This chapter will describe the background of the study, the problem statement and the sup problems. It will give the purpose of the study to determine if there is a relationship or not, the limitations and the thesis setup of this study. This research will focus on what the result would be if eating behavior is the cause of and what the consequences would be for the children. Also of home environment and stress can be consequences. The enormous amount of research that has been done shows that eating behavior is one of the causes of obesity. Other variables like stress and home environment are also causes of obesity.
This study is a starting point for monitoring obesity in young people, where trends in obesity are made clear. Bonaire is unique due to the fact that Kentucky Fried Chicken and Watta Burger restaurant are the only 2 fast food restaurants. Education, intervention and prevention are the best methods for the reduction of health problems caused by poor nutrition and solve the overweight and obesity problem. Healthy physical activity and balanced nutrition will contribute to the lifestyle of young children.
Worldwide the prevalence of overweight among children increased dramatically. In the last years, the prevalence of overweight and obesity has risen drastically, especially among children. Moreover overweight children are getting fatter. Overweight is expected to be a more growing, serious and costly health problem. The goal of this study is to observe the prevalence of overweight and obesity among children of 12-20 year old who are visiting the after school program of Jong Bonaire, MBO, HAVO, VWO, neighborhood Rincon and Tera Cora. The result of this will give an understanding in the relationship between the variables home environment, eating behavior, perceived stress, physical activity and the health of the students that causes obesity.
In a health study done on Bonaire in 2002 was the prevalence of overweight and obesity very high among the children of 7 till 16 years old. The population of this study was all the children from Bonaire between 4 and 16 years old. Eight years later in 2010, the Government of the Netherlands Antilles did a study to find out if obesity had increased. They concluded that obesity did increase especially among children.
In addition to dietary factors that cause overweight there are other factors that must be taken into account and examined. Better understanding of what the different factors is those that contribute to obesity in order to develop a strategy to combat this problem. Most of the children, who are obese, are from families with a low social economic status. The Government has to take the responsibility to make a plan to prevent and combat obesity.
1.2 Background of the study
Overweight is a growing health problem on Bonaire, due to the high prevalence among children and adolescents who run this risk. Poor nutrition has been linked with outcomes such as retarded development and life-threatening illnesses, including health diseases and cancer (World Health Organization, 2003). Ever since the World Health Assembly endorsed “Healthy for All by the Year 2000” in 1977, more and more countries have become aware of the need for reliable information to sustain health policy. Good health is an important prerequisite to a good quality of life. Good or bad health originates from biological factors, factors in the environment, health care provision, and lifestyle (Grievink et al., 2002, p. 11). Childhood obesity is a crisis facing the United States of America (USA) youth, and action to control must be taken now according to Hill and Trowbridge (2006). (Rappange, Brouwer, Hoogenveen & Baal, 2009) pointed out that Obesity is a major contributor to the overall burden of disease and associated with high medical costs due to obesity-related diseases. An unhealthy lifestyle is associated with the incidence of several prevalent chronic conditions. Obesity is assessed by means of height, weight, hip and waist measurements. Overweight by children is a growing problem in the world, also on Bonaire.
Obesity is one of the most serious health problems facing the youth of the United States of America (USA), and evidence suggests that the problem is worsening rapidly. The increase in the prevalence of childhood obesity, outlined by Troiano and Flegal, parallels the large increase in the prevalence of adult obesity that has occurred over the past 2 decades. Because of the close association of obesity with many chronic diseases, this condition presents an enormous challenge to our health care system Li and Hooker (2009). This has been proved by studies conducted by Hill and Trowbridge (2006) that showed, the percentage of obese adolescents aged 12-19 in the USA has more than tripled, going from 5% to 17.6% during a small period of time. Similar trends have been seen in other countries. Obesity can lead to many other complications, including hypercholesterolemia and hypertension, and this can lead to serious health consequences. Cardio Vascular Disease (CVD) and diabetes are two chronic diseases which are rapidly increasing globally. In recent years, childhood obesity has become a worldwide issue with increasing poor dietary habits together with inactivity being associated with rising levels of obesity in children concluded by (Rees, Thomas, Brophy, Knox & Williams, 2009).
