childhood obesity: is there a public health crisis in...

MDM4U Summative Assignment

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Childhood Obesity: Is there a Public Health Crisis in Canada?


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Abstract

This study investigated childhood obesity in Canada to determine whether an

epidemic existed. Potential contributing factors, such as levels of physical activity,

sedentary activity and family income were also examined. All the data examined

from the Canadian Community Health Survey were extracted from E-Stat and

Statistics Canada and analyzed using correlation analysis and descriptive

statistics. Findings revealed no relation between levels of inactivity and obesity,

and a negative correlation between levels of physical activity and obesity. It was

concluded that there is an obesity epidemic among children in Canada.


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Executive Summary

The focus of this study was to investigate the obesity epidemic in Canada and to

determine what factors potentially have played a role in the high levels of obese

and overweight children in Canada. Studies examined through a literature review

found that two major causes of obesity were over eating and lack of physical

exercise. Along with no exercise, levels of inactivity or sedentary activity have

increased greatly as well. The studies unanimously concluded that prevention was

key to ending the worldwide obesity epidemic.

This study focused specifically on Canada with analyses illustrating that

approximately one in four Canadian children aged 2 to 17 were struggling with a

weight problem. It was also deduced that higher concentrations of overweight or

obese children were found in the Maritime Provinces. Analyses indicated that in

regions with increased levels of physical activity, the percentage of overweight or

obese children was lower, and that provinces with higher percentages of families

with low income had higher percentages of overweight or obese children. Data

concerning sedentary activity was limited and did not provide conclusive results.

Data were not available for children in the Northwest Territories and Yukon.

The research concluded that Canada is facing an obesity epidemic but there is no

single factor that has led to such high levels of overweight and obese children. It

was also discovered that the Maritime Provinces contained higher concentrations

of obese children than the other regions of Canada and that a negative correlation

exists between obesity rates and hours of physical activity. This means that the

more time spent exercising, the lower the percentage of obese or overweight

children. Lastly the study deduced that the percentage of low income families is

directly proportional to the percentage of the population who are overweight or

obese.


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Table of Contents

Rational for the Study 4-5

Literature Review 6-10

Research Methodology 11-12

Analyses & Findings

i. Is there an obesity epidemic in Canada? 13-15

ii. Is there a correlation between level of obesity and physical activity? 15-18

iii. Is there a correlation between level of obesity and sedentary activity? 18-21

iv. Is there a relationship between obesity and household income? 21-22

Conclusions 23-24

Appendices

i. Appendix A – Data Tables 25-27

ii. Appendix B – Newspaper Articles 28-29

References 30

Glossary 31


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Rationale for the Study

This study investigated the following four research questions:

Is there an obesity epidemic in Canada?

Is there a correlation between level of obesity and physical activity?

Is there a correlation between level of obesity and sedentary activity?

Is there a relationship between obesity and household income?

The study examined whether Canada, as a nation, was facing a childhood obesity

epidemic. From this, further analysis explored whether the percentage of obese or

overweight children varied from province to province, and if province of residence

had an effect on body mass index (BMI).

Following the initial analysis, the study examined possible factors linked to obesity

levels in Canada. Factors identified from the literature review, such as levels of

physical activity and levels of sedentary activity were investigated first. Cross-

province comparisons were done to determine linkage between levels of obesity or

overweight children residing in each province and levels of physical activity or

sedentary behaviour. A third factor, family income level, was researched with the

prospect of potentially detecting a link between low income and obesity.

The study was feasible however limitations to the data must be taken into

consideration. Limitations were as follows:

Children from the Northwest Territories and the Yukon were not included

in the study as there was no data available.

There was only data on physical activity for children between the ages of

6-11 and sedentary activity between the ages of 12-17 making a

comparison between the data sets unfeasible.


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No longitudinal data was available to look at changes over time so the

study examined only one point in time, the year 2004.

Based on the literature review, it was anticipated that results from the analysis

would lead to findings that supported other documented research which identified

physical inactivity as a contributing factor in obesity.

This study should appeal to educators, health practitioners, public health

educators and Canadian parents concerned with their children’s well-being.

From a personal point of view, this study is of interest because I am planning to

study medicine and hope to become actively involved in the field of child health.

For this reason, I am concerned about the impact on health care that childhood

obesity will have on our generation as a whole and for those to follow.


