World health organization (WHO) defined obesity as abnormal or excessive fat accumulation that presents a risk to health. Body weight measure by the body mass index (BMI), a person’s weight (in kilograms) divided by the square of his or her height (in metres). A person with a BMI of 30 or more is generally considered as obese1.
According to Center of disease and control (CDC), childhood overweight is BMI at or above the 85th percentile and below the95thpercentile for children and teens of the same age and sex while Obesity is BMI at or above the 95th percentile for children and teens of the same age and sex 2.
Prevalence of childhood Obesity in Unites states estimated to be 13.9% among 2- to 5-year-olds, 18.4% among 6- to 11-year-olds, and 20.6% among 12- to 19-year-olds 1.
Southern European countries have the highest prevalence of child obesity. In Cyprus, Greece, Italy, Malta, San Marino and Spain, approximately 1 in 5 boys (ranging from 18% to 21%) are obese while Denmark, France, Ireland, Latvia and Norway are among the countries with the lowest rates, ranging from 5% to 9% in either sex3.
A study in Saudi Arabia including Jeddah, AL Dammam and AL Khobar only, showed obesity prevalence to be 24.1 % in males and 14% in females. High proportion of Saudi adolescents spent more than 2 hours on screen time daily and almost half of the males and three-quarters of the females did not meet daily physical activity guidelines.
Contributing Factors to Childhood Overweight and Obesity in Kuwait were assessed in a cross sectional study that predicted that family history of high cholesterol and diabetes were significantly associated with the children’s BMI categories, Age of the children was found an important predictor of increase of BMI. Hours spent on sedentary activities, such as watching TV, videos or DVDs per day, eating food from takeaway restaurants and lack of physical activity such as walking to or from school in the last 5 days for females are also important predictors to increase in BMI of the children6.
Childhood obesity campaigns are needed to reduce obesity, improve wellbeing of children, and reduce future pressures on the health services and society. An example of such campaigns is which was released by United Kingdom government on 2016. Actions include Introducing a soft drinks industry charge and the revenue from these charges will be used in programmes to reduce obesity and encourage physical activity. Charges will be on producers and importers, not on consumers. Other actions include Taking out 20% of sugar in products, support innovation to help businesses to make healthier product, support with the cost of healthy food for those who need it most, help children to enjoy an hour of physical activity every day, Healthier schools food and Enabling health professionals to support families such as talking to them about their diet , referring them to weight management services, clubs and websites.
Many ethical considerations arise from application of such campaigns. From Utilitarian’s point of view the benefits of this public health action must outweigh the burdens and risks however libertarians main concerns are respect of parents’ choices, liberty and child privacy.
Benefits VS harms and risks: In order to conclude benefits of such action we must know first the negative consequences of childhood obesity. Childhood obesity found to be largely responsible for diseases like fatty liver, sleep apnea, glucose intolerance and insulin resistance and diabetes, asthma, cardiovascular disease, high cholesterol and cholelithiasis (gallstones). It is not only causes diseases, but it also has socio-emotional consequences. Overweight and obese children are often bullied for their weight. It puts the child on a negative stereotype, makes him or her gets discriminated such as exclusion from physical activities or social marginalization. All of these consequences will contribute to low self-esteem, low self-confidence, and a negative body image. Childhood obesity also has academic consequences; a study done in US found that overweight and obese children were missing their school frequently which affects their academic performance.
Main harms and risks of childhood obesity campaigns are Stigmatization and parents’ involvement. Targeting obesity would target the obese person, not the behaviors leading to obesity which my lead to child stigma, so it would be better to use measures that aim at promoting a healthy lifestyle in general, without focusing on overweight or obesity. Another is parents’ involvement in term of parents’ autonomy and their obesogenic environment.
Consent, Privacy and confidentiality: childhood obesity control campaigns will include taking body measurements of the children and hence their personal information. where three essential ethical considerations will arise: consent, privacy and confidentiality. CDC has set specific safeguards for each of them to ensure children safety and protection of their rights.
Clear description of the program should be sent/explained to the parents to eliminate confusion. Communications with parents should focus on the health effects of obesity. Parents must have the choice of the option of refusal. Some programs use passive parental consent.
Privacy is defined as “A state or condition of limited or no accesses to Person”. According to CDC safeguards recommendations, height and weight measurements must not be taken within sight or hearing distance of other people. The trained staff taking the measurement should be the only person to see the results and the results should not be announced out loud.10