INTRODUCTION:

The prevalence of childhood obesity has increased significantly in the twenty-first century, posing serious challenges to both individual and societal health. Childhood obesity is a global health epidemic that is rapidly spreading, with countries that are experiencing rapid economic development, like China, reporting a marked increase in the number of overweight and obese children.¹ According to the World Obesity Federation (WOF) has recently made a prediction that by the year 2030, about one billion individuals around the world will be living with obesity. This statistic includes one in every five women and one in every seven men.²

In Malaysia, 16% of preschoolers between the ages of 4 and 6 are overweight or obese, underscoring the urgent need for effective interventions.³ There are many different and complex factors contributing to this epidemic, including sedentary lifestyles, excessive screen time, and unhealthy eating habits.⁴ Physical inactivity, measured by non-compliance with daily physical activity standards, has been reported worldwide for all age groups, including preschool-aged children.^3,5 Besides, the discrepancy between the amount of energy that is taken in and the amount that is expended by the body is the most immediate cause of obesity. This energy imbalance, which is of the size that is observed in the population of today, is the result of the intricate interplay between biological susceptibilities and changes in the socioenvironmental environment.⁶

Obesity in childhood has been linked to major long-term health issues, including an increased risk of metabolic and cardiovascular abnormalities as an adult.⁷ There is a correlation between obesity and an increased risk of developing diseases such as type 2 diabetes, hypertension, fatty liver, and cancer, which in turn leads to a decrease in both life expectancy and quality of life of the individual.^8,9 Some common complications of obesity shown in table 1.^10-12

Table 1: Common complications of obesity

Body system	Disease/condition
Cardiovascular	The individual has hypertension, atherosclerotic heart and peripheral vascular disease, myocardial infarction, stroke, peripheral venous insufficiency, thrombophlebitis, pulmonary embolism, and atrial fibrillation.
Endocrine and reproductive	Polycystic ovarian syndrome is associated with female infertility, a higher likelihood of experiencing pregnancy problems and fetal abnormalities, male hypogonadism, and an elevated chance of developing malignancies in the endometrium, breast, ovary, prostate, and pancreas.
Gastrointestinal	The conditions mentioned are cholelithiasis (gallstones), gastro-esophageal reflux disease (GERD), metabolic-associated fatty liver disease, hepatic cirrhosis, hepatic carcinoma (liver cancer), and colorectal carcinoma (colon cancer).
Metabolic	Type 2 diabetes mellitus, impaired fasting glucose, impaired glucose tolerance, dyslipidemia
Musculoskeletal	Degenerative disc deterioration, lumbar muscle strain, and osteoarthritis of the joint that supports weight of the body Blount's disease when it occurs in younger children, slipping capital femoral epiphysis when it occurs in juveniles or adolescents
Neurological	Idiopathic intracranial hypertension
Psychological	Anxiety, depression, and issues with body image
Respiratory	Asthma, obstructive sleep apnea, and obesity-hypoventilation syndrome.
Urologic	Stress incontinence

Moreover, the individuals who are overweight or obese should undergo a thorough clinical evaluation to identify any issues or risk factors associated with obesity. This evaluation should include analyze the effects of extra body fat on the person's physical and mental well-being, ability to perform, and overall quality of life. During this physical examination, the physician should strive to discover the factors that contribute to weight gain, such as medical conditions, medications, metabolism, dietary habits and calorie consumption, sleep patterns, and a sedentary lifestyle. It is important to examine psychological issues such as stress, anxiety, eating disorders, and depression, as well as family and financial circumstances. The clinician and patient ought to work hand in hand to determine suitable weight objectives and any obstacles to effective treatment.¹³

In addition, obesity among children is largely caused by sedentary lifestyles and lack of physical activity. In order to address the problems associated with childhood obesity, a comprehensive approach that centres on modifying modifiable behaviours must be used. This entails promoting physical activity, cutting down on idle time, and improving sleeping patterns.⁵ By the same token, engaging in physical activity and exercise has been recommended as effective interventions to prevent obesity and enhance obesity-related risk factors in children and adolescents^14-16, with moderate-to-vigorous movement for one hour resulting in a 10% reduction in the likelihood of acquiring obesity¹⁷. Besides being beneficial, regular physical activity is regarded as a potent remedy for decreasing inflammation¹⁸, risk factors associated with obesity, and the occurrence of illnesses¹⁹.