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Literature Review

Numerous issues related to obesity were identified in an important article

published in the prestigious medical journal The Lancet (Ebbeling, Pawlak, &

Ludwig, 2002). The study revealed that there had been a dramatic increase in

childhood obesity worldwide over the past two decades. Being overweight or

obese were major risk factors for a number of chronic diseases, including

diabetes, cardiovascular disease and cancer. Once considered a problem only in

developed countries, obesity was found to be on the rise in developing, low-

income countries as well.

Ebbeling et al., (2002) illustrated how research has provided new insights into the

causes of childhood obesity. Although genetic factors have played a role, the

sharp increase in childhood obesity rates suggested that it is predominantly

environmental factors that are the cause. Lack of physical activity, particularly TV

viewing, has been identified as a key factor. A national study in the U.S. showed

that children who engaged in little physical activity or spent long hours watching

TV were the most overweight. TV viewing not only replaced physical activity, it

increased the eating of energy-dense foods. The study also revealed that U.S. and

British children saw on average 10 food commercials per hour advertising fast

food, soft drinks, and sugar-sweetened cereals. This increased the likelihood that

children would make poor food choices.

According to the study (Ebbeling et al., 2002), fat intake has decreased over the

years and the proportion of total calories consumed as fat in the average diet is

diminishing. This however does not mean that fats are not a contributing factor in

the diet of obese children. Trans fats, commonly found in fast foods, have been

linked to an increased risk for heart disease and type 2 diabetes. While fat intake


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Literature Review Methodology As a first step, a comprehensive article in a well-known, prestigious journal that was identified. Ebbeling et al., (2002) identified 164 pieces of original research, reviews, and commentaries by searching computer databases—eg, Medline, PsycINFO, Agricola, Lexis-Nexis—and by reviewing issues of journals that publish obesity research. Next the findings of Ebbeling et al., (2002) were validated by comparing their study to several other childhood obesity studies found through a Google search. The findings of these studies reached many of the same conclusions as the Ebbeling et al., (2002) study. Finally, in order to determine if the same childhood obesity issues were present in Canada, a comprehensive study completed by Statistics Canada was compared to findings from the other studies reviewed.

has decreased, carbohydrate intake in the form of refined foods (such as bread,

cereal, soft drinks etc) has increased. Large portions of carbohydrate rich foods

produce high blood sugar levels which stimulate hunger and cause overeating.

Soft drinks are a common source of carbohydrates. Research has shown that total

energy intake was 10% higher among school children who drank soft drinks when

compared to those who did not. By contrast, milk (a low-sugar drink) has been

found to protect young adults from becoming obese.

The study (Ebbeling et al., 2002) also discussed how everyday family life had

changed over the past 20 years. Trends had developed in which eating out and

watching TV have become more

frequent and common activities.

At restaurants, children

consumed more energy due to

the larger serving sizes of energy

dense foods. It was also observed

that the presence of a TV in the

bedroom increased viewing by

approximately 38 minutes a day.

By contrast, eating family dinners

together reduced the hours of TV viewing and improved diet quality. Time spent

together as a family also provided social support for children which in turn

increased participation in physical activity.

Ebbeling et al., (2002) also investigated prevention and treatment of childhood

obesity. Treatment solutions such as eating smaller portions and being more

active have proved to be challenging. Earlier studies had determined that long-

term weight loss was very difficult to achieve, thus, prevention had become more


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of a main focus. Unfortunately, many have invested in family-based or school-

based programs and few of these programs have shown any long-term benefits.

The study (Ebbeling et al., 2002) concluded that childhood obesity has risen at

alarming rates worldwide. It was also found that obesity has been linked to the

development of serious medical complications both physically and psychologically.

Better prevention and treatment methods need to be developed and more

research and study is required to solve this public health crisis.

In order to further validate the findings of Ebbeling et al., (2002), a comparison

was done between their findings and a number of other childhood obesity studies.

The first study examined (Daniels et al., 2005) came to a similar conclusion that

the number of overweight children and adolescents had increased dramatically

and that this in turn had led to a number of negative health effects including type

2 diabetes and high blood pressure. Their research suggested that the best

approach to this problem was prevention of abnormal weight gain.

A second study (Dehghan, Akhtar-Danesh, & Merchant, 2005) stated that

childhood obesity had reached epidemic levels in developed countries. Twenty-five

percent of children in the U.S. were overweight and 11% were found to be obese.

In the future, this will have serious impacts on both physical and psychological

health. Dehghan et al., (2005) found that both over eating and reduced physical

activity were causes of childhood obesity. They found that almost all researchers

agreed that prevention could be the key strategy for controlling the epidemic.

