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Childhood obesity refers to a condition where surplus body fat becomes a problem to a kid affecting his or her wellbeing (Yahia, et al, 2008). Normally obesity (in adult) is assessed using the BMI (Body Mass Index) calculated as (weight/height2) standards which are internationally accepted (Yahia, et al, 2008). However when we come to obesity in child the assessment become a bit ambiguous, this is due to the multiplicity of factors, such as puberty and growth, that inform fat accumulation in children (adolescents included) which makes delineating a global standard for assessing this kind of obesity among child almost impossible (Yahia, et al, 2008).
The particular cause of obesity has eluded researchers and medical practitioners alike, this is because it is multi-factorial, and highly influenced by several factors some of which are modifiable while an equally huge chunk is not. However, the main causes of childhood obesity include socioeconomic status, dietary composition and pattern, and sedentary life (Beach, 2010). Obesity has for a long time been considered a predisposing factor whose effect normally takes a toll at an individual's health. Yet, the significance of obesity among children has only come to be highlighted quite recently globally. The Middle East region is particularly hard hit by this scourge. In fact this region tops the list of the regions with the highest dietary energy surplus in the developing countries category (Beach, 2010).
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The purpose of this research is to estimate the prevalence of obesity in Lebanon and Jordan and establish its relationship with the prevalence of the phenomenon of working mother in the two societies especially in the context of the current hard economic times which is forcing mothers to work in order to sustain their families (Beach, 2010). Specifically this research will;
- Seek to estimate the prevalence of childhood obesity among school going children between the ages of 6 to 12 years in a place in the Governorate of Irbid, north Jordan.
- Investigate the relationship between childhood obesity and the working status of the mothers.
Background and Justification
Obesity in the Middle East has become a health issue that is notable and an analysis conducted by the World Health Organization in the year 2005 clearly shows this. The changes in the lifestyle that are connected to a number of factors have contributed to this. The effect of Urbanization has been realized in the lives of the people as a result of technological advancements as well as other factors dealing with other behaviors that people have adopted. Increased caloric as well as fat intake in a region in which the exercise does not form part of the culture, has also led to increased cases of this particular condition.
Obesity may be refereed as the condition of having a high accumulation of fat in the body and this can be determined with taking measurements of the Body Mass Index commonly known as the BMI. The BMI is obtained by dividing the weight of an individual with the square of their height. The higher the BMI value the greater the risks of a getting of obtaining a chronic disease such as cancer, cardiovascular disease and others due to obesity (Kiess et al, 2008).
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According to the MONICA Project that was executed by the World Health Organization, 30% of the Arab World population is obese or overweight. This included the children, adolescents as well as adults. One of the major causes was predicted to be the effect of the western lifestyle. The major reasons include; the intake of with food that has undesirable composition though dense, rise in consumption of animal fats as well as sugars, decreased fiber consumption, and lack of physical exercises among others. One of the areas that were affected by this problem includes Jordan and Lebanon. This paper seeks to establish the reason why the cases regarding the children in these two major reasons were prevalent (Khader et al, 2008).
One of the things that the study noted in regard to this case is that most of the obesity cases involved children whose mothers were working. This is due to a number of reasons, most of the women in the region started working and as a result they do not find enough time to spend with their children and as a result the necessary measures that needs to be taken to ensure that the children follow the dietary precautions are not satisfied. This means that most working mothers left their children to be cared for by other people in order to get time to attend to their working duties As a result those left to look after the children end up feeding them poorly. These poor diet choices then lead to poor feeding patterns that affect the diet recipient negatively .This in turn becomes a major leading cause to such complications such as obesity (Kiess et al, 2008).
It is common sense to argue that all mothers would wish their sons and daughters to lead a good life and a healthy one. Therefore they would not hesitate to do anything that would ensure that their children are kept safely from any kind of a disease or disorder. As mentioned
Though it may appear that the main concern with someone suffering from obesity is the outside appearance but on the contrary the main problem is actually on the health status of the individual. This is the reason why the mothers of the children in the region should get concerned with the status of these young ones who have become susceptible to obesity (Kiess et al, 2008).