Furthermore, the consumption of more calories and a greater proportion of less nutritious options, such as high-calorie meals, along sweetened beverages, and junk food, are significant contributors to the growing epidemic of obesity among children. There is a link between the rise in childhood obesity and the meals parents choose to prepare. The types of foods available at home and the meals parents prefer can influence what their children eat.²⁰ According to Gidding and his colleagues mention an article in which they address the dietary recommendations developed by the American Heart Association for children who are two years old or older. The consumption of vegetables and fruits on a daily basis while restricting juice consumption, the reduction of sugary beverages and meals, the consumption of whole-grain bread and cereals rather than refined grains, the consumption of more oily fish, and the reduction of salt intake are some of the strategies that are included in this category.²¹

Interventions aimed at these critical domains have the potential to positively impact children's overall well-being, cognitive development, and physical health. Considering obesity in children is becoming increasingly prevalent, it is essential to understand the factors that contribute to it and to implement solutions that are effective in combating this persistent problem. This is necessary to protect the health and future of the population of adolescents. This article will emphasize the fundamentals of variables that contribute to childhood obesity, which is very helpful for both healthy and obese children and is mostly ignored in this 21^stcentury.

Analysing the phenomenon of childhood obesity

Over the past few years, the problem of childhood obesity has become increasingly serious due to its complexity and the many facets it encompasses. The worrying rise in the prevalence of childhood obesity is not only concerning because it raises the probability that young children may develop non-communicable diseases as adults, but it also raises questions about the idea that children should be the only ones to blame for this regrettable trend.^22-23 Moreover, several complex factors contribute to the development of childhood obesity. Each of these aspects influences a distinct child due to a variety of circumstances, including the environment and experiences that are related to eating. It has been established on multiple occasions that these factors play a significant part in determining the eating habits of children.⁷ Furthermore, it is important to remember that preferences formed in childhood often carry over into adulthood, highlighting the importance of treating childhood obesity as a chronic health risk.²⁴

The etiology of obesity is multifaceted, arising from a confluence of both personal and societal influences. At the individual level, the presence of one's own hereditary risk, together with biological and physiological factors, directly impact food intake and predisposition to weight increase. Multidimensional factors contributing to child and adolescent obesity shown in figure 1.²⁵

In additional, lack of sidewalks and restricted availability of affordable, wholesome food are the main causes of the obesity pandemic, not a lack of personal responsibility [26]. Since the appeal of fat, sugar, and inactivity frequently outweighs the benefits of choosing healthy choices, schools play a critical role in consistently promoting the importance of doing so²⁷. Research has demonstrated that teenagers who are overweight or obese are more likely than those who maintain a healthy weight to be overweight or obese as adults. The rising prevalence of childhood obesity poses a significant public health challenge by increasing the burden of chronic non-communicable diseases.^28-29

Obesity heightens the likelihood of early puberty in children³⁰ and monthly abnormalities in adolescent girls^28,31. Sleep disorders, such as obstructive sleep apnea (OSA)^28,32, are associated with cardiovascular risk factors, including prediabetes, type 2 diabetes, high cholesterol levels, hypertension, non-alcoholic fatty liver disease (NAFLD), and metabolic syndrome^28,33. In addition, children and adolescents who are obese may experience psychological problems including sadness, anxiety, low self-esteem, body image concerns, difficulties in peer relationships, and eating disorders^34,35. Society must act proactively to stop the current global surge in overweight and obesity rates as well as to shield today's kids from early chronic illness and incapacity. In order to address adolescent obesity, a comprehensive strategy that recognises and addresses the complex and interrelated factors that contribute to this urgent public health issue is required.

Courtesy: Lytle, 2009²⁵

The many factors that lead to childhood obesity are currently being investigated as part of a study that is currently being carried out. Over the past few decades, kid obesity has gained prominence as a major public health concern due to the alarming rates that have been observed all over the world. There is a complicated chain of events that led to the outbreak of this pandemic, which includes interactions between biological, environmental, and social elements. In order to develop effective strategies for intervention and prevention, it is necessary to have a comprehensive grasp of these fundamental components.

