Childhood Obesity and Interventional Policies and Programs

The United States urban areas are experiencing a massive epidemiological and nutritional evolution characterized by obstinate dietary deficiencies evidenced by minerals like iron, prevalent anemia, and stunting. Concurrently, there is a progressive increase in related nutritional complications such as diabetes, obesity, cardiovascular illness, and some cancer forms (Gittelsohn et al., 2017). Obesity has become a severe condition and has become an epidemic in most urban areas of the U.S. The highest levels of childhood obesity are observed primarily in urban areas compared to other regions. Females are the most affected due to the inherent hormonal variations compared to males. It is convincingly emerging that coronary heart disease and Type2 Diabetes genesis during childhood; obesity is a primary influencer. Obesity cases in children have risen phenomenally in the last four decades. Childhood obesity underwent a massive increase between 1980 and 2013 in the urban United States, 8.4% to 13.4% for females and 8.1% to 12.9% for males (Liberali et al., 2020). The World Health Organization by 2016 reported that there were at least 10 million overweight children in American urban areas aged less than five years. The condition is considered among the most prevalent public health problems of the 21 st century (Sahoo et al., 2015). Childhood obesity is a growing epidemic in most urban areas of the United States. Therefore, there is an urgent need to develop preventive measures, alternative medication approaches, and treatment processes to help reduce childhood obesity in the United States urban areas. Overweight and obesity in children are among the 21 st century's most severe public health areas of concern in the U.S. urban areas. These problems are considered predictive risk factors of adulthood obesity, leading to chronic diseases. The United States has seen the most alarming increase in the last 30 years, where childhood obesity and overweight in boys increased by 4.1% and 5.0% for girls where more than 60% of each are children from urban areas. In 2015, most researchers found that obesity prevalence in rural areas was higher by 20-25% than in urban centers. Rural children have 18.6%, while urban children have a 15.1% prevalence (Wu et al., 2020) . However, as urbanization and rural-urban migration increase, children in urban centers have become constantly prone to the disorders. Childhood obesity rates in Los Angeles, New York, and Huston have increased alarmingly. The Houston Department of Health indicates that children in urban areas are at a higher risk of becoming obese. In urban Houston areas, 34% of children between 12 and 18 are overweight, while only 15% of rural children are obese. 13.5% of students living in New York City were obese by 2017, which has increased to 39% in 2020 among children between 12 and 18 ( Cdc.gov, 2021) . The rates are higher in New York City than in other rural areas of New York, such as Fairport, Roxbury, and Newfield, which have a combined percentage of 13.2. Also, Los Angeles is an urban hotspot of childhood obesity rates of 20%, while rural areas of California such as Amador, Calaveras, and Modoc have relatively lower rates combined. Children living in the United States urban areas are constantly exposed to childhood obesity. There is a widely accepted consensus that obesity results from imbalanced energy intake and expenditure. An increase in Positively balanced energy is closely allied to dietary preferences and adopted lifestyle, which, when not done, results in an imbalance. Childhood obesity risk factors include physical activity, sedentary behavior, and dietary intake moderated by factors like gender and age. Family characteristics, including parent lifestyle, the home environment, and parenting style, play a vital role in developing this condition. Obesity is commonly influenced by unhealthy eating patterns, environmental factors, community, and inaccessibility to healthy fares. Unhealthy eating behaviors include poor meal planning, overeating, eating on the move, and consuming foods with too much sugar. These triggers are primarily witnessed in Urban areas. However, research has shown that genetic backgrounds can be the primary cause of obesity in some individuals. Research has found that BMI (body mass index) can be between 25 and 30% heritable for a child (Sahoo et al., 2015). There is a chance that children will have a similar height and mass as their parents. However, genetic susceptibility has to be coupled with behavioral and environmental risk factors. Environmental factors including demographics, family setting, and work demands for parents influence the child's activity and eating behavior. Also, environmental factors can include the child's mental health and academics. Prevalence levels of obesity in the United States cities are among Hispanic kids with 21.9% than non-Hispanic children when Blacks have prevalence rates of 19.5% and Whites 14.7% ( Griauzde et al., 2020). Children from low- and middle-income earning families are likely to develop obesity since they cannot afford balanced diets. Some parents hold beliefs caused by environmental factors restricting their children from eating certain foods, leading to excess caloric intake. Also, some parents are violent or have demands causing mental and emotional disorders among their children. Mental and emotional instability can trigger unhealthy eating habits. Consequently, previous studies have shown that proximity to fast foods outlets leads to an increase in unhealthy food intake. Low-income children are the most vulnerable to instant accessibility