Background

Background

Childhood obesity affects everyone, irrespective of age, gender, or racial group. However, it has been shown to be more prevalent in countries that have experienced growth in the economy, rapid urbanisation, technical advancement, and micronutrient behaviour change, all of which are significant compared to the UK. Few studies on childhood obesity as well as its lifestyle factors have been conducted in the United Kingdom, which seems to be a challenge. There have been no studies published in the UK that focused on dietary and physical activity as risk factors for childhood obesity (OW/OB) (Rauber et al. 2020). Obesity prevention in younger generations ought to be prioritised since it is extremely difficult to reverse the impact of obesity after it has been identified. Anaemia, iron and zinc deficit are all on the emergence as a consequence of rapid epidemiological and dietary shifts occurring around the world. Obesity has reached epidemic proportions in advanced countries. Obesity in children is somewhat more prevalent in developed countries, but it is also have become more prevalent in developing countries (Rauber et al. 2020).

In Canada, males aged 5–9 have a two-fold greater prevalence of extreme obesity compared to females (Carsley et al. 2019). Analogously, in China, the rates of childhood obesity have risen substantially over more than a 25-year period (1985–2010), with boys steadily outnumbering girls aged 7–18 (Song et al. 2016). Between 2000 to 2010, the incidence of obesity and overweight in children aged 3 to 19 elevated in Poland, with boys having a higher incidence than girls (Kowal et al. 2016). Women also have significantly elevated levels of leptin, the hormone that suppresses the appetite as well as promotes energy use. Elevated serum leptin levels are a component of fat mass and therefore are in direct proportion to adiposity stages. Females are much more likely to be overweight than men due to hormonal differences (Shah et al. 2020). Childhood obesity appears to play a critical part in the development of Type 2 Diabetes and cardiovascular disease. Obesity is generally associated with alterations in glucose-insulin homoeostasis, and the majority, not all though, of those who have type 2 diabetes have become obese at the onset of the disease. While the disease specifically targets adults, the rising prevalence of obesity in children has led to an increase in the emergence of type 2 diabetes in children (Jensen and Dabelea 2018).

Figure 1: Obesity in England within the age group 4 to 5 and 10 to 11, depicting 1 in 10 children has obesity. Also, depicting a similar age range but based on depravity in England

Prevalence of Childhood Obesity Globally

(Source: Baker 2021)

Over the last four decades, notably in the developed world, the proportion of children who are obese had already risen dramatically. Several research studies in the last decade from different parts of India exhibit a consistent pattern (Bann et al. 2018). This concept has already been questioned in recent years, and now we all consider them as distinct aspects of the global malnutrition problem. With this experimental method, researchers can address the underlying causes of nutrient deficiencies while also minimising the chances of obesity, diabetes, as well as other NRCDs (Rodriguez 2020). A life-course approach to nutrition and childhood development is used to provide a public health overall view of important topics related to obesity and chronic disease prevention.

Figure 2: Percentage of children aged in the range of 4 to 5, classified as underweight, healthy weight, overweight as well as obese from the year 2012/13 to 2017/18 by Child Measurement Programme for Wales

(Source: Bailey et al. 2019)

Children are innocent bystanders of an unhealthy environment, and the entire society bears responsibility for their protection. Obesity observed in children has long-term health-related consequences, including one with a strong connection between obesity and its associated comorbidities throughout adulthood as well as short and long-term health implications (Roth and Jain 2018). This emphasises the importance of ongoing efforts on BMI monitoring, early diagnosis, as well as effective treatments of obesity and other health challenges, and assessment of meal systems activity and the surrounding environment, along with prospects to workout. Determining the relative impact of environmental, biological, as well as cognitive factors contributing to the development as well as the tenacity of obesity in children will aid in efficaciously restoring the epidemic also lowering the well-being and other costs associated with that as well (Weihrauch-Blüher and Wiegand 2018).

