Research articlesPublic perceptions of childhood obesity
Introduction
Obesity in the United States has been identified as an epidemic by the Centers for Disease Control and Prevention (CDC). The prevalence of obesity has doubled in the past 25 years; today, two thirds of adults are overweight. As a consequence, the incidence of obesity-attributable diseases, including diabetes, heart disease, cancer, musculoskeletal disorders, sleep apnea, and gallbladder disease continues to increase, as does obesity-attributable mortality and economic costs.
Poor diet and inactivity, the primary modifiable contributors to obesity, are estimated to be responsible for 400,000 deaths per year,1 and it is expected that obesity will soon surpass smoking as the number one preventable killer in the United States. Finkelstein et al.2 estimated that overweight and obesity-related U.S. medical expenditures are as much as $93 billion per year, or approximately 9% of total annual medical expenditures for adults. They also report that half of the costs of obesity are funded by taxpayers through the Medicare and Medicaid programs, providing a motivation for governments to implement strategies to reduce the economic burden of obesity.
The obesity epidemic is not restricted to adults. Today, 15% of children and adolescents are overweight.3 The increase in child and adolescent overweight can be traced to the 1980s. In the time interval between the second National Health and Nutrition Examination Survey (NHANES II) (completed in 1980) and third survey (NHANES III) (completed in 1994), the prevalence of obesity increased from an estimated 7% to 11% among children aged 6 to 11 years and from 5% to 11% among adolescents aged 12 to 19 years. This trend suggests that a new generation of Americans will enter adulthood already obese or at risk for obesity, and will already have or be at risk of multiple related health conditions, such as diabetes and cardiovascular disease, unless actions are taken to reverse the epidemic.3, 4
Over the past 20 years, the increase in news coverage for obesity and related topics has grown at least as quickly as the epidemic itself. Whereas 20 years ago, news coverage of obesity was virtually nonexistent, today stories related to the causes and consequences of obesity are featured almost daily throughout the media. Moreover, both state and federal governments have implemented health promotion campaigns aimed at obesity awareness and prevention.
Researchers have recently begun to measure public attention, awareness, and attitudes about obesity. Oliver and Lee5 conducted what they describe as “the first study of public attitudes toward obesity and obesity policy” in spring 2001. Based on a nationally representative sample of U.S. households, they found that “contrary to the views of most health experts, most Americans are not seriously concerned with obesity, express relatively low support for obesity-targeted policies, and still view obesity as resulting from individual failure rather than environmental or genetic sources.”5
More recent polls have documented a shift in the public’s attitude concerning obesity. Two years after Oliver and Lee’s data were collected, Harvard University sponsored a similar survey.6 The Harvard study found that Americans consider obesity to be a major public health issue, comparable to smoking. Several more recent polls confirm these results. In spring 2003, the American Public Health Association commissioned a poll concerning Americans’ attitudes about obesity.7 This survey found that 82% and 74% of Americans, respectively, were concerned about childhood and adult obesity, and 89% and 83%, respectively, considered childhood and adult obesity to be a serious problem. In fall 2003, The San Jose Mercury News and the Henry J. Kaiser Family Foundation conducted a survey on childhood overweight,8 and found similar results for youth. The differences between the results of Oliver and Lee5 and those of the more recent surveys may indicate that public concern is growing in response to the increased media and government attention toward obesity.
For the most part, these surveys focus on attitudes and perceptions of obesity and prevention efforts in relatively broad terms. Although the surveys reveal that Americans recognize the problem of obesity, they also find that there is generally little support for obesity prevention efforts, with one notable exception. There is broad public support for government interventions aimed at preventing and reducing obesity among children and adolescents. Although this information is informative, the surveys provide little evidence concerning which childhood interventions are supported in light of competing demands for scarce public health resources.
This study seeks to investigate in more detail public perceptions concerning intervention strategies to combat childhood overweight and obesity. The main research questions are as follows: How serious does the U.S. public consider the problem of childhood overweight and obesity in comparison to other youth health threats? What specific interventions to control or prevent childhood overweight and obesity does the U.S. public support? To what extent does the public continue to support these interventions in light of potential consequences, such as increased government regulation or taxes? What sociodemographic characteristics are associated with support for specific childhood overweight and obesity interventions?
Section snippets
Methods
An instrument was developed designed to capture opinions on the seriousness of childhood overweight and obesity compared with other youth issues; support for specific interventions; and potential barriers to support, such as negative consequences or increased taxes. Also included were some questions about adult obesity and sociodemographic characteristics of respondents. The specific intervention questions were based on a review of childhood interventions that have recently been implemented or
Sample characteristics
Table 1 presents sociodemographic characteristics of respondents. Nearly 60% of respondents were female, and roughly this same percentage attended at least some college and had incomes >$25,000. The self-reported percentage of overweight is similar to that from BRFSS; however, whereas BRFSS reports a self-reported nationwide obesity prevalence of 22% in 2002,10 only 3% of respondents to this survey report being obese. This may be due to the fact that participants were aware of the nature of the
Discussion and policy implications
Consistent with other recent surveys, this study confirms that there is strong public support for interventions aimed at reducing overweight and obesity among children and adolescents. Additionally, this is the first survey to compare and contrast support for specific types of childhood interventions that have recently been implemented or proposed. Such data are likely to be of great interest to policymakers and others who might consider endorsing specific interventions.
Overall, the public
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