Efforts to change behavior of individuals in diet and exercise have not worked in

stopping the epidemic. Because it is difficult to lose weight once it has been

gained, they concluded that children should be the priority for intervention

strategies and that pre-school, in-school, and after-school should be the target

periods for changing diet and exercise.


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The literature review indicated consistent findings across all research reviewed.

The following are key points of agreement:

Childhood obesity has reached epidemic proportions in developed

countries.

The main causes are over eating and lack of physical exercise (this includes

eating too much fast food and watching too much TV).

Childhood obesity leads to serious medical problems (both physical, such

as heart disease and type 2 diabetes, and psychological, such as

depression and poor self esteem).

Prevention appears to be the key because once extra weight is gained, it is

extremely difficult to lose it.

Although eating less and being more active seem like simple steps to take,

efforts to prevent childhood obesity haven’t worked and this serious

problem has grown to epidemic proportions.

More research is required to find better ways to prevent the childhood

obesity epidemic.

The next step in the literature review was an examination of the Canadian

context. It was essential to determine if a similar epidemic was in existence in

Canada. A Statistics Canada study (Shields, 2008) showed that in 1978/79, 12%

of 2 to 17 year olds in Canada were overweight, and 3% were obese—a

combined overweight/obesity rate of 15%. By 2004, the overweight rate for this

age group was 18% (an estimated 1.1 million), and 8% were obese

(approximately half a million) for a combined rate of 26%.


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Shields (2008) suggests that contributing factors involved in the increase of

childhood obesity in Canada included increased consumption of fast food and

more time spent watching TV, playing video games and computer usage. The

study also showed that children who were overweight reported more health

problems. The research concluded that some of the factors causing overweight

and obesity among young people could be changed. Increased consumption of

fruit and vegetables, more physical activity and less time spent watching TV and

playing video games could contribute to reversing the problem.

Two recent articles published in the Ottawa Citizen illustrated that prevention is

still a main focus in the battle against obesity. Sibley (2011) wrote that First Lady

Michelle Obama and Walmart had formed an alliance in which Walmart will now

cut the amounts of sodium and added sugars in packaged foods and reduce the

costs of fruits, vegetables, and healthy alternatives to snack foods. This will

increase the availability of healthy foods to low income families and help in

promoting a healthy diet – a key factor in reducing levels of obesity. Walmart

Canada Corp has stated that it will aim to buy locally grown foods in order to

reduce the prices of fresh produce in stores across the nation.

The second article (Cleary, 2011) stated that in Ottawa, Mayor Jim Watson, had

proposed in his 2011 draft budget that recreational venue user fees would be

frozen for the next four years. High rental fees have kept many children out of

sports and if they continue to climb, would threaten the activity levels of more

children. The Mayor stated that obesity has become a huge problem and freezing

user fees will remove financial barriers and encourage people to get active – the

second key ingredient in lowering obesity rates.


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Research Methodology

With the research questions in mind, relevant data sets on E-Stat and Statistics

Canada were scanned to determine which would be most appropriate to support

the analyses and address the research questions.

Data regarding the body mass index of children in the age categories of 2 to 17; 6

to 11; and 12 to 17 were extracted from the 2004 Canadian Community Health

Survey (CCHS) located on E-Stat. Data were found in the category – health,

subcategory lifestyle and social conditions, Table 105-2002 – Measured child body

mass index (BMI), by age group and sex, household population aged 2 to 17

excluding pregnant females, Canadian Community Health Survey cycle 2.2,

Canada and provinces, occasional.

Data concerning the number of hours of physical activity and sedentary activity

were extracted from the same category, subcategory and study on E-Stat. Hours

of physical activity were determined using Table 105-2003 – Children's

participation in physical activities, in hours per week, by sex, household

population aged 6 to 11, Canadian Community Health Survey cycle 2.2, Canada

and provinces, occasional. Hours of sedentary activity were determined from Table

105-2005 – Children's participation in sedentary activities, in hours per week, by

age group and sex, household population aged 12 to 17, Canadian Community

Health Survey cycle 2.2, Canada and provinces, occasional.

