconomic status children were obese compared to only five per cent of
children from middle or higher income families. The expert added "It's
really an issue of social class. "And that's where we need to be very
careful to approach it as a social justice issue for these low income
communities, and disadvantaged communities, where we see the most childhood
obesity." Serving healthy breakfasts in schools - known to stabilise and improve a child's eating pattern throughout
the day - was one key way to address the problem.
The expert team
called for more of a focus on "assisting physical activity in safe
neighborhoods, in school programs, in after school programs, in non-competitive
physical activity where children can be encouraged to play".
7. CONCLUSION:
Obesity is a chronic disorder that has multiple
causes. Obesity in childhood has significant impact on both physical and
psychological health. In addition, psychological disorders such as depression
occur with increased frequency in obese children. Overweight children are more
likely to have cardiovascular and digestive diseases in adulthood as compared
with those who are lean. It is believed that both over-consumption of calories
and reduced physical activity are mainly involved in childhood obesity. A
number of potential effective plans can be implemented to target built
environment, physical activity, and diet. These strategies can be initiated at
home and in preschool institutions, schools or after-school care services as
natural setting for influencing the diet and physical activity and at home and
work for adults. Both groups can benefit from an appropriate built environment.
However, further research needs to examine the most effective strategies of
intervention, prevention, and treatment of obesity. These strategies should be
culture specific, ethnical, and consider the socio-economical aspects of the
targeting population.
8. REFERENCES:
1.
Livingstone MB.
Childhood obesity in Europe: a growing concern. Public Health Nutr. 2001, 4:109-116.
2. James PT: Obesity:
The worldwide epidemic. Clinics in Dermatology. 2004, 22:276-280.
3.
"WHO |
Obesity and overweight". www.who.int. Retrieved 2017-03-01.
4.
"Childhood overweight and
obesity". Australian Institute of Health and Welfare. 2014.
5.
Health at a glance 2013. Organization for Economic Co-operation and
Development (OECD). 2013. p. 48.
6.
"Obesity
Prevention | Healthy Schools | CDC".
www.cdc.gov. Retrieved 2017-03-03.
7.
"WHO
| Childhood overweight and obesity".
www.who.int. Retrieved 2017-04-03.
8. "No
Time to Weight". www.obesityaustralia.org. Retrieved 2017-02-01.
9.
Old TS. Tomkinson GR. Ferrar
KE. Maher CA. Trends in the prevalence of childhood overweight and obesity in
Australia between 1985 and 2008. International journal of obesity. 2010.
34(1):57-66.
10.
"Obesity
in children - causes - Better Health Channel". Retrieved 2017-01-01.
11.
"Background
Briefing 7 December 2014". Radio
National. Retrieved 2017-02-09.
12.
"Department
of Health and Human Services Centres for Disease
Control and Prevention" (PDF). Body
Mass Index: Considerations for Practitioners.
13.
"Life
at 3 - The Science - Childhood Obesity - ABC TV". www.abc.net.au. Retrieved 2017-02-01.
14.
"Parental
influence on children's food preferences and energy intake (EUFIC)". www.eufic.org. Retrieved 2017-02-01.
15.
"Department
of Health | 2007 Australian National Children's Nutrition and Physical Activity
Survey - Key Findings".
www.health.gov.au. Retrieved 2015-09-03.
16.
"Australian
Dietary Guidelines" (PDF). Eat for
Health. Australian Government. 2013.
17. "Food advertising directed at
children | Nutrition Australia".
www.nutritionaustralia.org.
Retrieved 2017-02-01.
18.
Morgan Spurlock- "Super Size Me"
Documentary (2004)
19. O'Connor J, Youde
LS, Allen JR,
Hanson RM, Baur LA. Obesity and under-nutrition in a
tertiary paediatric hospital. See comment in PubMed Commons belowJ Paediatr Child Health. 2004;40 (5-6):295-8.
20. Silventoinen K, Rokholm
B, Kaprio J, Sørensen TIA;
The genetic and environmental influences on childhood obesity: a
systematic review of twin and adoption studies. International Journal of
Obesity 2010:34, 29–40;
21. Crawford D. and Ball K. Behavioural
determinants of the obesity epidemi.Asia Pacific
Journal of Clinical Nutrition. 2002.11(8), 718-721.
22. Philipson T. and Posner R. Is the
Obesity Epidemic a Public Health Problem? A Decade of Research on the Economics
of Obesity. NBER.2008. Working Paper No. 14010.
23. "Should
industry care for children?". Public Health advocacy and law in Australia.
2009.
24. Hesketh,
K. Waters, E. Green, J. Salmon, L. Williams, J. "Healthy eating, activity and
obesity prevention: a qualitative study of parent and child perceptions in
Australia". Health Promotion
International. 2005:20 (1).
25. David
R. Basset Jr.Pucher J.Buehler
R. et al.;"Walking, cycling and obesity rates in Europe, North America and
Australia". Journal of Physical Activity and Health. 2008:5,
795-814.
26. "Department of Health |
Physical Activity and Sedentary Behaviour". www.health.gov.au. Retrieved 2017-02-01.
27. Haslam
D and Wittert G. Fast Facts: Obesity. Health Press,
England: 2014.
28. "The Emotional Toll of
Obesity". HealthyChildren.org. Retrieved 2017-03-03.
29. "Eating Disorders and
Obesity". www.nedc.com.au. Retrieved 2017-01-01.
30. "Journal of Lancaster General
Health - Behavioral and Psychological Factors in Obesity". www.jlgh.org. Retrieved 2017-01-03.
31. "Childhood Obesity Dietitians
Association of Australia".
daa.asn.au. Retrieved 2017-02-05.
32. "Nonalcoholic fatty liver
disease-Mayo Clinic".
www.mayoclinic.org. Retrieved 2017-01-04.
33. "Go for
2 and 5" (PDF). 2 fruit 5
veg. Government of Western Australia. 2004.
34.
"Find
Thirty |The campaign".
www.findthirty.tas.gov.au.
Retrieved 2017-01-01.
35. Local Government Action to Prevent
Childhood Obesity. Washington, DC, USA: National Academies Press. 2009.
36. "What is
Bariatric Surgery?". www.news
medical.net/health/What-is-Bariatric-Surgery.aspx. Retrieved 2017-04-012.
37. Childhood
obesity exaggerated.www.smh.com.au/lifestyle/diet-and-fitness/childhood-obesity-exaggerated-expert-20101108-17l58.Retrieved
2017-04-02.
38.
O’ Dea A and Eriksen M. Childhood
Obesity Prevention. International Research, Controversies and Interventions.
England. Oxford University Press, 2010.
Received on 29.06.2017 Modified on 31.07.2017
Accepted
on 21.08.2017 © RJPT All right reserved
Research J. Pharm. and Tech. 2017; 10(8): 2727-2734.
DOI: 10.5958/0974-360X.2017.00500.5