School of Nursing
Online Journal

Does Socioeconomic Status effect the rates of childhood obesity in New Zealand?

Charlotte Paterson

Introduction

It is no surprise that obesity has become an epidemic globally. New Zealand has considerably high obesity rates, with the third largest percentage of children who are obese or overweight in the world (BPAC, 2012; Kelly & Swinburn, 2015). Not only is it a growing concern for adults but increasingly so, in children. Statistics show that one in nine children in New Zealand alone are obese – that’s a staggering 11% of children that are obese (MOH, 2016; Kelly & Swinburn, 2015). Children are also three times as likely to be obese if they are living in deprived areas (MOH, 2016). This includes families living in lower socioeconomic areas, children attending lower decile schools and families living in poverty. Socioeconomic status (SES) is split into three categories those being low, middle and high SES – this is a statistical measure of one’s income, occupation, and education in relation to where they sit in the categories (Germov, 2014).

Obesity is one of the most significant health problems in New Zealand that is preventable. If caught in the early stages and good habits are taught young, we can reduce the rate that we are currently seeing (BPAC, 2012). A study undertaken in New Zealand from 1977 until 2003 showed a steady increase in the rate of obesity from just under 10% of the total population to just above 20% (MOH, 2004). These rates are focused on adults not children, but the rates have doubled in just under 30 years, which can be a flow on effect from childhood obesity.

Clinical Issue

Obesity is a topic of interest for many health professionals.  Primary health and Practice nurses often get the most one on one time with children and parents, therefore need to have the knowledge and information on hand. SES has an immense impact on health, in particular childhood obesity, and this warrants further exploration.  

Search Question Identified

Schneider, Whitehead, LoBiondo-Wood, & Haber (2013) PECOT model (below) was used to formulate the question “Does Socioeconomic Status effect the rates of childhood obesity in New Zealand?”  Through understanding cultural influences, looking at the cost of food, finding out the implications of childhood obesity and comparing New Zealand statistics to other countries, the impact of socioeconomic status on childhood obesity is explored.

Evidence and findings

According to the literature of Sutherland, Finch, Harrison and Collins (2008) a study undertaken in New South Wales, Australia, assesses the reality of socio economic status (SES) and childhood obesity. Through the research of primary and secondary aged school children (5-18 year olds) from low, middle and high SES families, a pattern became clear. 56.6% of male and female students were classed as overweight or obese. In regards to SES the proportion of students living in a low SES the rate of obesity was 5.2% higher than those living within a high SES (Sutherland, Finch, Harrison & Collins, 2008). Not only is this a concerning rate but the most prominent age of children first showing that they are obese were between the ages of six and seven. Living and attending school in a lower SES children were shown to be 1.5 times more likely to be in the obese and overweight group (Sutherland, Finch, Harrison & Collins, 2008). The ability to afford out of school activities such as sports groups proved to be challenging which also has an impact on the rates of obesity. Physical activity or the lack of is not the leading cause of obesity but it is a recognised factor that needs to be addressed.

In 2006 O’Dea completed a study whereby she not only looked at SES but the ethnic groups, gender and culture. The findings of this study showed that children in the lower SES were at the highest risk of becoming or already being obese. It stated that overweight was becoming the ‘norm’ as it was so prevalent and body image perceptions were seeing excess weight as acceptable, or even desirable (O’Dea, 2006). This can be seen in New Zealand as cultural preferences/values/norms of what was seen as beautiful is varied by different cultural and ethnic groups. New Zealand statistics show that people of Pacific Island and Maori decent are more likely to be obese than those of European decent (MOH, 2016; Statistics NZ, 2015). Pacific Islanders do not see obesity as being an issue – studies show that overweight or obese Pacific people have a positive perception of their body image and see themselves as healthy as those of a normal weight (Brewis, McGarvey, Jones & Swinburn, 1998; Teevale, 2011). Although they may not be entirely happy with their weight they do not see their weight as a health risk. Cultural influences and behaviours are very much a factor for childhood obesity - what we are surrounded with as we grow up is what we perceive to be ‘normal’.