The health study done in 2002 on Bonaire indicated that causes of mortality, prevalence of diseases, risk factors, lifestyles and attitudes are essential to be able to: Predict trends in the population’s health status, develop health promotion and prevention policies, Substantiate the planning of medical facilities and care providers and anticipate on the development of costs in health care Grievink et al. (2002). The international prevalence of childhood obesity and obesity-related diseases has received increasing attention explained by Li and Hooker (2009). Health related quality of life in obese children has been shown to be similar to that in those diagnosed as having cancer in a clinical sample. Childhood obesity has a high prevalence in many countries. This indicates that we need to take action to diminish a major factor reducing the health of children today (Cole, Faith, Pietrobelli & Hoe, 2005).
Risk factors for disease that definitely have to be attended to in a population are eating habits, home environment, perceived stress and overweight. Even from the crude measures of dietary intake used in this study some distinct nutritional shortcomings are apparent. Health promotion campaigns, aimed at changes in knowledge, attitudes, and risk behaviors are needed, and these messages need to be reinforced by health care professionals in daily clinical practices. However, before promoting healthy eating habits it is important to figure out why so few people eat vegetables and fruit on a regular basis. Is it the high price, or other causes?
In that case dietary recommendations could be tailored to the less well-to-do by promoting a balanced intake of affordable, locally produced foods, if available explained by Croft et al. (1992). A healthy diet is fundamental to good health and wellbeing. Good nutrition benefits health throughout the lifespan. Despite the numerous benefits of a healthy diet, unhealthy habits are common, and trends such as rising obesity indicate that its incidence is increasing World Health Organization (2003). Efforts to both manage and prevent childhood obesity must involve education, research, and intervention. Hill and Trowbridge (2006) pointed out that educational efforts should be directed toward policy makers, health care professionals, community leaders, and parents.
Obesity prevention will increase long-term care expenditures substantially, while savings in the other healthcare segments are small or non-existent. Successful preventive strategies may reduce obesity-related morbidity but also increase longevity and the prevalence of unrelated diseases explained by Rappange et al. (2009). In the prevention of eating disorders and child obesity with a specific examination of whether teachers and school professionals are currently adequately trained and prepared to undertake a preventive role.
At the individual level, overweight is a difficult condition to treat or prevent; weight loss efforts are often unsuccessful or may even be harmful if they disrupt the balanced intake of nutrients. Dietician supervision and physician attention may help to increase the likelihood of weight loss. Primary care physicians can play an important role in the identification and clinical management of overweight. Moreover, given the resiliency of overweight to treatment, pediatricians and GPs should emphasize preventive efforts beginning in childhood and continuing into adolescence and adulthood. Due to the food and physical activity offered at secondary schools, improvements can be made that can contribute to the reduction of overweight among youth. This was shown in the first national survey on the prevention of overweight at Dutch secondary schools. (Lombard, Deeks, Jolley & Teede, 2009).
Obesity, childhood obesity and the prevention of obesity were not defined topics, with learning outcomes and students had reported, anecdotally, concerns about this omission postulated by (Fhea, Furmedge, Appleton, Toop & Coats, 2009). Weight control programs for obese children monitor change in body mass index (BMI) adjusted for age Cole et al. (2005). Changes in lifestyle may change future healthcare costs projections, not only at a total cost level, but also for the different segments of the healthcare sector concluded by Rappange et al. (2009). In dealing with childhood obesity we face a crisis that demands immediate action in the form of coordinated efforts on the part of policy makers, health professionals, community leaders, and parents suggested by Hill and Trowbridge (2006). Economic costs to obesity are high and are expected to continue to rise (Li & Hooker, 2009). To assess that factor that influences the willingness of young people to intervene, to dissuade peers from risky behaviors pointed out by Grievink et al. (2002).