The prevalence of overweight and obesity in children globally has increased, according to current statistics from 195 countries, directly impacting a combined capacity of 107.7 million children just in the year 2015 (GBD 2015 Obesity Collaborators 2017). Obesity, as well as type 2 diabetes, have been increasing at a faster rate throughout children than they really are in adults. Paediatric obesity has increased the risk of substantial comorbidities such as respiratory problems, non-alcoholic fatty liver disease (NAFLD), musculoskeletal conditions, psychosocial problems, metabolic disease, polycystic ovary syndrome, intolerance to glucose, diabetes, chronic renal diseases or failure, atherosclerosis which thus begins in early childhood, as well as most forms of cancer. Throughout many regions of the world, cardiovascular disease remains the major cause of obesity-related fatality (Simmonds et al. 2016). Despite various efforts to reverse such patterns, established intervention as well as prevention practices have not yet been successful in reducing rapidly increasing childhood rates of obesity in children, conceivably because they really do not adequately identify the fundamental causes (Ma et al. 2022). There seems to be a vastly increased plethora of highly energy-dense as well as appealing meals, and also frequently exposed to food cues, that trigger excessive consumption, in contemporary times as well as the recently switched surroundings throughout many developing nations. Due to the rapidly modifying health and nutrition environments as well as behavioural patterns, the rates of childhood obesity has been continuing to increase not just in larger cities as well as in smaller cities inside the United Kingdom (Selbie 2018).

Consequences of Childhood Obesity

Obese children along with their parents may visit paediatricians more often; seeking explanations for their children’s rapid weight gain or rather seek simple weight-loss strategies. A few parents and their children may be unaware of the healthcare consequences of obesity, and they require comprehensive but meaningful information (Lindberg et al. 2020). It is possible that distinguish between the exogenous obesity in children, which is induced between either the exogenous obesity in children, which is induced either by persistent unequal distribution in energy intake as well as expenditure, and indeed the specific hereditary, clinical manifestations, and immune function aspects are crucial. Understanding the physiological responses of body composition regulation has been critical for identifying unusual aspects of monogenic weight gain, and also syndromic facets of weight gain as well as their relevant attributes (Koves and Roth 2018). Obesity in children could be characterized by progressive delays, organ congenital abnormalities, or even other clinical characteristics, as well as hyperphagia.

Obesity in children has been rising every year, for the past four decades and rather than seeing a decline in the percentage of obesity in children, it has been consecutively rising. The aim of the current study has been to assess the prevalence of the rise in obesity in children not for a single aged group rather in the age group from five until 15 mostly in the United Kingdom. Furthermore, the study’s aim would be to evaluate and analyse the underlying causes along with the consequences of being overweight as well as obese in the age group of 5 to 15.

Objective

To accomplish the study, the objective of the focus would be on the following:

• Assessment of the prevalence as well as the underlying cause of obesity in the age group of 5 to 15.
• Determination of health consequences caused by obesity on the concerned aged group.
• Development of effective measures to reduce obesity-related health conditions in the aged group.

The prospective research question with respect to the study is as followed:

• In the United Kingdom, what is the prevalence and cause of obesity in the age group 5 to 15?
• How has obesity affected the health of children in the age group?
• How to reduce obesity and bring back the aged group of 5 to 15 in the healthy BMI range.

Figure 3: Dissertation Structure

(Source: Created by the researcher)

The dissertation would follow the pattern of systemic review, in a broader sense, papers and articles, which describes or has conducted research on the aged group correspondingly, would be searched. The paper would be following the literature review, which would annotate the relevant articles, papers, and findings carried out by other researchers in understanding the cause of obesity, from a general perspective to molecular perspective, as in the causative reasons of the formation of obesity in children as well as adolescents. Then following the literature review, research methods would be evaluated, wherein the research questions formed, in the paper, and after review, the limitations associated with them would be studied, focusing as such in ethics, limitations. Then the chapter would focus on the results segment of the evaluated literature, concluding the paper after discussion on the relevant findings.

Aim and Objectives

Obesity has become a chronic, multifaceted health condition that has significant adverse effects on human health. Throughout the last three decades, the prevalence of overweight and obesity has exponentially increased nationally as well as internationally, with adult and childhood obesity (for 6 to 11 years of age) percentages doubling and adolescent children obesity (within 12 to19 years of age) percentages tripling. Obesity had already evolved into a matter of public health with substantial and far-reaching implications for mortality, morbidity, as well as the cost of healthcare (Upadhyay et al. 2018). Obesity is often stigmatised, and there is a common misconception that it has been primarily caused by only a lack of self-control, which leads to poor diet preferences as well as a lack of physical activity. Obesity, on the other hand, is described in a wealth of evidence-based literary works as a complex chronic health condition resulting from the interaction of various genes, ecological, metabolic, as well as behavioural characteristics (Bray et al. 2017). In the United Kingdom, more than one out of every five children seems to be overweight when they begin school. Obese children would be at an elevated risk of conditions such as asthma as well as type 2 diabetes, as well as they are also said to possess low levels of self-esteem. Obesity, once formed, follows people well into adult years and therefore is associated with an increased risk of heart problems as well as certain forms of cancer (Lanigan et al. 2019). Obesity has always been associated with a higher risk of much more over 20 medical problems, including type 2 diabetes, high blood pressure, dyslipidemia, Cardiovascular events, cerebrovascular disease,  gall bladder disease, sleep apnoea, urogenital problems, and numerous different forms of cancer (World Health Organization 2020). Obesity not only creates a negative effect on people’s health, but it does have a negative impact on individuals’ psychological health, as this is linked to low levels of self-esteem, depression, as well as poor quality of life.