Nine out of ten parents in New Zealand of obese children perceived their child to be a normal weight (Kelly & Swinburn, 2015). This shows us that parents are not educated on what a normal child’s weight looks like therefore are not doing anything to fix it. Parents play a huge role in reducing the statistics we currently see as they are the primary role model. Nutrition is the key component to weight loss, it does not matter how much you exercise if you are not eating right nothing changes (Kelly & Swinburn, 2015). Children cannot be blamed for the obesity epidemic, they can only do with what their parents give them. Before school checks (B4SC) are part of the New Zealand government initiative for childhood obesity which targets the preschool aged children. Each child needs to have these checks before they start attending their chosen school. The routine tests are done including height and weight and if the nurse or general practitioner (GP) are concerned they will be offered a referral for clinical assessment, family based nutrition, lifestyle interventions and activity (MOH, 2017). The aim of the B4SC is to identify 95% of obese children by December 2017, this then gives the government statistics and information to create new strategies and targets (MOH, 2017). For those who are living in lower SES areas access to health care can be difficult, for many transportation is an issue therefore children who are sick or are offered a referral to see a specialist can turn these down as it is too hard to get their children to the GP. Parents need to be educated and informed of just how serious their child’s weight is to their health.

The price of healthy food for someone of a lower SES or single income is almost impossible. Diet is the most important factor in reducing the obesity epidemic but with healthy food costing on average 40-50% of ones total income puts a strain on those living within that lower SES (Kelly & Swinburn, 2015; Robinson, 2010). A study in 2010 carried out in Wellington showed a range of scenarios for families and single parents living off either minimum wages or on a benefit. For a single mother of two children who relies on the benefit for income will get roughly around $500 per week, with this she must cover rent, other bills, transportation and school fees. To provide her family with a ‘basic’ balanced diet after rent is 42.1% of her income – this is a huge amount of money needed to provide a healthy diet (Robinson, 2010).This illustrates how hard it must be to afford healthy food for a family living on a lower income. The saying ‘you are what you eat’ is exactly true when it comes to obesity – of course genetic factors do contribute to the overall build of a child but food fuels the body and the mind (Farrell & Dempsey, 2010). The median income in New Zealand for someone of Pacific Island ethnicity is $19,700 whereas for a European adult it is $30,900 – this is a significant different in yearly wages for two different ethnic groups (Statistics New Zealand, 2013). This confirms that there is a SES difference between the two ethnicities that is contributing to the number of Pacific Island and European children that present as obese.

The implications of childhood obesity can lead to many different factors - cardiovascular disease, diabetes, and musculoskeletal disorders such as osteoarthritis (MOH, 2016). O’Dea 2006 states that actual risk of heart disease, hypertension and diabetes are an assumed risk in the future rather than an accurate diagnosis of a condition as a child. Statistics do show that the more overweight you are the more likely you are to have comorbidities affecting your health (O’Dea, 2006; Sutherland et, al., 2008). Practice nurses and primary health care nurses who work within the community have the most contact with these children, therefore patient and parent education needs to be established as early as possibly, primary intervention – where we want to educate and promote wellness. School activities and programmes like ‘Jump Jam’, ‘Push Play’ and ‘5+ a day’ all promote healthy living and eating within school time (NZ Nutrition Foundation, 2013; Te Ara, 2013). Not only do the likes of Jump Jam provide regular exercise routines for children but it also offers interschool competitions making it fun (Jump Jam, 2017).