As exemplified by Jotangia (2005), Child obesity has been addressed by many writers in different regions across the globe. For example in America, Obesity during Childhood has already been identified as an epidemic. This is because the cases of heart attack, high blood sugar, diabetes type II and other diseases that are related to obesity have become a common occurrence in the region due to increased cases of the condition.
One of the things that have been blamed on causing obesity is technological developments. The media is said to promote different forms of obesity and its not yet clear to scientists whether it is food advertising, sedentary television viewing nature or other forms related to the media that actually promote obesity. According to some of these writers, it has been discovered that obesity cases are more prevalent in children who watch a lot of Television as opposed who rarely do it. This is the reason why it is argued that the sedentary kinds of entertainment that most of the children are enjoying today are a source of their own death (Khader et al, 2008).
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In addition to the normal meal portions which most of them enjoy, snacking among the children has increased a lot. Based on the fact that food is sold anywhere, the children are presented with the opportunity of eating anywhere and at anytime. It has been established almost a quarter of the consumed calories by the children are sourced from the snacks. As opposed to what is supposed to be the typical snacks like a fruit or milk, the children have developed a tendency to feed on other junks such as snacks, and chips (Kiess et al, 2008).
As noted earlier obesity in the USA has been blamed on fast food culture and lack of physical activities the same factors that affect the American society can be today found in most countries in the world. This has largely been influenced also by the technological advancement especially in the last century .these technological advancements have affected the physical tasks that used to be there by making things easier. However this comes at a price and the easier work becomes the more physical activities are drastically reduced. In children case technological advancement have also eliminated physical activities that the children required to perform when playing their children games .These physically demanding games have been in the modern world replaced by videos games and computers .Indeed the sad part is that as mothers get employment in Jordan their disposable incomes increases. This means that families where mother are working in Jordan have additional incomes to spend. These additional incomes are directed to buying luxurious goods and gifts for their children. Most of the gifts however are technical toys that require little or no physical activities. Additional as the family lifestyles physical activity as further removed in their lives since such luxurious commodities as cars become affordable. The irony is that cars and other motorized Vehicles that are meant to make life convenient and easy rob of these families' physical demanding activities such as walk that would ordinarily accord the children the much needed exercises inform of taking walks.
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As noted by Ajlouni et al (1998) the six to twelve age group when the kids are supposed to be most active is ironically the age group that obesity was found to be rampant in. Besides buying the technically advanced gadgets the increased disposable incomes have also meant that families can afford to eat expensive consumables .These consumables that are often referred to as "junk foods" are in most cases filled with fattening ingredients that are not easily metabolized and eventually end up in the children's bodies. High lifestyles also means that the families can in most case afford to dine out every other day. These dinners prepared at expensive returning are often made sweetened by adding additives that can only add to the body fat contents. The chefs pay more attention to the taste in order to retain their customers than the health repercussions that one derives from consuming their tasty foods. It is therefore unfortunate that rather than only improving lifestyles the additional incomes also are in most cases also responsible for health concerns such as obesity. Fast food restaurants have increased significantly which is a contributing factor to the increased cases of obesity (Khader et al, 2008).
In the past, chubby children used to be considered as pretty based on the argument that as they grew up, the fatness would melt away leaving a healthy adult. However, this has come to be identified as childhood obesity and it has been proved to be harmful to the lives of these children. It causes both psychological and health problems to these children if it is not avoided early enough (Kiess et al, 2008).
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As noted by Ajlouni et al (1998), According to the National Center for Health Statistics, obesity among children of between five years to twelve years has increased by more than 16% over the last one decade or so. This is figure causes some concern and this should be addressed before it gets way out of hand. Most of these cases have been blamed to the lack of physical exercise among other reason other reasons. Though it may seem to be not justifiable enough, the parents have a part to be blamed on this problem based on the fact that most of the children have been left to feed on their own. The responsibility of choosing what to feed and when to feed has been totally left to the children to decide and as a result this gets out of hand and most cannot be able to control this.
Physical education is no longer emphasized in schools and the parents too don't take sometime to teach their children on this. The parents assume that the children would be disciplined once they get home on doing some physical exercises as well as controlling their feeding habits. On the contrary these children spend a lot of time in front of the TV or other games such as computer games that do not keep the body active (Khader et al, 2008).