Clinical significance of Childhood Obesity

A major contributing factor to childhood obesity is the lack of nutritious dietary practices and regular physical exercise. The allure of sugary, fatty, and highly processed foods, combined with a lack of physical activity, results in an imbalance that ultimately causes an increase in body weight. Schools play a crucial role in promoting healthy choices and fostering physical activity throughout the day, as they offer a well-organized setting for cultivating these habits. Moreover, the domestic setting and the impact of parents play a crucial role in shaping a child's connection with food and physical exercise, highlighting the necessity for a comprehensive strategy to tackle this matter.³⁶

Moreover, variations in childhood obesity rates can be attributed to socioeconomic and cultural variables. Children from economically disadvantaged backgrounds may face limited access to affordable and nutritious dietary options, as well as fewer opportunities to engage in physical activities, increasing their susceptibility to health risks. The growth in childhood obesity has been attributed to urbanisation and the consequent lifestyle changes, including heightened dependence on automobiles and decreased availability of natural spaces.³⁷

Childhood obesity has a direct impact on the likelihood of acquiring orthopaedic, neurological, pulmonary, gastrointestinal, and endocrine disorders. Children who are severely overweight are at a higher risk of developing obesity-related comorbidities, which can greatly affect their quality of life.³⁸. Childhood obesity can also result in social and psychological difficulties, including bullying, taunting, low self-esteem, and depression.³⁹. Childhood obesity carries a significant societal and economic burden, as it can result in lower academic performance, limited economic opportunities, and higher healthcare expenses.⁴⁰. The obesity-related health comorbidities shown in figure 2.⁴¹

Figure 2: Obesity-related health comorbidities

Courtesy: Kansra et al., 2021⁴¹

These components have an intricate relationship, and a thorough understanding is critical for the development of effective solutions. Although personal accountability and behavioural modifications are significant, effectively combating the obesity pandemic necessitates comprehensive societal transformations that tackle the structural obstacles and establish circumstances conducive to healthier choices for every child. Immediate intervention is necessary to tackle this pressing public health emergency and alleviate the immediate and long-lasting effects of childhood obesity.

Dealing with the difficulties: Actions and approaches

The prevalence of childhood obesity has emerged as a significant public health issue, characterised by distressing levels of overweight and obese children and adolescents. Childhood obesity has a multitude of physical and psychological effects, which frequently persist into adulthood, increasing the likelihood of developing chronic illnesses like heart disease, stroke, diabetes, and some types of cancer. In the event the agenda does not contain a strong focus on forming coalitions across society sectors and expanding the ability to combat obesity, then multilevel research and interventions will not be able to be carried out or maintained⁴². To tackle this problem, a comprehensive strategy is needed that encompasses treatments at both the individual level and wider societal transformations⁴³.

An essential approach to combat childhood obesity is to enhance the levels of physical activity among children throughout their time at school. Physical education teachers can significantly contribute to this endeavour by employing tactics to enhance student engagement in physical activity, such as integrating more strenuous exercises, optimising the duration of activity, and involving students in pleasurable physical pursuits. In addition, schools can implement environmental modifications that encourage physical activity. This can be achieved by enhancing the availability of recreational facilities and incorporating physical exercise into the curriculum across several subjects⁴³. An additional crucial strategy involves the implementation of primary care-based weight control programmes tailored exclusively for overweight and obese children. The ABCD Weight Management Programme specifically designed for children between the ages of 6 and 17 who have a body mass index that exceeds the 95th percentile for their age and gender⁴⁴. This programme tackles the intricate issue of childhood obesity by offering a complete, evidence-based strategy that encompasses food, physical activity, and behavioural aspects. The example of the exercise for children shown in Table 2.

Table 2: The example of the exercise for children

Exercise types and examples for children:⁴⁵

· Aerobic exercise: This type of exercise increases heart rate and respiratory strength. Examples include skateboarding, paddle, dancing, basketball, soccer, volleyball, tennis, swimming, gymnastics, jumping rope, house cleaning, running, and cycling.

· Muscle strengthening: climbing a rope, tree, rock, push-ups, weightlifting

· Bone strengthening: Recommended to perform at least three times weekly, e.g. jumping rope, climbing mountain, walking, basketball, volleyball, running.

· Extension (Strain): Causes muscles to become more elastic and there is less risk of injury, e.g. yoga, dancing, gymnastics.