Low income data were collected from Statistics Canada under publication

13F0022X – Income Trends in Canada, Table 2020408 – Distribution of total

income, by census family type, 2007 constant dollars, Canada, provinces and

select CMAs. Data from the year 2004 was used. To determine the percentage of

Canadian families who qualified as low income earners, the low income cut off


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(LICO) rates of 2004 were determined using the model developed by the Canadian

Council on Social Development. The LICO rate of 2004 was rounded to an annual

salary figure of $24,999.


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Analyses & Findings

Is there an obesity epidemic in Canada?

Over the past few decades, childhood obesity has become an increasing issue in

nations all over the world. Is there a similar concern in Canada?

An initial search was conducted to find and determine the breakdown, in

percentage, of Canadian children with or without a weight problem. Figure 1

illustrates the percentage of Canadian children with a healthy body mass index

(BMI) versus those who would be considered overweight or obese. Despite the

high percentage of children who are not overweight or obese, there is still a large

number of children carrying unhealthy weight. The combined percentage of

children who are overweight or obese is approximately 26.2%. This indicates that

approximately one in four Canadian children, aged 2 – 17 are struggling with a

weight problem. A more in-depth analysis was needed to better understand this

figure and the following sub-questions were explored: how does the percentage of

Figure 1. Measured BMI of Canadian children, 2004. Data sourced from E-Stat. Data Table found in Appendix A, Table 1.1.


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overweight and obese children differ from one province to another?; and, does

geography have an effect on BMI?

0

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60

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Neither Overweight Nor Obese

Overweight Obese

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Measured Child BMI

Measured BMI of Children Aged 2-17 By Province

Newfoundland & Labrador

Prince Edward Island

Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

British Colummbia

A more thorough look at the breakdown of BMI by province was conducted to

further examine obesity in Canadian children. Figure 2 shows the breakdown of

BMI for Canadian children by province relative to each province`s population. The

graph is further subdivided into three regions with dark blue representing the

Maritime Provinces, Central Canada in green, and the Western Provinces in light

blue.

After reviewing, it is evidence that the Maritime Provinces have the largest

concentration of obese or overweight children, averaging around 16.6% of their

population aged 2 – 17 years. Three of the four highest percentile provinces of

obese children come from the Maritimes. Newfoundland (16.6%) is the highest,

followed by New Brunswick (13.1%) and Nova Scotia (9.4%). Central Canada and

Figure 2. Measured BMI of Canadian children by individual province, 2004. Graph reads from left to right in correspondence to the legend. Data sourced from E-Stat. Data Table

found in Appendix A, Table 1.2.


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the Western provinces have on average only 13.2% of their populations in the

obese or overweight categories.

It is also noted that Central Canada and the West have five of the top six highest

concentrations of children who are neither obese nor overweight.

This information would suggest that Canada is part of the childhood obesity

epidemic. Further analysis examining potential contributing factors will assist in

understanding why the percentage of overweight or obese children in Canada is so

high? It will also be important to understand why the Maritime Provinces have

such high percentages of obese children? A closer look at these factors will help

determine answers to these questions.

Is there a correlation between level of obesity and physical activity?

Exercise and physical activity are known methods of staying fit, keeping in shape,

and maintaining a healthy weight. Therefore it is logical that the more hours of

physical activity undertaken should lower the percentage of overweight and obese

children.

0

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Less Than 7 Hours Per

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7 to 13 Hours Per

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14 to 20 Hours Per

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21 Or More Hours Per

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Hours of Physical Activity Per Week

Hours of Physical Activity Per Week of Children Aged 6-11



Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

British Columbia

Figure 3. Hours of physical activity per week, 2004. Graph reads from left to right in

correspondence to the legend. Data sourced from E-Stat. Data Table found in Appendix A, Table 1.3.


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Figure 3 shows the number of hours of physical activity for children aged 6-11.

As is evident from the figure, most children spend between 7 and 20 hours a week

engaging in physical activity. At this age, children are in elementary school where

physical education classes are a mandatory requirement of the curriculum. This

helps keep kids active, a key factor in maintaining a healthy weight.

Figure 4 illustrates the BMI breakdown of children aged 6-11 by province

(excluding the 2-5 year olds and 12-17 year olds). With this smaller age sample,

the Maritimes continue to have a larger percentage of obese children than other

regions of Canada but the gap is not as significant as the one in Figure 2 (ages 2-

17).

0102030405060708090

Neither Overweight Nor Obese

Overweight Obese

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Measured BMI

Measured BMI of Children Age 6-11 By Province



Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

British Columbia

Using Figure 3 as a reference point, it has been observed that Newfoundland has

the lowest percentage of children participating in physical activity for 21 hours or

more a week. Newfoundland also has a higher percentage of overweight or obese

children than other provinces.

