Childhood Obesity: A Multifaceted Disease,a Multifaceted Approach

Unfortunately, it is no longer alarming news that the obesity epidemic continues to worsen and that the prevalence of overweight and obese children and adolescents is following the same trend. In 2010, the World Health Organization (WHO) estimated that 43 million children under the age of 5 years were overweight or obese. ¹ While obesity has typically been considered a disease of western societies, it is perhaps surprising then that the absolute number of overweight and obese children in developing countries is four times greater than in developed countries. There are an estimated 8 million children in developed countries that are considered overweight or obese, while in developing countries, the number is estimated to be 35 million. ¹

This issue of Bariatric Nursing and Surgical Patient Care is dedicated to the increasing problem of childhood and adolescent obesity. While the fundamental cause of overweight and obesity may appear to some as no more than an imbalance between calories consumed and calories burned, the root cause of why this imbalance is so widespread is really the question. According to public health experts, globalization, urbanization, and other societal issues are largely to blame. ²

Globalization is a term used to describe the spread and interrelatedness of the world's technology, culture, and economy. While globalization is considered a positive evolution of society because it has reduced infectious disease, poverty, and hunger, there have been some unintended consequences associated with it, including an increase in overweight and obesity. Simplistically, globalization has resulted in the increased availability of food throughout the world, which has led to lower food prices and has created a situation in which people are able to buy more food and therefore consume more food. The efficiency of importation and exportation has also resulted in increased access to lower quality, processed foods. Urbanization refers to a shift in the communities and settings where people live, specifically a shift from rural areas to city environments. The conveniences associated with living in developed cities can lead to less active, more sedentary lifestyles, as well as unhealthier eating habits that result from the availability of convenience foods and/or the lack of adequate grocery stores. As you can see, the cause of obesity is much more complex than the simple mathematical equation of calories consumed and calories burned.

These complex issues require several disciplines to be involved and engaged, including healthcare providers, public health officials, sociologists, and policy-makers to name a few. Policy development, multidisciplinary programs of research, efficient integration of evidence into practice, and perhaps even more specialized training are needed. The WHO challenges public health officials to move beyond studying small populations in developed countries and challenges researchers and leaders to collaborate and coordinate efforts to apply what is known in specific population groups to other groups. ¹

Although the title of our organization is the National Association of Bariatric Nurses (NABN), President Sharon Sarvey, PhD, RN, highlights in her quarterly update that we are increasingly becoming an organization with international interest and participation. While NABN members might not have the experience or the resources to answer the WHO's challenge directly, members should continue to study and evaluate populations in ways that can contribute to policy development, multidisciplinary models of research and care, and integration of evidence into practice. As NABN becomes more global, opportunities for collaboration with international colleagues will arise, and we should be prepared to take full advantage. We should continue to question clinical practice and models of care delivery, as well as to develop and evaluate various programs.

There are many opportunities for the development and implementation of both treatment and prevention programs in all settings. In his guest editorial, Dr. Jay A. Perman makes an excellent case for a multidisciplinary approach to addressing and preventing childhood obesity. The concept of the multidisciplinary team is paramount in Dr. Perman's work, and he describes a novel program that includes multiple disciplines caring for children in the outpatient setting. Also in this issue, Ms. Anne Dearth Williams, Ms. Elsie Stines, and their colleagues describe innovative community programs that involve teachers and community outreach providers, as well as graduate school faculty, students, and staff. Both of these programs were implemented in urban settings and sought to address some of the challenges faced by children living in urban communities. Finally, Ms. Christina DiNapoli and colleagues describe survey results that identify deficiencies in the self-reported abilities of pediatric nurses to provide adequate education and information to patients and families about obesity. If society expects the healthcare community to effectively intervene and educate pediatric patients and families about overweight and obesity at every encounter, it is likely that educators in all of the social sciences will need to change how students are educated in order to provide the next generation of both healthcare providers and social scientists with the appropriate skills to address the obesity epidemic.

Globalization and urbanization will continue to impact human choices and behaviors; therefore, it is important that these complex social factors are appreciated and factored into clinical programs and programs of research. It is our hope that this issue of Bariatric Nursing and Surgical Patient Care will enlighten and inspire you to think about childhood obesity from the multiple vantage points from which it presents itself. Whether you work in an acute care setting, a community, a school system, or the international arena, your contributions will impact the health of future generations.