of first food outlets, which has been a contributing factor to increased obesity. The community within which a child is brought up could influence their eating habits. Children adapt to the living standards of their peers and the community in which they reside. Some communities consider slim bodies unhealthy and unattractive. Therefore, the child will overeat to have an attractive and healthy body leading to obesity. Also, societal beliefs and perceptions expose children to obesity. People from different communities have different feeding beliefs and practices. For instance, Hispanic mothers in urban areas are more likely to introduce solid foods early and perceive toddler chubbiness as a good health sign ( Griauzde et al., 2020). Blacks have different food patterns and choices from Whites since they consider sugary and high caloric foods prestigious. Low-and-middle income earners in urban areas frequently eat caloric and sugary foods since they are cheap and achievable. Such factors constantly expose children to obesity which can persist to adulthood, primarily in urban areas. Health fares help people enjoy highly nutritious foods. They can equip children and mothers with knowledge about healthy eating habits. However, they are inaccessible to most individuals especially low-and-middle-income earners. It makes them constantly consume unhealthy foods. Most urban settings in the United States are designed to make the child less likely to engage in physical activities. It has made many children resume a sedentary life. A sedentary lifestyle is one of the primary factors closely associated with childhood obesity. According to Sahoo et al. (2015), Obesity prevalence increases by 2% with each additional hour watching the television. Children in urban areas have better access to television programs than rural areas. Therefore, they are more likely to have reduced physical activities, which help children burn calories crucial to avoiding obesity. Excessive body fats are converted into energy needed for physical activities. However, the world is vastly evolving and technology advancing, introducing social media, video games, and television programs. Children as young as two years own and know how to operate phones. They are constantly on social media platforms, including YouTube, Instagram, Twitter, and Facebook. Urban areas are connected to internet services, and mobile phones are easily accessible. Combined with television, these media outlets are the most effective advertising channels used by food and beverage companies in the urban United States. Therefore, the children will view the foods advertised and seek to eat them. Research reveals that the time spent by kids watching television and browsing on social media platforms correlates with the consumption of the most advertised products, such as sweets, salty snacks, sweetened cereals, and sweetened beverages ( Wu et al., 2020) . Although there are challenges in empirically assessing mass and social media impacts, the effects of advertising should not be disregarded. Children who spend most of their free time watching television or browsing social media platforms have limited time for physical activity. Parents in urban areas ensure their children access television and internet services since most spend most of their time at work. They barely engage in physical activities, which leads to the cumulation of fats since they are not converted into energy. In most cases, children spend time on social media eating snacks, leading to obesity. Also, school policies are significantly influencing obesity among children and teenagers. Some schools have limited time to engage in sporting or physical activities. They focus on academics where children only burn calories when walking between venues. Children are picked up by a school bus at their doorstep or dropped at school by their parents in most urban settings. They then sit in the class for at least 80% of schooling time, board a bus back home, or get picked up and spend their afternoons watching or on social media. Unlike children in rural areas who have limited transport and internet services, making them walk and engage physically during their free time, children in urban areas have all the infrastructure surrounding them. Parents prepare dinner, after which the children go to sleep, and the cycle repeats itself. Parents take their children for outside meals to compensate for their absenteeism during the weekend. The sequential occurrence of most children's activities constantly exposes children to obesity. Also, the advent of video games has seen many children fall prey to obesity since they spend most of their time playing virtually. Every parent tries to give their children everything without knowing that it can lead to lifetime conditions. Studies have shown that about 4% of children who play esports are obese ( Wu et al., 2020) . There is a significant connection between obesity and the parents will provide everything for their kids, reducing physical activity. Figure 1.4 shows a child eating food with high caloric content as they watch the television. The United States government, in collaboration with international and community-based organizations, has enforced further interventions to reduce the upsurging rates of childhood obesity. They include introducing community-based sports, cooking classes, swimming lessons, dance classes, nutritional education, and physical activity education programs. These activities focus on urban areas such as Los Angeles, Houston, and New York City. Community-based sports present every child in each community with an opportunity to engage in a physical activity that helps