Reduced physical exercise; elevated television viewing times as well as sedentary lifestyle, enhanced food intake, notably energy-dense, intake of higher calorie, palatable prepared food in vastly increased serving sizes, including the use of prescription drugs with gaining weight as both a side effect are all contributory factors towards the rise in obesity (Njike et al. 2016). Regardless of the fact that almost all individuals are subjected to all these natural conditions, not everyone becomes obese, implying that different genetic mechanisms potentially lead specified individuals towards obesity. Many genetic materials have already been distinguished as possible contributing factors to obesity, some of which may work in conjunction; research findings with twins have revealed that eating patterns are relatively heritable (53% to 84 %) (Bray et al. 2016). The fat mass and obesity-associated (FTO) gene is amongst the most well studied. This has mimal influence by itself and appears to be influenced by way of life (Bjørnland et al. 2017). Whereas up to 200 forms of solitary genetic mutations have indeed been reported to induce obesity, only a small percentage of people have monogenic types of obesity (Pigeyre and Meyre 2018). There are only a few well-known monogenic genetic changes that account for less than 10% among all cases of severe obesity, including such mutations through leptin or even the leptin receptor, as well as mutations inside the melanocortin-4 receptor (Kohlsdorf et al. 2018). Syndromic aspects of obesity account for a tiny percentage of clinical studies and therefore are linked to genetic diseases, which thus present with a unique variety of healthcare phenotypes as well as obesity (Engle et al. 2021). WAGR (Wilms tumour, aniridia, genitourinary anomalies, and mental retardation), Bardet Biedl, Prader-Willi, as well as Cohen syndromes, for instance, are amongst the most prevalent (Gowda et al. 2019).

Hypothyroidism, pseudohypoparathyroidism, Cushing disease, hypothalamic induces, growth hormone deficiency, as well as PCOS, are just some of the neuroendocrine consequences of obesity, in addition to genetics (Ghanemi, Yoshioka and St-Amand 2021). In individuals surmised of having to underpin neuroendocrine or even genetic factors for obesity, early referring to that of an endocrinologist as well as an intervention has been beneficial. Epigenetic components, like those for modifications in methylation of DNA, microRNA expression, as well as non-coding microRNAs, have been recently been linked to obesity throughout research findings (Ouni and Schürmann 2020). Apart from genetics, epigenetics could perhaps change over time and even with changes in lifestyle such as physical activity and diet. As research on this subject progresses, researchers are discovering as much about the complex genetic environment interplay, which thus contributes to weight gain and how these conversations can really be designed to be targeted like a treatment (Cuevas-Sierra et al., 2019). To learn more about obesity, search into the central nervous system (CNS) mechanism which thus regulates feelings of hunger and how that could become dysregulated as a result of genetic environment modifications.  Even though the earliest research was based on adjustments in the hypothalamic homeostatic CNS regulation of consuming, more recent studies suggest that the other channels, for instance, reward, emotion or even memory, awareness, as well as cognitive control, seem to be more powerful inside the regulation of desire to eat in individuals (Farr, Chiang-shan and Mantzoros 2016). The hypothalamus controls homeostatic caloric intake as well as expenditure by integrating as well as communicating signals of hormones from the periphery towards the remaining portion of the CNS. Leptin, for instance, would be produced by adipose tissue as well as circulated in proportion to the number of fat mass in the body, as well as in response to acute energy insufficiency (Farr, Gavrieli and Mantzoros 2015).