Figure 4. Measured BMI of Canadian children aged 6-11 by individual province, 2004. Graph reads from left to right in correspondence to the legend. Data sourced from E-Stat.

Data Table found in Appendix A, Table 1.4.


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Quebec has the lowest percentage of obese children, second lowest percentage of

overweight children, and the highest percentage of normal weight children. Based

on these statistics and given the strong link between physical activity and healthy

weight, one would assume that children in Quebec would be participating in a high

number of hours of physical activity per week. However, Quebec has by far the

highest concentration of children participating in less than 7 hours a week and a

very small percentage participating in 14 hours of physical activity or more a

week. These findings are counter to what was originally hypothesized.

Furthermore, British Columbia has the highest percentage of children participating

in 21 or more hours of physical activity a week. It also has the second lowest

percentage of obese children at 7.5%.

R² = -0.8048

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Average Number of Hours of Physical Activity Per Week

Average Number of Hours of Physical Activity Versus Provincial BMI Breakdown

Knowing that exercise and physical activity help maintain a healthy weight, it was

assumed that there would be a negative correlation between the hours of physical

activity per week and the level of obese children. Figure 5 displays the correlation

between the average number of hours of physical activity by province and the

percentage of obese children present in that province. As predicted the correlation

Figure 5. Correlation between physical activity and percentage of obese children. Data sourced from E-Stat. Data Table found in Appendix A, Table 1.5.


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was negative, however it was not very strong, R2=-0.1273. When Quebec and

Saskatchewan data were excluded, the correlation increased drastically,

R2=-0.8048. In this case Quebec and Saskatchewan were outliers in that their

data did not follow the trend set by the other provinces. Quebec had an extremely

low percentage of obese children and Saskatchewan had the highest average

hours of physical activity per week yet still had a high percentage of obese

children.

Is there a correlation between level of obesity and sedentary activity?

Based on the literature in which there is a clear link between inactivity and

obesity, one would assume a similar relationship should exist for Canadian

children.

0

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40

Less Than 10 Hours

Per Week

10 to 19 Hours Per

Week

20 to 29 Hours Per

Week

30 to 39 Hours Per

Week

40 Hours Or More

Per Week

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Hours of Sedentary Activity Per Week

Hours of Sedentary Activity Per Week of Children Aged 12-17 Newfoundland &

LabradorPrince Edward Island

Nova Scotia

New Brunswick

Quebec

Ontario

Manitoba

Saskatchewan

Alberta

British Columbia

Figure 6 shows the average number of hours of sedentary activity per week of

children aged 12 – 17. The largest percentages of children spend between 20 to

29 hours a week simply doing nothing. This averages out to approximately a full

day per week of watching TV or playing video games. Provinces with high

Figure 6. Hours of sedentary activity per week, 2004. Graph reads from left to right in correspondence to the legend. Data sourced from E-Stat. Data Table found in Appendix

A, Table 1.6.


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concentrations of sedentary activity were thought to have higher percentages of

obese children between the ages of 12 and 17.

Figure 7 shows the measured BMI of children aged 12-17 by province. It is

important to note that in comparison to the data presented in Figure 4, the

population of Canadian children who are obese has increased. As in the two

previous BMI graphs, the Maritimes, and more specifically Newfoundland, had the

highest percentage of obese children, averaging to approximately 14.2% of the

total population. However, Figure 6 illustrated that Newfoundland and New

Brunswick, the two provinces with the highest percentage of obese children, had

the least sedentary population of children. The percentage of children participating

in 30 hours of sedentary activity or more was noticeably lower than the majority

of the other provinces. This observation contradicts the findings in Figure 7.

It was also observed that in Figure 4, Quebec had the lowest percentage of obese

children. In Figure 7, the percentage of obese children in Quebec increased by

2.7% when we shifted to the older age group. This indicated that an increase in

age does have an effect on levels of obesity.

Figure 7. Measured BMI of Canadian children aged 12-17 by individual province, 2004. Graph reads from left to right in correspondence to the legend. Data

sourced from E-Stat. Data Table found in Appendix A, Table 1.7.


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Additionally, Figure 7 showed that British Columbia had the lowest percentage of

obese children. This however does not align with Figure 6 which indicated that

British Columbia had the second highest percentage of children participating in

over 40 hours of sedentary activity per week.