Studies in Australia, America and China show the comparison on rates of childhood obesity to New Zealand. In all of these countries childhood obesity is an epidemic, a study in America stated that the prevalence of obesity has doubled over the last three decades (Fredrick, Snellman & Putman, 2014). A study in China showed that that the childhood obesity rate has changed over the last twenty years from 2.6% to 15.05% (He, James, Merli & Zheng, 2014; Wang & Lim, 2012). This is a huge percentage change considering there are 1.37 billion people that live in China (Live Population, 2017). 19-23% of Australian children are classified as overweight or obese which is double over the last thirty years (Sutherland et. al, 2008). These statistics give a direct comparison with New Zealand data and demonstrates a need for strategies and initiatives to be put in place. SES has shown to play a role in all of the countries stated above with the same conclusion that the lower the SES the higher rates of obesity and the higher the SES the lower the prevalence of obesity (Fredrick et, al., 2014; He et, al. 2014; Sutherland et, al., 2008; Wang & Lim, 2012).

Implications on clinical practice

The implications for clinical practice are increasing, the amount of funding spent on obesity alone in New Zealand is rising by the year. An in depth study in 2006 found that 4.5% of the total health care expenditure of New Zealand was being spent on obesity alone (Parliamentary Library, 2014). That was estimated at $686 million dollars per year on a preventable disease. The health system is trying to provide suitable care for overweight and obese patients on hospital wards but are finding that they need to purchase bigger beds, wheel chairs and commodes (Stuff, 2011). This is funding that could be used on advancing medical procedures but is instead having to be used on new equipment to provide care for obese patients. If obesity is caught in childhood there is more chance of getting it under control before it leads into adult obesity and the need for more equipment. Kelly & Swinburn (2015) show that 80% of children who are obese will go on to be obese as adults. There does need to be a focus on the lower SES of New Zealand in regards to childhood obesity, preventing this disease from continuing throughout a life time is something registered nurses and other professionals should be aiming towards. It is a responsibility to the world of health to reduce the statistics we are seeing and change the cultural ‘norms’ (Brewis et, al., 1998; Teevale, 2011).

Recommendations

Socioeconomic status is something that health professionals cannot change, they can be aware but cannot change patient’s circumstances. In regards to health care it is important to know what services are available within the community especially those in a lower socioeconomic area. Childhood obesity is unfortunately a risk factor of low SES as we can see through the literature. Although this is not to say that the prevalence is not higher than it should be among middle and high SES children (Sutherland et. al, 2008). Education needs to be readily available and regularly updated for registered nurses particularly those who work in a primary or community setting.

Many health care professionals may find the topic of obesity challenging. It is a topic that needs to be taken seriously when providing information to patients. Educating the health care team on risk factors for childhood obesity will not only improve professional knowledge but being able to understand that those who are living in a lower SES could need followed up. Knowing who is more at risk saves time and targets key populations when doing a routine check-ups for example, the B4SC where the New Zealand government aim to identify 95% of obese under 5’s by December 2017 (MOH, 2017).

Interventions will be more successful if children are the target audience, although parents are the ones who are providing for their child if children are seeing what is right and wrong they will be more aware of the decisions they make. Physical activity like ‘Jump Jam’ are targeting the right audience, they are making exercise fun for young kids and part of a daily or weekly routine. Education in schools no matter what the SES provides information for all kids to see the healthy options. Visual options for kids like posters around schools or child friendly areas are a constant reminded of healthy options. Regardless on the SES of the school, the Ministry of Education should send a package out to schools containing posters and learning information about healthy living and eating. The fact that society is normalising overweight or obesity is concerning and is something that needs to change.

Conclusion

In conclusion, childhood obesity is a serious public threat in many different countries worldwide. This epidemic calls for an appropriate approach to face the challenge in front of us. There is no single solution for obesity but there are initiatives and strategies implemented to help. 11% of New Zealand children are obese a number that will continue to rise if we do not do anything about it. Research shows that SES and childhood obesity do correlate, the lower the SES the higher the prevalence of obesity. These statistics are worldwide and come down to many different reasons – parental education, access to food, lifestyle behaviours, physical activity patterns and the demographical area you live in (Sutherland et, al., 2008; Wang & Lim, 2012). There is no quick fix solution to the problem but many areas can be improved with the Ministry of Health strategies and the fact that Childhood obesity have become a priority (MOH, 2016). It is important that health professional do see SES as a risk factor for childhood obesity and are aware of just how prevalent it is in our country.

References

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