In obesity, the situation is reversed, and leptin is circulated at significant concentrations; but even so, due to resistance of leptin or tolerance, leptin would not decrease the energy consumption and increase calorie expenditure, exemplifying a resistance towards the homeostatic regulation of consuming. Numerous different peripheral molecules, including such glucagon-like peptide 1 (GLP-1) as well as its analogues, have also been shown to behave upon that attention as well as reward channels, according to a growing body of evidence (Farr et al. 2016). The two main theories would be that people have a hypo-responsivity towards rewards, leading them to pursue incredibly rewarding, high-calorie types of food or even that people have a hyper-responsivity to food cues, leading them to eat more highly palatable types of food. Such theories have been supported by the evidence of reduced accessibility of rewarding dopamine D2 receptors in obese people and increased activity of reward-related areas of the brain, such as with the orbitofrontal cortex as well as nucleus accumbens, in response to sensory food cues (Leite and Ribeiro, 2020). Obese people, as well as normal weightage individuals who put on weight subsequently, have poor inhibitory control once confronted with food cues also even when having to perform non-food activities. Increased tumour necrosis factor (TNF)-α (Wu et al. 2018) expression inside the adipose tissue of obese rodents and humans nearly two decades ago recommended inflammatory linkage between overweight as well as insulin resistance (IR) or even metabolic disease.

BMI has been the most commonly used metric for determining obesity. Obesity results in an increase in morbidity, mortality, as well as serious health problems. When especially in comparison to grade I of obesity (BMI 30 to 35 kg/m2), grade III as well as II of obesity (BMI equal to or higher than 35 kg/m2 as well as equal to or higher than 40 kg/m2, in both) has been associated with a greater risk of cardiovascular events as well as comorbidities (Phillips et al. 2013). Even though several research findings have used exclusions in consideration of blood pressure, IR measures (for instance, fasting serum glucose concentration, haemoglobin [Hb]A1c, cholesterol (high-density lipoprotein [HDL], as well as low-density lipoprotein [LDL], homeostatic model assessment [HOMA]- insulin resistance [IR]), Triglyceride (TG), Total cholesterol (TC), or rather TG/HDL ratios).  Since there is no present set of criteria that thus distinguishes health metabolic compared to metabolically unhealthy obese (MUO) individuals (Achilike et al. 2015). The metabolically unhealthy normal weight (MUHNW) phenotype is another that had also sparked an interest. Those same patients are still not obese by BMI standards, but they do have such a metabolic activity profile that is standard of obesity. Individuals of Asian origin, notably the Asian Chinese as well as the Indian subgroups, who do have a BMI being normal but elevated visceral adiposity, are more likely to experience all these (Belenkaya 2018). According to the Korean National Health and Nutrition Examination Study, 12.7% of normal weight range individuals (BMI 25 kg/m2) have had the MUHNW phenotype, while 47.9% of the obese people (BMI >30 mg/m2) have the MHO phenotype (Lee and Oh 2009).

Obesity has been linked to a higher risk of IR (Ni et al. 2020). Visceral fat mass [causative link factor (r) found to be 0.570], total fat mass (r found to be 0.492), BMI (r found to be 0.482), as well as waist circumference are all significantly associated with HOMA-IR (r found to be 0.466), whereas lower extremity fat, on the other hand, is not linked to HOMA-IR (Zhang et al. 2015). Non-esterified fatty acids (NEFAs), proinflammatory cytokines, glycerol, immune system cells (lymphocytes, macrophages), as well as hormones including leptin as well as adiponectin are all regulated by adiponectin. The release of many of these compounds has been enhanced in overweight, and it can also actually impact insulin sensitivity in a number of different ways. The release of so many of these substances has been elevated in obesity, and that might actually affect insulin sensitivity in a number of different aspects (Liu et al. 2021). The biochemical, as well as physiologic impacts of obese people on IR, are well understood. Initially, elevated NEFA distribution as well as, as a consequence, enhanced intracellular concentration compete with the glucose for the substrate oxidation, inhibiting key glycolysis enzymes (pyruvate dehydrogenase, phosphofructokinase, and hexokinase II) (Gil-Campos et al. 2011). Furthermore, fatty acid substances (diacylglycerol [DAG], ceramides, fatty acyl-coenzyme A [acyl-CoA]) seem to be elevated, likely to result in threonine or serine phosphorylation of insulin receptor substrate (IRS)-2 as well as IRS-1, decreased stimulation of phosphatidylinositol (PI)-3-kinases (Day and Bailey 2011) as well as inhibitory activity downstream of insulin-receptor signalling. Furthermore, the steadily increasing release of  IL-6, TNFα, and monocyte chemoattractant protein-1 throughout the liver, adipose tissue and muscle activates proinflammatory signal transduction pathways (Osborn and Olefsky, 2012).