As a matter of fact, it emerges clearly, the fact that one of the most formidable causes of obesity among the Lebanese and Jordanian children is the political and militant nature of the Middle East area. In the constant existence of the Israeli-Palestinian war, other countries such as Jordan and Lebanon have joined in the fray, leading to an all out war in the Middle East. It is not uncommon to have in these wars, the imposition of curfew so that people remain indoors. While indoors, there exist no recourse to inactivity and the watching of TV. At the same time, it is a fact that the adoption of sedentary lifestyle is directly proportional and concomitant with the failure to burn calories in the body and resultantly, higher amounts of calories in the body.
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It is also interesting to note that in these areas of Lebanon and Jordan, the presence of Islamic fundamentalism and religious extremism cannot only be discounted, but the same is formidable to an extent that matters that tend to liberal democracy are totally opposed. Among these fundamentalist circles, anything tending towards the liberalization of the media is illegitimate, as the same is perceived as a manifestation of a token of the US and the West.
The liberalization of the media (the provision that the government desists from controlling the media so that in stead, it is the media moguls and owners of media empires who control the dynamics of the material aired through mass media) when absent, gives very little room for balancing of contents being aired- with majority of content being overtly and unproportionately biased towards religion and politics. Matters pertaining to lifestyle, occupation and free expression of ideas are totally proscribed, so that it is relatively difficult to cover contents that are pertinent to health and healthy eating. The same case applies to exercises as the same are considered as matters too peripheral to be given media attention or as vestiges of the morally bankrupt America and the West. This state of affairs has been only vital in the undermining of consciousness about health and healthy living and diet by members of the public.
To Ibrahim and Ali (2010), another way in which the failure to adopt liberalism in these areas have either directly or indirectly contributed to obesity, is in the strict adherence to religiously prescribed mode of dressing. The emphasis on loosely fitting clothes which cover the wearer from head to toe is said by Ibrahim and Ali (Ibid) to normally assuage the glares of being in the public while overweight, as these freely fitting clothes tone down the ability to easily detect obesity. Parents as grown ups who cannot see the outright shame or inconvenience of being too overweight or obese are not likely to priorities telling their children of the dangers of being overweight and obese.
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Study design, sample and population:
The objective of this research proposal has been to estimate the incidence of obesity and to determine its associated factors, prevalence of working mothers to be precise, among the children from both society of the age of 6-12 years. In this case we went ahead and conducted a cross-sectional study among school going children in the north of Jordan, Governorate of Irbid to be precise. We selected a total of 2,131 children (1,079 girls and 1,052 girls) at random from the respective schools, whereby we were guided by the multistage cluster sampling method in selecting a representative sample for this population (children). The questionnaires that we were using had two parts, the first part was to be filled by the children themselves in school while the second was filled by their parents back at home. In this research we measured weight, height, and circumferences of waist, hip, and mid upper arm. A total of 2,262 questionnaires were issued out of which 2,131 were filled successfully and returned. The appropriate sample size was determined using a 0.5 expected prevalence of obesity and a 0.1 margin of error. A 0.5 value of prevalence was employed to give the largest possible sample size.
The researchers in this particular study strived as much as possible to ensure that it complied with the prevailing ethical standard principles. In this regard they sought permission from the head of the educational directorates to interview children and even had the consent forms signed by the parents of these children who participated in the study (Khader, et al, 2008). Children were asked to fill the first part of the research in the class in the presence of the researchers, as for the second part they were requested to have it filled by their parents back home. The second part of the questionnaire essentially contained details about the parents' ages, height, weight, job, income, family size, living place, and educational level (Khader, et al, 2008). It also contained any other information that was considered relevant, a better example of such information being; time spent watching television, computer, and video games; average number of meals per day, average times that they drink fizzy drinks and eat junk food, and frequency to eating snacks (chocolate, chips, and biscuit). On the material date when they were supposed to bring back the questionnaire that were to be filled by their parents they were collected while those who had defaulted to bring them back were asked to come with them the next day.
