Predisposing Factors Related to Childhood Obesity

Alissa Sipus, Karlina Milano, Kayla Rosetti, Micah Beal

Department of Nursing, Youngstown State University

Nursing Research 3749

Danielle Class

April 6, 2022
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Predisposing Factors Related to Childhood Obesity

Obesity has a high prevalence in the United States within all age groups. Childhood

obesity “is a critical health issue with one-third of all children and adolescents in the United

States being either overweight or obese.” (Williams et al., 2018) There are many causes related to

obesity in children some modifiable other nonmodifiable. This literature review focuses on how

the nonmodifiable factor, genetics is related to childhood obesity. Some modifiable factors

including socioeconomic status, sedentary lifestyle, and food insecurity.

PICO

The purpose of this literature review was to identify the predisposing factors on children

that can lead to obesity, specifically during their childhood. The following PICO question was

developed: “For children, what are the predisposing factors influencing childhood obesity?”

Search Strategy

After forming the PICO question, the search for articles began by using EBSCOhost and

Google Scholars. An advanced search on EBSCOhost was initiated using the terms child* or

adolescence, and affects or causes or “predisposing factors”, and obese or obesity or overweight,

and sedentary or nonactive and life* and “food insecurity”. The databases used included

Medline, CINAHL Plus with Full text, and Academic Search Complete, Pub Med. Initially the

search yielded 843 articles. The search was then limited to literature from 2017- 2022 and refined

to only show results of full text, peer reviewed articles and English language. After refining the

search, it yielded 359 articles. The articles titles and abstracts were looked over and then were

narrowed down to four of the articles used in this literature review. The other four articles were
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found using Google Scholar, a search was initiated using pervious terms along with genetic or

genes and “socioeconomic status”.

Literature Review

This literature review focuses on the factors related to obesity such as genetics,

socioeconomic status, sedentary lifestyle, and food insecurity. Each plays a significant role in

how obesity affects children and families in our society. Obesity is a major concern in our

society and this review focuses on how big of an impact each of these factors plays on an

individual. As each summary explains each factor, some play into each other. For example, food

insecurity and socioeconomic status go hand in hand if there is poor decision making or poor

financial situations. Genetic Factors

The growing concern for obesity has increased due to the increase in obesity in children.

These obese children and adolescents can run a risk of being obese in their futures. Various

factors play a role in obesity from childhood to adulthood. The role of genetic factors is

emphasized in a study written by Louis Perusse and Claude Bouchard (2017) called “Role of

Genetic Factors in Childhood Obesity and in Susceptibility to Dietary Variations.” This study

focuses on genetic factors related to Mendelian disorders and mutations of a single genes and is

studied on children from the ages of 2-17 years old.

About 30 Mendelian disorders are linked as a clinical feature of obesity and about one

third are autosomal dominant and X-linked (Perusse & Bouchard, 2017). One particular disorder,

The Prader-Willi syndrome, is the most common for obesity disorders. It is caused by a mutation

in the paternal segment of a gene which leads to obesity. From about 2015 to 2017, there have

been about 25 cases of obesity that have single-gene mutations. There are seven genes that had

mutations with at least two cases for each gene which totals the 25 cases. Perusse and Bouchard
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study has established that obesity does in fact run in family genetics. It is said to show that many

obese children have obese parents. About 30% of cases, both parents of obese children are obese

(Perusse & Bouchard, 2017). Fat distribution and adiposity have factors that show the status of

obesity in parents which is looked at as a good determinant for obesity in the children.

Among the Mendelian disorders and single gene mutations, there are more factors that

play in with genetics. Dietary changes with the role of genetics is one factor that plays a part in

obesity as well. According to this study, “There are differences in the response to various

lifestyle and environmental exposures and that genetic factors play an important role in

modulating responsiveness” (Perusse & Bouchard, 2017). Increases in gene mutations being

identified show evidence that many determine the susceptibility of many diseases and it is

obtained with diet. The main dietary factors that put people at risk are lipids and lipoproteins

(cholesterol).