them burn calories. Team sports have also been introduced in schools to allow children to concert excessive fats into energy for playing. Organizations have recommended family activities such as morning runs, evening runs, or biking after school. Parents escort their children during these activities. Cooking classes helps parent cook healthy and well-balanced meals that do not include excessive calories. Physical activities education such as swimming classes and martial art play a vital role in influencing children to engage in healthy activities during their free time. These interventions are supported by the governments, schools, communities, and families and have helped prevent obesity in young children (Puga et al., 2020). Also, they help children lead healthy lives, which ensures they do not develop chronic diseases such as diabetes, cancer, and cardiovascular complications. Below is a graph of the effectiveness of community-based intervention programs among the Spanish population. The increasing statistics of childhood obesity have triggered the need to develop interventions and policies. Federal initiatives and agenda-setting organizations have called for all-inclusive approaches with multiple community policies and programs (CPPs) delivered in many sectors. The CPPs are designed to eradicate the problem in all urban areas across the United States. Multi-setting, comprehensive intervention approaches are widely considered the best practices to advance community health. Recommendations of accelerating obesity prevention progress call for comprehensive approaches. These strategies focus on child development environmental transformation such as retail outlets, media, schools, workplaces, and health care. Also, the interventions should focus on modifying settings exposing kids and their families to physical activities opportunities and healthy nutrition from a social determinants and health equity perspective. Preventive measures can include eliminating desserts, increasing the availability of fruits and vegetables in food outlets, and increasing the time for school physical activities. CDC's Healthy Communities Study (HCS) analyzed the relationship between CPPs associated with childhood obesity and obesity-related results in 130 urban United States communities ( Collie-Akers et al., 2018). The researchers collected data that describes the type and number of CPPs examined over ten years. 

The table shows the most prevalent policies and programs implemented among 130 urban United States communities. The activities were applied in urban areas to offer options for children. Table 1.0 portrays a statistical analysis of policies and programs observed over ten years in 130 urban United States communities. The research recorded that team sports were the most common intervention programs reported by 1441 informants, followed by nutritional education with 282 reports and cooking classes with 168 reports (Collie-Akers et al., 2018). More than 50% of the CPPs are based in school, and 95.4% of the target children are in urban areas of the United States. Nutritional-focused interventions aim to increase the consumption of vegetables and fruits, while physical activity interventions increase community-based physical activity participation. Also, physical activities interventions seek to increase home and family-based and afterschool physical activity programs. They are a mix of nutrition and physical activities CPPs. Community-based organizations and government agencies introduced the intervention strategies. United States urban areas have been at the forefront of developing interventional measures for childhood obesity. Children living in the rural United States have higher odds of between 20 and 25% of developing obesity than those living in urban areas (Wu et al., 2020). It can be reflected by the rates of interventional programs and policies implementation in urban areas. Research shows that urban and suburban areas had more measures than rural areas. However, the levels have increased alarmingly in urban areas between 2018 and 2020, calling for the need to have more CPPs. Mean CPPs in urban areas are 80.9, 74.1 in suburban areas, and 62.6 in rural areas (Collie-Akers et al., 2018). Based on these statistics, more people in urban areas can access CPPs than rural areas since they are the most vulnerable. Despite that the government and children's health organizations have constantly introduced more CPPs in urban areas, the obesity rates are still high compared to rural areas. Children's rates of obesity are constantly increasing not because there are no CPPs but because of slow implementation. Therefore, the community, healthcare facilities, local and international organizations, schools, and the government in cities and urban areas should collaborate to implement and finance the CPPs in urban areas. New York City is the top urban area in the United States with the highest obesity rates. Followed by Houston, which has over 34 % of its children obese, the city has childhood obesity rates of 39% ( Cdc.gov, 2021) . The children are primarily in urban areas from different ethnic and income backgrounds. Unlike ten years ago, rural areas have reduced rates of childhood obesity currently. Multiple actors can be attributed to the childhood obesity in United States' urban areas, including higher population, urbanization, and lifestyles. Urban areas have improved their quality of life than rural areas. Therefore, people can afford snacks and foods with large amounts of calories. Also, Han et al. (2020) note that fast foods outlets are easily accessible in the U.S. urban areas than in most rural areas across the United