In exercise recommendations for children, exercise programs corresponding to the English acronym FITT (Frequency, Intensity, Time, and Type), which means having a high level of conditioning, are recommended in exercise treatment in obesity⁴⁶ The compatibility recommendations in exercise treatment in obesity (FITT) shown in Table 3. The physical exercise programs that can be recommended by applying the FITT principles in children and adolescents shown in table 4.^46,47

Table 3: The compatibility recommendations in exercise treatment in obesity (FITT)⁴⁶

Frequency: Frequent/each day of the week

Intensity: 55–90% of maximum heart rate

Time: 30–80 minutes

Should increase gradually

Beginning; 10 minutes of walking, 3–5 days/week

Continued; 60–80 min, almost every day /week

Type: Aerobic, resistant

Table 4: Physical exercise programs that can be recommended by applying FITT principles in children and adolescents^46,47

FITT	Cardiovascular (aerobic) program	Interval program	Muscle resistance program
Frequency	≥3/week	≥3/week	2–3/week
Intensity	Moderate-severe exercise	3–5 min. Mild-moderate Interrupting for 6–8 times 1–3 min high intensity exercise	High (50–70% MVC)
Time	20–60 min	Total 20–60 min	2–3 min. per muscle group (8–20 repetitions) Total ≥30
Type	Running, jumping, biking Swimming, soccer	Running, jumping swimming, biking	push-ups, climbing paddle
Program duration	8–12 weeks	6–12 weeks	6–12 weeks

Aside from school-based and clinical interventions, it is imperative to implement population-level efforts to establish an environment that promotes healthy behaviours. These solutions may involve implementing policy modifications, such as enhancing the availability of nutritious food and drinks in schools and communities. Additionally, public awareness campaigns can be conducted to educate individuals about the significance of maintaining a healthy diet and engaging in physical activity⁴⁸. To effectively tackle the issues surrounding juvenile obesity, it is necessary to have a well-coordinated approach involving several sectors such as education, healthcare, and public policy. Through the implementation of various treatments and methods, one can establish an environment that enables children and families to embrace healthier lifestyles and decrease the prevalence of childhood obesity^49,50.

When it comes to prevention, the 5-2-1-0 rule appears to be the most straightforward guideline. This rule states that 5 or more servings of vegetables and fruit, less than two hours of sitting in front of the television or computer, at least one hour of daily physical exercise, and no sugary drinks are allowed.^47,51. Practical exercise recommendations in prevention of obesity shown in table 5.^45,47

Table 5: Practical exercise recommendations in prevention of juvenile obesity

1. 5 – 2 – 1 – 0 Rule stated

Ø that individuals should consume 5 or more servings of vegetables and fruit.

Ø Engaging in sedentary behavior for less than 2 hours by sitting in front of the TV or computer.

Ø Engaging in 1 hour of organized physical activity.

Ø Choosing low-fat milk or water over sugary beverages.10 000 steps each day (2000 steps in excess daily burns 100 calorie) (difficult in children, but they should be informed)

2. It is advised that children and adolescents engage in moderate to high intensity physical activity for at least 60 minutes per day on a weekly basis. However, in order to reduce insulin resistance and cardiovascular risk, this time period should be extended to 90 minutes. Glucose and glycogen undergo oxidation predominantly during exercise, but fat oxidation initiates after 90-120 minutes.

3. The positive effects of physical activity last for a duration of 24 to 72 hours. Consequently, it is recommended to engage in physical activity at least three times every week.

4. Weight loss can be achieved with any form of exercise, as long as it is done for a minimum of 4-10 hours each week.

5. Children may exhibit improved adherence to frequent, brief exercise sessions.

Childhood is the optimal period for cultivating nutritious eating patterns that children can sustain throughout their adult lives. Since it is important for children to reach their full potential, they require healthy snacks and meals that are abundant in nutrients. Within the framework of the Dietary Guidelines for Americans, 2020–2025, it is recommended that children consume a wide variety of meals and drinks. Some examples of foods that fall into this category are fruits and vegetables, whole grains, dairy products that are fat-free or low-fat, non-dairy beverages that have been fortified with calcium, vitamin A, and vitamin D, and meals that are loaded with amino.⁵²

The guidelines also advise children to restrict their consumption of meals and drinks that include excessive amounts of sweeteners, saturated fats, and salt, as these substances might contribute to an increase in calorie intake without offering significant nutritional value. In order to substitute them with more nutritious alternatives, reduce the frequency of consuming fast food and choose for healthier accompaniments, such as soup or fruit salad, rather than fries. Choose lean protein sources such as turkey breast, legumes, or tofu instead of high-fat items like sausage and fried chicken.⁵²