Figure 4: NDNS RP for year 1 to 6 (2008 to 2014) children population, the percentage reported based eating locations by the age group. [The National Diet and Nutrition Survey Rolling Program (NDNS RP) is an abbreviation for the National Diet and Nutrition Survey Rolling Program.]

(Source: Toumpakari et al. 2019)

Stimulation of JNK, as well as inhibitor of the nuclear factor kappa-β kinase, leads to phosphorylation of the IRS-2 as well as the IRS-1, along with a steadily increasing transcription of the inflammatory genes, throughout proinflammatory signal transduction pathways (Feng et al. 2020). Eventually, elevated expression of the proteins like retinol-binding protein-4 as well as leptin, as well as relatively low levels of adiponectin, hamper insulin sensitivity whilst also inhibiting PI (3) kinase signalling throughout the muscle, triggering the expression of both the gluconeogenic enzyme phosphoenolpyruvate carboxy-kinase inside the liver, as well as stimulating fatty acid oxidation (Engin 2017). The advancement of type 2 diabetes has been strenuously linked to obesity (Yaturu 2011). To preserve normoglycemia, IR inside the muscle, liver and adipose tissue necessitates an exponential rise throughout insulin provided by the pancreatic b-cells. B-cell abnormalities could be caused by both genes as well as environmental influences (Panagiotopoulos et al. 2018). Certain genetic variations or single nucleotide polymorphisms (SNP) in genetic makeup associated with critical b-cell pathways could have a significant effect on the beta-cell survival ability and feature (Hara et al. 2014). Hyperglycaemia would then consequence in the genetic susceptibility of β-cells struggles to reach the increased insulin requirements resulting in chronic enhanced calorie consumption as well as insufficient physical activity (Wickramasinghe et al. 2013).

Obesity has been linked to dyslipidemia (Oliosa et al. 2019). Elevated plasma triglycerides as well as apolipoprotein B (apo B) levels, and also lower levels of HDL cholesterol (HDL-C), characterise this condition (Elmao?ullar? et al. 2015). The build-up of lipolytically active visceral fat coupled with the initiation of IR led to a dramatic increase in free fatty acid flux inside the portal vein as well as, as a direct consequence, inside the liver, due to higher triglyceride formation. A BMI of moreover 30 kg/m2 has been linked to a 6:1 odds ratio with lower HDL-C as well as a 3:1 odds ratio for an increase in the levels of total cholesterol (Deeb et al., 2018). Hypertension is exacerbated by obesity (Brady 2017). People with a BMI of more and over 30 kg/m2 have just a 9-fold higher risk of high blood pressure (Brady 2017). Obesity-related high blood pressure is thought to be caused by a number of different mechanisms. Obesity, for starters, is marked by modified hemodynamics as a result of volume overload (Kazakidi 2018). Moreover, increased sodium ingestion as a consequence of increasing food intake disrupts sodium homoeostasis, leading to high blood pressure (Uddaraju and Ram 2013). Moreover, hormonal fluctuations (hyperinsulinemia, hyperaldosteronism, and also hyperleptinemia) induce the renin-aldosterone-angiotensin process to be activated, the sympathetic nervous system to be stimulated, and the parasympathetic nervous system to be suppressed (Zhu et al. 2016). Eventually, vascular injuries are caused by endothelial dysfunction through combination with vascular stiffness; induce oxidative stress, as well as chronic low-grade inflammatory processes (Bruyndonckx et al. 2016). Overall, obesity is linked to IR, hypertension, dyslipidemia, hyperglycaemia, as well as diabetes in some kind of a cause and effect situation. Obesity’s metabolic repercussions (dyslipidemia, hypertension, and diabetes) are responsible for the surplus risk of developing cardiovascular disease as well as stroke (Matjuda et al. 2020; Davidsson et al. 2021; Matsumoto et al. 2021; Elmao?ullar? et al. 2015; Lee and Yoon 2018). Hypertension appears to play one of the most prominent influences within and between them, the increased risk of cardiovascular disease and the risk of stroke.

