According to the Centers for Disease Control and Prevention, childhood obesity has more than tripled in the past 30 years. Data show significant disparities exist among race, ethnicity and income. Sandra G. Hassink, MD, MPH, FAAP, in her address to the U.S. Senate Committee on Health, Education, Labor and Pensions, stated that there is no single one factor responsible for childhood obesity. Recent research indicates that any approach to address obesity should be multi-faceted; including not only the individual, but also the environments (social, structural and environmental) in which they live. Creating a healthy living environment should be an essential component of addressing childhood obesity. Developing a comprehensive community-based strategy that promotes and supports healthy lifestyle behaviors has the potential to eliminate the risks for childhood obesity. Prolonged and sustained social change will prevent this medical issue for future generations.

Parramore District

The Health Council of East Central Florida received a grant from the Blue Cross and Blue Shield of Florida Foundation to address the disproportionately high rates of childhood obesity in Parramore, a vulnerable neighborhood in downtown Orlando, Florida.

  Parramore is the historical hub of Orlando’s African-American community. This vulnerable neighborhood is located on the west side of downtown Orlando, Florida. Parramore is comprised of four communities: Lake Dot, Callahan, Parramore and Holden Heights. A disproportionate share of the city’s crime is reported here. All of the shelters for the city’s homeless are located in this 1.4-square-mile neighborhood. Parks are frequented by vagrants and drug dealers. The 22 convenience stores located throughout the community offer an abundance of snacks and ready-to-eat foods but fresh fruits and vegetables are difficult to find. There is not one full-service grocery store located in Parramore.  

According to the U.S. Census American Community Survey (2005-2009), 7,012 people reside in Parramore. Demographically, 68.7 percent of community members are Black, 25.8 percent are White, and less than 3 percent reported belonging to other races. Twenty-two percent of the population is less than 20 years of age. More than half of all children 0-19 years of age are below the age of 10. Educational attainment is low, with only 33.9 percent of residents over the age of 25 earning a two-or four-year college degree. Black residents were almost six times more likely than their White counterparts to leave high school before graduating. In 2009, the median family income in Parramore ranged from $17,544 to $25,238, far below that for families in Orange County at $57,738. More than half of the residents reported an income within the past 12 months that was below the poverty level. Female households with no husband presently make up 57.9 percent of all family households in Parramore. They are 28 times more likely to live in poverty than their married counterparts. Eighty-three percent of Parramore children between the ages of 0-17 years live below 200 percent of poverty. Sadly, 86 percent of Parramore students who attend Orange County Public Schools receive free/reduced price lunch, a prime indicator of poverty and food insecurity.

The Problem

Research indicates that the characteristics of the community environment affect the overall health of its residents. Broken sidewalks, unsafe parks, lack of grocery stores, and too many fast-food restaurants make it very difficult for anyone, let alone children, to be physically active and eat healthy foods. When this happens, children can gain more weight than is needed for normal growth and development. This imbalance of energy consumed (food eaten) and energy expended (physical exercise) causes a medical condition known as childhood obesity.

According to published research, obesity in children increases their risk for serious health conditions like Type 2 Diabetes, high blood pressure and high cholesterol. When cardiovascular risk factors are present in childhood, it can lead to serious medical problems such as heart disease, heart failure and stroke as children grow into adulthood. Obese children may also be prone to low self-esteem that stems from being teased, bullied, or rejected by peers. Children who are unhappy with their weight may be more likely than average-weight children to:

• Develop unhealthy dieting habits and eating disorders, such as Anorexia Nervosa and Bulimia
• Be more prone to depression
• Be at risk for substance abuse
• Be at risk for developing other medical problems that affect their present and future health and quality of life, including:
  • Bone and joint problems
  • Shortness of breath
  • Restless or disordered sleep patterns, such as obstructive sleep apnea
  • Tendency to mature earlier
  • Liver and gall bladder disease

At The Local Level

In 2006, the Health Council of East Central Florida, The Winter Park Health Foundation and Florida Hospital sponsored Professional Research Consultants, Inc., to conduct the first child and adolescent health survey in the district. The random telephone survey captured responses from 1,600 parents and 263 adolescents living in Brevard, Orange, Osceola and Seminole counties. The sampling structure used for the survey ensures the data is significant at the ZIP code level. Using height and weight measurements provided by surveyed parents and the CDC definition of overweight and obese, the data revealed that 32.3 percent of children living in Parramore (Zip code 32805) are overweight and 37.5 percent are obese. This is higher than the percentage of overweight children in Orange County, Florida, and far above the Healthy People 2020 goal to have no more than 14.6 percent of children overweight or obese.

As observed at both the state and county levels, socioeconomic and demographic characteristics influence the overweight status of children. The high rates of childhood obesity in Parramore are reflective of the challenging social environment that exists in this community. There is no single factor to blame, but many factors coming together at one time and in one place. Childhood obesity carries serious but preventable health risks for children. Left untreated, these health risks become even greater as children grow into adults. Creating a healthy Parramore can help reverse childhood obesity and further ensure the health of the community.