States. However, stakeholders in urban areas have introduced CPPs to reduce the number of overweight children and eradicate the problem. Although they haven't been fully implemented, policies and programs can significantly reduce obesity. Childhood obesity has proven to be a prevalent condition among urban areas children. Therefore, it needs a more problem-centered solution. Despite that policies and programs have been formulated and implemented, the rates of childhood obesity continue to increase in cities and urban areas. The most effective way to deal with obesity includes physical activities and proper nutrition. For the combination to work, all stakeholders must work closely with one goal, eradicating childhood obesity. The fundamental stakeholders include the parents of obese children, the school they attend, the community, and the government (Sahoo et al., 2015). They should consider that most urban areas are designed to reduce the child's need to engage in physical activities for fun. There is the internet, television services, and caloric or sugary foods accessibility than rural areas. All educational institutions in the urban United States should have at least one hour every day where obese children engage in intensive physical activities. However, the school physical experts should know what sport each child is interested in to motivate them to participate. Parents should be present in the lives of their obese children. They should introduce physical activities such as afterschool walks, morning runs, weekend swimming, and bike riding. However, the activities should be accompanied by proper nutrition where the parent ensures the child eats food with fewer calories. Also, the schools, through government funding, should give children fruits during mid-day breaks and vegetables during lunch. Nutritional education, engagement in physical activities, extra taxation of sweetened foods and beverages, and reduced media intake are central to preventing childhood obesity in Houston, New York, and Los Angeles. Nutritional education can mainly be offered to parents during pregnancy or when the children are below five years old. It will help the parents know what foods to feed their children to avoid the future possibility of obesity. Children should be constantly exposed to physical activities they love at home, school, and within their community (Wang et al., 2017). It will help the children reduce the time they spend on media outlets. Urban communities can develop competitive sports tournament which accommodates all children to trigger athletic will among children. Also, the government can increase taxes on foods that can cause obesity, primarily in urban areas (Chung et al., 2021) . They will be unaffordable for most children and teenagers, reducing the risk of obesity. Implementing these policies and programs will improve individual and community health. Also, community health can be achieved by introducing nutrition-related campaigns within the communities and estates. Healthcare facilities middle-and-low-income communities can seclude four days a month to sensitive the community about healthy eating and the most appropriate physical activities. They can also offer free services for obese children and take children's data in such communities to understand the condition's causes. Many websites can help parents with obese children or obese children deal with the condition. Also, they can help the public learn about obesity and how to prevent the condition. They include Healthy Kids, Healthy Future which helps education providers ensure children acquire a healthy start of life, and Healthy children.org, backed by 67 000 pediatricians focused on enabling children to achieve optimal mental, physical and social health (Puga et al., 2020). Others include ClinicalTrials.gov, catchusa.org, www. Letsgo.org, and www.nccor.org, all working towards dealing with and preventing obesity in urban areas. Community resources can include competitive sports, public parks where children can go for walks or runs, bike riding tracks, and gym facilities. 

Conclusion 

The world is constantly advancing, which massive rural-urban migration. As a result, children have been constantly exposed to unhealthy foods and behaviors. Therefore, obesity has alarmingly increased in United States urban areas. Based on the statistics, children are among the most affected by obesity. Childhood has evolved into an epidemic affecting millions of children, primarily in urban areas. The highest levels of this condition have been observed primarily in urban areas of the United States. Several factors cause childhood obesity: unhealthy eating habits, community factors, and reduced physical activities. Children eating habits are significantly influenced by their environment, including demographics, family setting exposure, accessibility of unhealthy foods, and parenting. Also, the community beliefs and norms can influence a child's health leading to obesity. Nutrition and low physical are widely considered the causes of obesity. With advanced technology, children spend a lot of time on media platforms reducing their activities, especially in cities. The government, communities, and local and international organizations in the U.S. urban regions have introduced interventional policies and programs (CPPs). They have been introduced across many urban communities and tested to be effective. However, the rates of childhood obesity continue to increase in most cities. Therefore, childhood obesity needs a problem-centered solution where the stakeholders focus on the causes and deal with existing cases. 

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