(Eyles, Wilson, Mu, Keller-Olaman & Elliott, 2009) wrote that air pollution and proximity to industry were frequently implicated in neighborhood environments. In particular, perceptions of the environment-health link at different scales vary between residents of two socially and environmentally contrasting neighborhoods. Each scale may represent a different level at which individuals experience links between environment and health and take action to minimize environment-health risks. According to (Timperio, Salmon, Telford & Crawford, 2005) availability of healthy food in the environment outside the home may be important. Children are eating regularly outside the home. Improving the quality of the food served outside resulting in decreased fat intake. According to (Tamayo, Christian & Rathmann, 2010) Psychological factors and socioeconomic status (SES) have a notable impact on health disparities, including type 2 diabetes risks. In adults, adverse psychosocial factors such as low socioeconomic status, deprivation and traumata have been shown to be associated with, obesity, cardiovascular disease and unhealthy lifestyle habits. Adverse social conditions in childhood are independently associated with an increased risk of metabolic impairments and insulin resistance. Risk factors of childhood psychosocial factors according to Tamayo et al. (2010) are public housing, housing condition, unemployment, household dysfunction, child abuse, depression, anxiety and parental stress.
(Maas, Verheij, Spreeuwenberg & Groenewegen, 2008) stated that physical activity, like walking and cycling during leisure time also sports and gardening is an underlying mechanism in the relationship between the amount of green space in people’s direct living environment and self-perceived health. More natural living environment positively influences people’s self-perceived health and leads to lower mortality risks. If the amount of green space in the living environment stimulates people to be physically active, green space could have consequences for the physical activity of the population. Relation between green in the living environment and physical activity focuses on walking and cycling activity. In the Netherland the availability of local green space has little or no influence on how often people walk or cycle.
1.3 Research question and Sub problems
Question to be answered by this research:
To what extent is there a relationship between child eating behavior and child overweight and health?
Sub question derived from the problem statement.
1 What is the relationship between physical activity and obesity?
2 What is the relationship between eating habits and obesity?
3 What is the relationship between obesity and stress?
4 How can home environment affect the health of the students?
The sub-question in general is related with the problem of obesity, the eating habits of the children, if stress is a consequence of obesity and the home environment. The sub question of preventing the obesity crisis is related to the physical activity.
1.4 Purpose of the study
The purpose of this study is to determine if there is a relationship in the eating behavior of the students between 12 and 20 years with their health that causes obesity. The focus will be on the home environment, perceived stress, eating awareness, physical activity and overweight of the children. This research among a group of the students offers effective information about health and eating behavior of the students. An advantage of this research is that, by making use of internationally validated instruments, the research allows for regional comparisons. Determinant of health are those variables that are directly related to health status, either as causal or risk factors for disease, or as chance factors that contribute to good health. Factors of lifestyle aspects are, eating habits, exercise, use of alcohol and tobacco, aspects of the home environment, economic, situation, attitude and living conditions.
The study was done at Jong Bonaire located in Bonaire, Jong Bonaire has an after school program for the students of the Scholengemeenschap Bonaire (SGB), MBO, HAVO, VWO, neighborhood Rincon and tera cora. The first selection was the students of a secondary school of Bonaire, the Scholengemeenschap Bonaire. They didn’t cooperate with this study, Jong Bonaire was chosen. The target group was the students of a secondary education in the age category of 12 to 20 years. Variables that will be measure are gender, age, nationality, education level, Religion, obesity, home environment, perceived stress, eating awareness, physical activity. In consideration has to be taken the fact that not all the youth between the age categories of 12 to 20 years old visit the afterschool program of Jong Bonaire, MBO, HAVO, VWO, neighborhood Rincon and Tera Cora.
1.6 Set up of the study
As follow: chapter 2 describes obesity and the consequences of obesity. The purpose of this study is the literature reviews of secondary data to get information about childhood obesity, home environment, perceived stress, eating awareness and physical activity to explain the problem and the prevention of obesity. Chapter 3 describes the methodology used for the primary information with questionnaires to evaluate the results and opinions. Also the validity and representativeness of the sample will be addressed.
In chapter 4 the result from the study will be analyzed and compared with the aid of graphs and tables. Chapter 5 will give the conclusions and recommendations of on analysis made in the study. Further research in the area of overweight, obesity and health were proposed. All the chapters begin with an introduction and end with a conclusion