What Are The Causes of Childhood Obesity?

There are many causes of childhood obesity. Overweight in children and adolescents is generally caused by a lack of physical activity, unhealthy eating patterns resulting in excess energy intake, or a combination of the two. Genetics and social factors, socioeconomic status, race/ethnicity, media and marketing, and the physical environment also influence energy consumption and expenditure. Most factors of overweight and obesity do not work in isolation and solely targeting one factor may not make a significant impact on the growing problem.

Nutrition and Eating Habits

Children and adolescents are eating more food away from home, drinking more sugar-sweetened drinks and snacking more frequently. Convenience has become one of the main criteria for Americans’ food choices today, leading more and more people to consume “away-from-home” quick service or restaurant meals, or to buy ready-to-eat, low cost, quickly accessible meals to prepare at home.

Physical Inactivity and Sedentary Behaviors

Watching television, using the computer and playing video games occupy a large percentage of children’s leisure time, influencing their physical activity levels. It is estimated that children in the United States are spending 25 percent of their waking hours watching television. Statistically, children who watch the most hours of television have the highest incidence of obesity.  This trend is apparent not only because little energy is expended while viewing television but also because children are prone to eating high-calorie snacks while watching television.

Physical Environment

In urban and suburban areas, the developed environment can create obstacles to being physically active. In urban areas, space for outdoor recreation can be scarce, preventing children from having a protected place to play. Neighborhood crime, unattended dogs or lack of street lighting may also inhibit children from being able to walk safely outdoors. Busy traffic can prevent children from walking or biking to school as a means of daily exercise.

Socioeconomic Status and Race/Ethnicity

The prevalence at which obesity has been increasing in children in the recent years has been even more pronounced and rapid among minority children. Between 1986 and 1998, obesity prevalence among African Americans and Hispanics increased 120 percent, as compared to a 50 percent increase among non-Hispanic Whites. The relationship among race/ ethnicity, socio-economic status, and childhood obesity may result from a number of underlying causes, including less healthy eating patterns (e.g., eating fewer fruits and vegetables, more saturated fats), less physical activity, more sedentary behavior, and cultural attitudes about body weight.  Clearly these factors tend to co-occur and are likely to contribute to the increased risk of obesity in children.

Parental Influences

Numerous parental influences shape the eating habits of youth. Several studies suggest that breast-feeding offers a small but consistent protective effect against obesity in children. 

o   Constraints on parents’ time potentially contribute to children’s weight problems, as working parents probably rely more heavily than non-working parents on prepared, processed and fast-foods, which generally have high calorie, high fat and low nutritional content.

o   Children left unsupervised after school may make poor nutritional choices and engage in more sedentary activities.

o   Child care providers may not offer as many opportunities for physical activity and may offer less nutritious food alternatives.

Conclusion

Research shows that there are a number of root causes of obesity in children. Selecting one or two main causes or essential factors is next to impossible because the potential influences on obesity are multiple and intertwined. However, the fundamentals are clear: to stay healthy, children should eat a balanced diet and devote adequate time to physical activity.

Parramore Kidz Zone (PKZ)

Launched in July 2006, this neighborhood collaborative modeled after the well-known Harlem Children’s Zone (HCZ) aims to reduce juvenile crime, teen pregnancy, and high school drop-out rates in Orlando’s highest poverty, highest crime neighborhood.

Rather than centering services around a particular school, PKZ focused on providing primary prevention services, such as tutoring and youth development programs, to children at neighborhood-based sites. PKZ lowers barriers for kids to join such programs through grassroots marketing, subsidized fees, streamlined paperwork, and transportation of children to programs. PKZ has expanded the capacity of participating (mostly neighborhood-based) non-profits to serve Parramore children by giving them funding, free space and technical and administrative support

Accomplishments

• Broad range of new programs launched including: free tutoring sites; enhanced access to high quality pre-kindergarten programs; teen facilities; youth employment program; college access program; comprehensive athletics program; and enhanced access to out-of-school time care for children of all ages.

• FY 2009-10: 466 Parramore children participated in PKZ after school tutoring programs, 126 in pre-kindergarten programs, 129 in health and fitness programs, and 333 in youth development programs, such as community service projects, youth employment, positive peer group meetings, college access programs, and field trips to educational and cultural sites.

• Since PKZ started in 2006, data show:

• Improvements in Florida Comprehensive Assessment Test (FCAT) math and reading scores for Parramore’s elementary and high school students.

·         Parramore specified juvenile arrests in 2006 accounted for 22.8% of Orlando arrests but in 2012, Parramore arrests accounted for only 9.9% of Orlando arrests (56.5% decrease)

Partnership

2014 will see the start of a pilot program in the Parramore area in partnership with PKZ. The Foundation will be introducing weekly soccer clinics at 5 locations in the Parramore area over the summer. Our partners in this venture will be Orlando Health who will add injury prevention, safe ways to play and nutrition to the program. This will not only introduce the sport of soccer to the youth of Parramore but also add in an educational aspect on healthy choices.