Another article, Childhood Obesity (2018) by Ahmad, et al. explains that endocrine

diseases which can be genetic can lead to obesity. Examples include Cushing’s syndrome and

hypothyroidism. These are hormonal causes which can be shared by genetics to children. In this

same study, the researchers looked at the interaction between genetic factors and environmental

factors of children between the ages of 5-17. Different variants in various genes control appetite

and metabolism that can lead to obesity. This rare genetic condition, the Prader-Willi syndrome,

also mentioned above is characterized by hyperphagia which leads to weight gain (Ahmad &

Ahmad et al., 2010). “The percentage of obesity that can be attributed to genetic varies from 6%

to 85% depending on the population examined” (Ahmad et al., 2010).

Offspring of two obese parents are more likely to become obese in adulthood than

offspring of two patients with a healthy normal weight. (Ahmad et al., 2010) The treatment for
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obesity varies depending on the cause. There are three factors that people need to understand

about why obesity happens: genetic causes, overeating and not exercising. The changing trend of

childhood obesity is on the parents who are the ones to control diet and physical activities.

Weight loss in children is more successful than adults and has many health benefits. Both studies

show that genetics plays a major role in how obesity affects children throughout adulthood. The

mendelian disorders, the single-gene mutations and many other metabolic disorders cause

obesity in children and adolescents. Some of these factors can play into the other three factors

discussed in this literature review.

Socioeconomic Status Factor

Another factor that seems to have an association to childhood obesity is socioeconomic

status, whether that be high or low. Two articles were found that included studies that showed

how much socioeconomic plays a role in childhood obesity. Fredkin et al. (2015) examined the

association between socioeconomic status and obesity during early adolescence, ages 10-13

years during two time points in early adolescence. The sample of early adolescence included

4,824 African American, Hispanic, and white fifth graders. The participants were recruited from

public school districts in and around Birmingham, Alabama, school districts in Los Angeles

County, California and the biggest public school district in Houston, Texas. Weight status was

determined from measured body mass index using a standard of two categories: nonobese and

obese. Socioeconomic status was determined based upon the highest education level achieved in

the household. Data was collected in two waves, in a longitudinal community study. Wave one’s

data was collected from the participant in fifth grade and wave twos data two years later, when

participants were in seventh grade.

The result of the study showed there were differences in childhood obesity related to

socioeconomic status. Adolescents that were grouped in lower socioeconomic status were shown

to be two times more likely to be obese in both waves one and two. The Lower socioeconomic

group included parents with less than high school degree and parents that just graduated high

school. Compared to adolescents of higher socioeconomic status, which was defined as living in

a household with the highest education achieved which was greater than or equal to a four-year

college degree. There is a strong connection between socioeconomic status which was decided

by the education level achieve (Fredkin et al., 2015).

Williams et al. (2018) conducted a second study that related obesity in childhood to

socioeconomic status. The study was generated to view how socioeconomic status modifies risk

factors for obesity in children. The sample included 14,000 children born in the United States in

2001 form the Early Childhood Longitudinal Birth Cohort. The sample also included children

from all different racial and socioeconomic backgrounds, and they were followed from birth

though the start of kindergarten. The socioeconomic status composite variable was used to

determine socioeconomic status of the parents. The composite variable included household

income, parents’ education, and parents’ education. The study measures the child’s weight

status, overweight or obese being greater than or equal to 85th percentile versus a healthy weight

which is considered less than the 85th percentile. The percentile is determined based on the age,

height, and gender of the child. Measurements were collected when parents were surveyed at

their child’s birth, 9 months, 24 months, and 4 to 5 years of age. Trained assessors went to the

participants and collected data necessary to the study at the chosen time periods.

The Longitudinal study found a notable association between socioeconomic status and

childhood obesity. In quantile one the lowest socioeconomic status that contained 1,263 of the
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participants, 44.94 percent of them were considered overweight or obese. In comparison to

quintile five the highest socioeconomic status that contained 1,622 participants, 27.09 percent of

them being overweight or obese. As stated, socioeconomic status was determined using the

composite variable. (Williams et al., 2018). In the study there was a direct correlation to

socioeconomic status and the prevalence of obesity in child.

Both articles show studies that support that socioeconomic status is a predisposing factor

in relation to childhood obesity. There are many factors that are associated with defining high

and low socioeconomic status within each study. Some the factors that were included in

determining it were education, occupation, and income. The parents are assigned groups or

quantiles according to their results. These factors then corelate to the increased or decreased risk

of obesity in their children.