Data was evaluated using the (SPSS) Statistical Package for Social Sciences. In this case we used mean, frequencies, percentages, standard deviations to describe data. We also used as much as possible both t-test and Chi-square test (Khader, et al, 2008). In determining the factors that are associated with obesity we conducted multivariate analysis using binary logistic regression. Obesity served as a dependent outcome variable in the logistic model. The forward likelihood ratio was used to estimate the independent variables. The last model comprised significant predictors only. For each and every variable in this equation, standard error of B, coefficient, confidence interval of exp (B), and estimated odds ratio (exp B) (Khader, et al, 2008). A less than 0.05 P-value was considered statistically considerable.
This study comprised a sample of 2,131 children, ranging from 6-12 years. The average age of boys and girls was 9.5 years and 9.9 years. Approximately sixty percent of the sample were dwellers of urban town, while the remaining forty percent were dwellers of the rural areas. 12.5 percent of these children were delivered through the caesarian section, while 60.5 percent were breastfed. 24.9 percent of these children had father, mother or both with university education. About half of the children were from families with an average month income of below 300 JDs.
Prevalence of the Obesity among these school children
Of the total number of children (2,131) in the study, 19.4 percent were overweight, while 5.6 percent were obese. As for the prevalence of obesity and overweight according to gender, there was no obvious trend. The highest prevalence of both obesity and overweight for boy was those boys aged 12 years (Khader, et al, 2008). The highest prevalence of obesity and overweight was 12 years and 11 years respectively for girls.
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Overweight and obesity was found to be directly related to income level of more than 300 JDs per month together with a pocket money of more than 0.20 JDs per day (Khader, et al, 2008). Obesity was also noted to be more prevalent in children from rich families than in poor background. There was a positive correlation between obesity and more than two hours per day of television watching. One of the reasons that were advanced to explain this obesity-television watching correlation was the fact that being sedentary for a long time had the potential of impairing energy balance regulation through uncoupling intake of food from energy expenditure.
Study time, taking fruits, sandwiches, sweet, vegetable, and juice to school; and the intake of fizzy drinks, chocolate, and junk food were found to have no major relationship with obesity or overweight among these children. This study differed with a previous one which found that a prevalence rate of obesity and overweight is higher from children of mothers who smoked while expectant. Another factor that was previously thought to be associated with obesity and overweight in children was parent education, however this was disputed by this study, a thing that was consistent with a study by Jabre et al (Khader, et al, 2008). Children with working mothers were found to have very high incidents of overweight and obesity. This has been explained by the idea that working mother are likely not to provide their children with home-cooked food and less healthy diets, which essentially means high incidents of obesity and overweight.
Challenges and Limitation
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The first shortcoming of this particular study was the possibility that Body Mass Index (BMI) has failed to differentiate between fat-free and fat, showing that the index had the potential of exaggerating obesity in those boys who are large and muscular (Khader, et al, 2008). Another potential limitation of this study was the self-reported data because of the way in majority of the case contain individual biases. Evidence might abound of self-reported weight and height corresponding with real or observed measures, however it is a common tendency for people to exaggerate their weight (underestimate) and height (overestimate). There are some studies that have shown that self-reported height and weight represent reliable data, with enough precision for epidemiological studies, and give a precise representation of the correct BMI in a number of populations. Therefore, if at all parent underestimated their BMI in this study, the findings are likely to be biased or leaning towards the null hypothesis.
In short obesity has reached a place where it cannot be ignored any longer. With the increased cases of some of these chronic diseases among the children, something needs to be done to correct the situation before it gets worse. The mothers should take their time to know the feeding habits of their children. Even though most of these mothers are working, they should dedicate some time to be with their children and find out their feeding habits as well as their physical and heath conditions. These mothers should also ensure that they instruct the ones left responsible for the kinds on the kind of food to give these kinds. In the daily program of the kinds, there should be incorporated time that is specifically allocated for physical exercises only and the parents should ensure that these children undertake those exercise. Some of the sedentary forms of entertainment that the children get addicted to should be controlled by the parents. The children also should be made aware of the potential dangers of obesity and what causes it so as to co-operate with the parents and the guardians in ensuring that it does not get to them.