In addition, substitute highly processed foods with whole foods such as fruits, vegetables, whole grains, nuts, and seeds. Replacement sugary sodas with water, low-fat or fat-free milk, or fortified non-dairy beverages. With the goal to encourage the development of healthy eating habits, it is advisable to position nutritious meals and beverages in visible and accessible locations, while refraining from purchasing or storing high-calorie foods and beverages. As an illustration, substitute the cookie jar with a fruit bowl. Minor modifications can greatly enhance the nutritional intake and overall well-being of children.⁵²

Apart from that, it can be beneficial to decrease the consumption of high-calorie meals and beverages for children who are overweight or experiencing an unusually fast weight increase. In addition, it is important to ensure that a child has regular meals, commencing with a well-rounded breakfast, in order to avoid them from constantly overeating throughout the day. This will help them consume less calories overall. When dealing with the issue of high-calorie snacks, one effective strategy is to repackage them into smaller containers. This approach helps to prevent providing excessively large servings and also allows for the opportunity to educate children about the appropriate portion sizes for their respective age groups. Furthermore, to promote conscientious eating behaviors, it is crucial to disallow consumption in the presence of electronic devices such as the television, computer, or other electronic gadgets.⁵²

An optimal meal consists of a minimum of three food items, each representing a different food group from the four essential ones. The dietary guidelines for children shown in the figure 3.⁵³

Figure 3: Dietary guidelines for children⁵²

DISCUSSION:

Childhood obesity has become a pressing public health concern in the 21st century, with far-reaching implications for the physical, mental, and social well-being of young individuals. The rising prevalence of obesity among children calls for an urgent need for comprehensive strategies that address the multifaceted causes and consequences associated with this epidemic, including dietary habits³⁶, physical inactivity⁵⁴, and psychological factors that contribute to poor health outcomes⁴¹. As the complexity of childhood obesity increases, it is essential to examine the role of race, ethnicity, and cultural influences, which significantly affect the prevalence and treatment of this condition across different populations. In particular, understanding how cultural norms and values shape dietary practices and perceptions of body image is crucial in developing effective prevention and intervention programs tailored to diverse communities, given that strategies that are not culturally sensitive may not yield the desired outcomes in reducing obesity rates among children.

Child obesity is also linked to unhealthy eating patterns like eating calorie-rich, nutrient-poor foods and sugary drinks. Promoting healthy eating is important since parents and caregivers influence children's diets. Educational programs should promote the American Heart Association's child dietary guidelines. These guidelines recommend eating fruits, vegetables, whole grains, and lean proteins and reducing sugary drinks and calorie-dense snacks^52,53. Promoting regular physical activity helps maintain a healthy weight and reduce obesity-related health problems. Schools and communities must work together to foster healthy lives. Organizational physical activity programs like the ABCD Weight Management Programme can drastically reduce childhood obesity and associated comorbidities.⁴⁴

To end the adolescent obesity pandemic, systemic problems that disproportionately affect low-income families must be addressed. These families typically struggle to find safe places to exercise and healthy eating. Therefore, governmental policies that provide equitable access to recreational facilities and nutritious diet are crucial. Community-based interventions that actively involve families in healthy living behaviours may reduce health inequalities and bridge socioeconomic gaps⁵⁶. Multi-component interventions—including food, exercise, and behaviour—need more investigation across varied populations and settings. Technology and digital health tools' effects on children's health and weight management must also be studied.

CONCLUSION:

The childhood obesity phenomenon has become a global concern that has sparked public health initiatives from different countries to prevent it, in the hope of improving quality of life as well as curtailing the astronomical costs involved in the management of the serious co-morbid conditions that accompany obesity in adulthood; these include cardiovascular, respiratory, gastrointestinal, renal and psychological diseases. Accessing nutritious foods and participating in physical activity are considerably more difficult for children from impoverished backgrounds. Targeted interventions that offer resources and assistance to vulnerable populations are necessary to address these disparities. The overall well-being of children can be enhanced by community-based programs and policies that promote equitable access to nutritious foods and recreational facilities, thereby reducing health disparities.

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Received on 05.11.2024 Revised on 16.01.2025

Accepted on 19.03.2025 Published on 02.05.2025

Available online from May 07, 2025

Research J. Pharmacy and Technology. 2025;18(5):2425-2432.

DOI: 10.52711/0974-360X.2025.00346

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