Sedentary Lifestyle and Inactivity

When considering factors that lead to obesity it has been deduced that a sedentary

lifestyle and inactivity can be a major contributor. This is a great cause for concern as developing

a sedentary lifestyle and being inactive at an early age can cause this same behavior later in life

sustaining an unhealthy lifestyle. In the experimental study “Physical Activity and Sedentary

Behavior from 6 to 11 years” by Phillipp Schwarzfischer et al., (2017). The study exemplifies the

prevalence of sedentary behavior and inactivity development throughout adolescents.

An increase in sedentary behavior and lack of physical activity is connected to several

noncommunicable diseases worldwide (Schwarzfischer et al., 2017). In this study, 1254

observations were done in which a child would wear a SenseWear Armband 2 at the ages of 6, 8,

and 11 to measure their physical activity and sedentary behaviors. This SenseWear Armband had

the ability to monitor a child’s sedentary behavior and physical activity which is divided into
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light physical activity and moderate-to-vigorous physical activity. Also, height and weight were

considered to determine body mass index through a BMI scale that was adjusted for the sex and

age according to the WHO growth Standards (Schwarzfischer et al., 2017).

Through the monitoring of physical activity, sedentary behavior and BMI, the study was

able to determine that growing children tend to decline in total physical activity and have a

significant increase in sedentary behavior from the ages of 6 to 11. More specifically moderateto-

vigorous activity had remained constant from the ages of 6 to 8 then saw a sudden decline from 8

to 11 years old while there was a gradual decline in total physical activity and light physical

activity across the ages 6 to 11 (Schwarzfischer et al., 2017). Along with the decrease in physical

activity there was a gradual increase in body mass index and fat mass index from the ages of 6 to

11 years. This shows that sedentary behavior and lack of physical activity have a direct

correlation on the BMI and FMI of children at as early of an age of 6 years old.

(Schwarzfischer et al., 2017)

The systemic review “2020 WHO guidelines on physical activity and sedentary behavior

for children and adolescents aged 5-17 years: summary of the evidence” by Jean-Philippe Chaput

et al (2020) summarizes the evidence on the associations between physical activity, sedentary

behavior and health related outcomes used to inform the 2020 WHO guidelines on

recommendations for physical activity and sedentary behavior (Chaput et al., 2020). The authors

used a total of 21 systemic reviews ranging from 2017 to 2019 to examine the association

between physical activity and/or sedentary behavior and certain health outcomes. The evidence

found had shown that a greater amount and higher intensities of physical activity are associated

with multiple beneficial health outcomes.

The health benefits to nonobese adolescents would include better cardiorespiratory

fitness, muscular fitness, bone health, and cardiometabolic health, while also reducing the risk of

experiencing depression. (Chaput et al., 2020). The review had also shown that there is evidence

that suggest more sedentary behavior, especially recreational screen time results in poorer health

outcomes for children and adolescents. Including, lower fitness, poorer cardiometabolic health,

shorter sleep duration, and unfavorable measures of adiposity (Chaput et al., 2020). The

reviewing of these articles had the authors conclude that “The evidence base is now more robust

and supports the conclusion that greater amounts of physical activity as well as different types of

physical activity are associated with improved health outcomes” (Chaput et al., 2020).

Through these two journals they both show sufficient evidence as to why sedentary

behavior and lack of physical activity can be a major contributor in an obese adolescent

lifestyle.

Through Schwarzfischer’s journal it is shown that these behaviors can start as early at the age of

6 to 8 years old and worsen through the age of 11. With Chaput’s journal it is shown that

Physical activity and sedentary behavior have a direct correlation on certain health outcomes.

Food Insecurity

The rates of obesity in children is a growing concern. The topic to be discussed in this

portion of the paper will be about availability and access to resources, such as healthy food

options, can impact the weight of adolescents. An article titled “Hunger in the household: food

insecurity associations with maternal eating and toddler feeding” by Bridget Armstrong et al

(2019) discusses this factor for children and obesity. In this article, a longitudinal study

investigates the association between household food insecurity and feeding practices. The

importance of doing studies like this is to find out early in a child’s life if kids will struggle with
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food insecurity if they are reaching the proper nutrition. For children and adolescents, they watch

what goes on around them and they will pick up habits from the parents in the household. This is

important to note, and in this study, they also look at how maternal feeding habits, such as

restricting, can affect the child.