R² = -0.822

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Average Number of Hours of Sedentary Activity Per Week

Average Number of Hours of Sedentary Activity Versus Provincial BMI Breakdown

In order to examine the relationship between obesity and sedentary activity, a

correlation was completed. Figure 8 shows the correlation between average

number of hours of sedentary activity versus the percent of obese children. It was

originally believed the correlation would be positive, the more time spent being

inactive would lead to more obese children. Surprisingly, the correlation was

negative, suggesting that the more hours of sedentary activity, the lower the

percentage of obese children. Figure 8 does not include the provinces of Quebec

and Ontario because they were outliers. Quebec had a very low average number

of hours of sedentary activity yet still had a low percentage of obese children and

Ontario had a very high average of sedentary activity and a relatively high

percentage of obese children.

Figure 8. Correlation between sedentary activity and percentage of obese children. Data sourced from E-Stat. Data Table found in Appendix A, Table 1.8.


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Is there a relationship between obesity and household income?

Enrolling children in organized sport or going to the gym to exercise can be

expensive. Some families are able to afford this additional cost, however, others

struggle to have food on the table.

This final analysis examines the relationship between low income families and

obese children. Figure 9 demonstrates the breakdown of Canadian families whose

annual salaries fall below the low income cut off (LICO) and those whose salaries

lie above. Figure 9 indicates that on average the Maritimes have a higher

percentage of families below the LICO.

It was determined that Newfoundland has a combined total of approximately

35.6% of youth who are obese or overweight. This was the highest combined total

of any province. Newfoundland also has the highest percentage of low income

families at 37.7%. When the combined percentages of overweight and obese

children of every province were compared to the percentage of low income

families, it was observed that the two values were similar. Table 1 shows the

Figure 9. Low income family distribution across Canada, 2004 LICO figure. Data sourced from Statistics Canada. Data Table found in Appendix A, Table

1.9.


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comparison between low income and overweight or obese children in each

province. Both values tend to differ by only a few percentile with exception to

Quebec and British Columbia.

Province Percentage of Low Income

Families

Combined Percentage of Overweight and

Obese Children

NL 37.7% 35.6%

PEI 29.3% 30.2%

NS 32.2% 32.0%

NB 32.9% 34.2%

QC 30.4% 22.6%

ON 27.2% 27.5%

MN 29.7% 30.8%

SK 32.2% 29.1%

AB 24.9% 21.8%

BC 31.0% 26.3%

Table 1. Percentage of low income families compared to the combined percentages of overweight and obese children, by province. Data sourced from E-Stat and

Statistics Canada.


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Conclusions

Findings from the study demonstrated that Canada is facing a childhood obesity

epidemic. It was also identified that there is no single factor that has led to the

high levels of overweight and obesity among Canadian children. More research

needs to be conducted in order to better understand factors contributing to the

epidemic.

Findings revealed that the Maritime Provinces have higher levels of overweight

and obese youth than other regions of Canada. However, this area of research

needs to be examined more closely in order to uncover the causal factors

influencing the high obesity rates on the East coast.

Furthermore, it was concluded that a negative correlation existed between levels

of physical activity and childhood obesity. Meaning that the more time spent

exercising, the lower the percentage of obese children in Canada. This finding is

encouraging in that it is supported by the existing research literature and helps to

explain at least in part why Canada`s children are overweight. Further research

will be required into a number of areas in order to understand additional factors

contributing to obesity. For example, it would be interesting to conduct a

provincial comparison across physical education policies in elementary and high

schools to determine whether mandatory physical education programming has an

influence on the incidence of overweight or obese children.

The study also looked at the relationship between sedentary activity and levels of

obesity. Unfortunately, findings did not align with the current research literature

and in fact, showed the opposite relationship to the anticipated trend. It`s

possible the data that was used for analysis was not sensitive enough to detect

the correlation. A study designed to specifically examine the impact of low activity


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levels on BMI would be required as follow-up. One possible design could include a

longitudinal study in which a group of children are monitored throughout high

school and post-secondary education (into young adulthood) in order to observe

more closely contributing factors related to weight gain, sedentary behaviour and

physical activity.

It was observed that obesity levels did increase with age, but due to time

limitations, no analyses were done to examine this more closely. It was also

unclear whether or not the sample of children reporting high levels of sedentary

activity participated in physical activity as well. If this were the case, any negative

effects of inactivity would be negated by the activity.