How we would determine if maternal eating practices affected the children is by

preforming a study. This study would include a childhood obesity trial, where two hundred and

seventy-seven mothers, that are WIC eligible, would be the participants. These mothers in the

study are also low-income parents, and parents to toddlers. This trial was performed at baseline,

6- month, and 12-month; and each time the mothers would complete a set of computer-based

questions. At baseline, 69% of the sample was living below the poverty threshold (Armstrong et

al., 2020). This study found that Increases in mothers' own restrained eating corresponded to

increases in restrictive feeding and decreases in responsive feeding (Armstrong et al., 2020). A

mother’s way of eating and feeding practices strongly are going to reflect on those of their child.

“The association of household and child food insecurity with overweight/obesity in

children and adolescents in a urban setting of Ethiopia” by Sibhatu Biadgilign et al (2021) is an

observational population cross sectional study to explore the association between child food

insecurity and childhood obesity. Food security is defined as access by all members at all times

to enough food for a healthy and active lifestyle that provides a significant base for good health

and nutrition. Unfortunately, many families do not have this type of security and this study is

exploring whether that could be a cause of childhood obesity:

There is evidence on the association of household and child food insecurity and

childhood obesity. These associations could be attributed to a high consumption of

poorquality high-energy foods, more processed foods, and foods high in saturated fat,

sugar, and salt which cause overweight and obesity. (Biadgilign et al., 2021, pg. 2)

This study used a total of six hundred and thirty-two mother-child pairs who were at

household level living. The children had to be 5-18 years old, of school age, to be included in

this study. The data in this study was also collected by questionnaire, a questionnaire which

included socio-demographic characteristics, socio-economic indicators, and food security levels.

Household food insecurity was measured by the household food insecurity access scale. There

are not many studies like these, looking at the relationship between food insecurity and obesity

rates, different studies will however show different results. “Studies also indicated that children

living in food-insecure households are more likely to be obese compared to children who are

food secure which support for the positive association between food insecurity and obesity”

(Biadgilign et al., 2021).

Overall, the information that’s been gathered has shown that to some degree, food

insecurity and obesity and related. From the first study, analyses revealed that increases in food

insecurity in the homes was directly related to changes in restrictive and responsive child feeding

practices. I believe more studies need to be done on a topic of this magnitude to really show

some evidence. I believe there is a strong link between foods in the household and children’s

eating habits, which can lead to obesity starting at a young age.

Recommendations

As shown in this literature review, there are many predisposing factors related to

childhood obesity. When it comes to genetic factors related to childhood obesity, the

recommendations that should be made are genetic testing to reveal genetic markers that are

indicative of certain disorders or mutations of genes. As for recommendations for socioeconomic

status related to obesity in children, the studies show higher education achievement of parents

decreases the chance of their children becoming obese. As studies show a sedentary lifestyle has

a direct correlation to obesity in adolescents. The recommendations to be made are, reinforcing

active lifestyle in children after the age of six so that they will maintain an active and healthy

lifestyle. The last recommendation to make is associated with food insecurity within the

household and maternal feeding practices. It is recommended that children start to develop a

healthy relationship with food at a young age and the parents reinforce good nutrition.

Conclusion

The evidence shows that there are predisposing factors related to the development of

obesity during adolescence. Also, it is shown that childhood obesity has a negative effect on the

child’s mental and physical health and can result in many noncommunicable diseases. The

modifiable factors included in his literature review are, socioeconomic status, sedentary lifestyle,

and food insecurity. The nonmodifiable factor that is related to childhood obesity that is

mentioned in this review is genetics. While there are many other causes, these are the

predisposing factors that this literature review focuses on.

References

Ahmad, Qazi Iqbal, et al. “Childhood Obesity.” Indian Journal of Endocrinology and

Metabolism, Mar. 2010, pp. 19–25.

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3063535/citedby/

Amy S. Williams, Bin Ge, Greg Petroski, Robin L. Kruse, Jane A. McElroy, & Richelle J.

Koopman. (2018). Socioeconomic status and other factors associated with Childhood

Obesity. The Journal of the American Board of Family Medicine, 31(4), 514-521.

https://doi.org/10.3122/jabfm.2018.04.170261

Armstrong, B., Hepworth, A. D,. & Black, M.M. (2020). Hunger in the household: Food

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