The low income analysis produced interesting results and some potential insights

for future research. It was determined that the percentage of families below the

LICO was proportional to the percentage of overweight and obese children.

Nonetheless, the data did not take into account families just above the LICO

whose annual salaries may be ten to twenty thousand dollars above the cut off but

who are still struggling. This however was only a link and further examination

needs to be done to understand how income might be a contributing factor in

childhood obesity.

Findings from this study would be of interest to public health policy and program

experts working in the area of child health. For example, if the federal and

provincial governments were interested in making improvements in the health of

the child population, they could look at these data to determine whether the

Maritimes are a specific concern or if targeting low income families would aid in

lowering the childhood obesity levels across Canada.


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_______________________________________________________________________ 25 January 2011

Appendix A – Data Tables

Table 1.1 - Measured BMI of Children Aged 2-17 in Canada

Table 1.2 - Measured BMI of Children Aged 2-17 in Canada by Province

Table 1.3 - Hours of Physical Activity per Week of Children Aged 6-11 by Province


Measured Child BMI Percentage

Measured Child BMI, neither overweight nor obese

73.8

Measured Child BMI, overweight 18

Measured Child BMI, obese 8.2

Measured Child BMI Newfoundland

& Labrador Prince Edward

Island Nova Scotia

New Brunswick

Quebec Ontario Manitoba Saskatchewan Alberta British

Columbia

Measured Child BMI, neither overweight nor obese 64.4 69.8 68 65.8 77.4 72.5 69.2 70.9 78.2 73.6

Measured Child BMI, overweight 19 22.4 22.6 21.1 15.5 19 21.9 18.8 14.3 19.7

Measured Child BMI, obese 16.6 7.8 9.4 13.1 7.1 8.5 8.9 10.3 7.5 6.6

Hours of Physical Activity Per Week



Nova Scotia

New Brunswick


Columbia

Children's physical activity, less than 7 hours per week 18.5 8.8 16.9 14 26.4 13.4 12.3 11.4 9.4 14.3 Children's physical activity, 7 to 13 hours per week 54.3 40.5 41.7 44.1 44.1 42.8 39 31.3 34.8 35

Children's physical activity, 14 to 20 hours per week 23.1 42.2 29.1 30.7 22.2 33.9 37.6 44 42.1 34.9

Children's physical activity, 21 or more hours per week 4.1 8.5 12.3 11.2 7.3 8.7 10.9 12.9 11.4 15



Island Nova Scotia

New Brunswick


Columbia

Measured Child BMI, neither overweight nor obese

62.4 70.7 75 72.9 81.6 70.5 70.3 76.6 80.6 70.2

Measured Child BMI, overweight

25.1 21.1 16.8 16.7 12.5 20.8 21.9 13.5 11.1 22.3

Measured Child BMI, obese 12.5 8.2 8.2 10.5 5.9 8.7 7.8 9.9 8.3 7.5


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_______________________________________________________________________ 26 January 2011

Table 1.5 – Average Number of Hours of Physical Activity vs. Percentage of Obese Children

Table 1.6 - Hours of Sedentary Activity per Week of Children Aged 12-17 by Province


Province Average number of hours

of physical activity per week

Percentage of Population


9.91 12.5

Prince Edward Island 13.28 8.2

Nova Scotia 11.84 8.2

New Brunswick 10.04 10.5

Quebec 10.47 5.9

Ontario 12.27 8.7

Manitoba 12.95 7.8

Saskatchewan 13.64 9.9

Alberta 13.31 8.3

British Columbia 13 7.5

Hours of Sedentary Activity Per Week



Nova Scotia

New Brunswick


Columbia

Children's sedentary activities, less than 10 hours per week

26.1 12.2 12.6 24.8 20.5 12.4 12.8 18.4 14.1 13.2

Children's sedentary activities, 10 to 19 hours per week

29.5 33.1 30 28.6 33.7 24.3 26.4 27.4 30.5 25.5


22.2 33.5 32.6 28.6 29.9 34.4 35.2 31.9 29.5 32.6


12.1 11.1 16.9 6.5 9 15.3 13.5 12.9 14.6 15

Children's sedentary activities, 40 hours or more per week

9.8 10.1 8 11.4 6.8 13.3 12.2 9.3 11 12.5



Island Nova

Scotia New

Brunswick Quebec Ontario Manitoba Saskatchewan Alberta

British Columbia

Measured child BMI, neither overweight nor obese

59.5 70.9 65.4 58.1 75.6 71.4 63.8 62.7 69.7 70.9

Measured child BMI, overweight

20.3 20.8 24.1 23.9 15.8 19.4 25.7 26.5 20.2 22.3

Measured Child BMI, obese 20.2 8.2 10.5 18 8.6 9.2 10.5 10.9 10.1 6.9


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_______________________________________________________________________ 27 January 2011

Table 1.8 - Average Number of Hours of Sedentary Activity vs. Percentage of Obese Children

Province Average number of hours of sedentary activity per

week

Percentage of Population


19 20.2

Prince Edward Island 21.4 8.2

Nova Scotia 21.9 10.5

New Brunswick 19.1 18

Quebec 14.6 8.6

Ontario 23.1 9.2

Manitoba 22.6 10.5

Saskatchewan 20.8 10.9

Alberta 21.7 10.1

British Columbia 22.4 6.9

Table 1.9 - Low Income Distribution in Canada by Province

Income Status Newfoundland


Island Nova Scotia

New Brunswick


Columbia

Annual Salary Below LICO ($24,999 and below)

37.7 29.3 32.2 32.9 30.4 27.2 29.7 32.2 24.9 31

Annual Salary Above LICO ($25,000 and above)

62.3 70.7 67.8 67.1 69.6 72.8 70.3 67.8 75.1 69


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_______________________________________________________________________ 28 January 2011

Appendix B – Newspaper Articles

Cleary, M. (2011, January 22). Watson’s freeze a crowd favourite. The

Ottawa Citizen, pp. G1, G2.


________________________________________________________________________

_______________________________________________________________________ 29 January 2011

Sibley, R. (2011, January 21). New alliance in the war on obesity. The Ottawa

Citizen, p. A6.


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_______________________________________________________________________ 30 January 2011

References

Cleary, M. (2011, January 22). Watson’s freeze a crowd favourite. The Ottawa

Citizen, pp. G1, G2.

Daniels, S. R., Arnett, D.K., Eckel, R.H., Gidding, S.S., Hayman, L.L., Kumanyika,

S, et al. (2005). Overweight in Children and Adolescents Pathophysiology,

Consequences, Prevention and Treatment. Retrieved January 9, 2011 from

http://circ.ahajournals.org/cgi/content/full/111/15/1999#SEC3

Dehghan, M., Akhtar-Danesh, N., Merchant, A., (2005). Childhood obesity,

prevalence and prevention. Retrieved January 9, 2011 from

http://www.nutritionj.com/content/4/1/24

Ebbeling, C.B., Pawlak, D.B., Ludwig, D.S., (2002). Childhood obesity: public

health crisis, common sense cure. Retrieved January 2, 2011 from

http://www.allhealth.org/briefingmaterials/lancetobesityrev-393.pdf

Shields, Margot. (2008). Overweight Canadian children and adolescents.

Retrieved January 9, 2011 from http://www.statcan.gc.ca/pub/82-620-

m/2005001/article/child-enfant/8061-eng.htm

Sibley, R. (2011, January 21). New alliance in the war on obesity. The Ottawa

Citizen, p. A6.

http://circ.ahajournals.org/cgi/content/full/111/15/1999#SEC3


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_______________________________________________________________________ 31 January 2011

Glossary

Body Mass Index (BMI)

A measure of someone's weight in relation to height; to calculate one's BMI,

multiply one's weight in pounds and divide that by the square of one's height in

inches; overweight is a BMI greater than 25; obese is a BMI greater than 30.

Chronic Disease

A serious disease lasting for a long time.

Epidemic

Of disease or anything resembling a disease; attacking or affecting many

individuals in a community or a population simultaneously.

Low Income Cut Off (LICO)

Commonly known as poverty lines, the low income cut off is an annual salary

figure that unofficially measures poverty. Individuals falling below the LICO are

considered to have a low income and be living in poverty.

Obesity

Overweight and obesity are defined as abnormal or excessive fat accumulation

that presents a risk to health. A crude population measure of obesity is 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

obese. A person with a BMI equal to or more than 25 is considered overweight.

Sedentary

Accustomed to sit or rest a great deal or to take little exercise.

Type 2 Diabetes

Diabetes mellitus type 2 or type 2 diabetes (formerly called non -insulin-

dependent diabetes mellitus (NIDDM), or adult-onset diabetes) is a disorder that

is characterized by high blood glucose in the context of insulin resistance and

relative insulin deficiency.

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