PCOS has been associated with the increase through the production of androgen, which also has an effect mostly on the hypothalamus-hypophysis-ovarian axis (HHOA) and therefore can affect fertility (Chung et al. 2018). Obesity is thought to play a role mostly in the pathophysiology of PCOS via two main pathways: IR (Tagi and Chiarelli 2020) as well as hyperandrogenism (Daan et al. 2016). Obesity, but on the other hand, could be taken into account as a complication of Polycystic ovary syndrome attributed to the prevalence of elevated visceral fat throughout the condition (de Zegher et al. 2018). In Polycystic ovary syndrome, hyperinsulinemia (Tagi et al. 2019), as well as IR, have also been shown to lower sex hormone-binding globulin concentration, contributing to increased concentrations of free androgens (Li et al. 2017). Reduced expression of hepatic nuclear factor–4α is often used to achieve all these within indirect means. The hypothalamus-hypophysis-adrenal axis (HHAA) has been stimulated by high insulin thresholds, resulting in an increased production of adrenal androgens.

Adolescent obesity is a major contributor to hyperandrogenism because insulin, as well as insulin-like growth factor 1 (IGF-1), stimulate steroidogenic enzymes inside the adrenal glands (Poddar et al. 2017). A mechanism that helps to explain hyperandrogenism throughout individuals with PCOS but also obesity is hyperleptinemia which further causes a decrease in the secretion concentration of the solubilized leptin receptor as well as an increase in the androgen levels (Calcaterra et al. 2021). A strong correlation appears to exist between PCOS, hyperandrogenism, hyperinsulinemia, and obesity, which thus needs to be researched even further.

Obstructive sleep apnoea (OSA) seems to be common in obese patients and is associated with a number of comorbidities, including high blood pressure, type 2 diabetes mellitus, hyperlipidaemia, congestive heart failure, non-alcoholic fatty liver disease, and cardiac arrhythmia (Andersen et al. 2019). Obese people have nearly twice the rate of OSA as lean people. Obesity has been assumed to have been a risk factor for OSA, as such due to deposition of fat around the upper respiratory air passages, truncal fat as well as chest wall, which results in the decrease of the functional residual capability (Savini et al. 2019). This balance appears to be disrupted in OSA, either through the increase in the mechanical influence of anatomic modification due to the presence of adiposity in the region of the neck or even a deformity throughout neuromuscular signalling into those instances or even by the combined impact factors of both instances (Xu et al. 2020). Furthermore, obesity lengthens the soft palate, which has also been linked to the magnitude of OSA. Snoring seems to be another hypothesized mechanism for said pathophysiology of OSA in relation to obesity (Tokat et al. 2022). The inflammatory reaction caused by snoring-related sound waves causes’ peripheral nerve damage, particularly to those liable for the negative pressure stress response.

Obesity has been linked to a variety of cancers (Bendor et al. 2020), which would include pancreatic cancer (Levi et al., 2019), hepatocellular carcinoma (Shaunak et al. 2021), colon cancer (Nuotio et al. 2022), breast cancer (Colditz and Toriola 2021), oesophageal adenocarcinoma (Lee et al. 2022), endometrial adenocarcinoma (Plagens-Rotman et al. 2019), as well as kidney cancer (Glicklich and Mustafa 2019).  Several hypotheses have been suggested to explain the link between carcinoma as well as obesity (Avgerinos et al., 2019; Reilly et al., 2018). Increased IR (Cardenas-Vargas et al. 2018) extremely high IGF-1 concentration (Quitadamo et al. 2021), low-grade chronic inflammation caused by obesity (M?rginean et al. 2019), dysregulation of adipocyte-derived factors (Maligianni et al. 2021), as well as changes in sex hormones are all etiologic factors. Even though hypoadiponectinemia is linked to adiponectin, IR has also been shown to improve IR and have anti-proliferative effects throughout cancer, type 2 diabetes, and atherosclerosis, making it an attractive therapeutic and diagnostic opportunity in carcinoma (Lega and Lipscombe 2020). The numerous different other undiscovered mechanisms, as well as biochemical pathways appending in obesity as well as cancer, are still being investigated. Furthermore, elevated concentrations of cytokines like IL-6 as well as TNF have since been linked to hepatic inflammation throughout humans (Marti et al. 2018) where it stimulates the Janus kinase–Signal Transducer as well as Activator of Transcription pathway, which also encompasses the oncogenic transcription factor STAT3 (Chong et al. 2019). But even so, the mechanisms that interconnect obesity, as well as cancer, are still unknown, and much more research needs to be done to demonstrate the above links. Overall, healthy body weight has various health benefits, as well as the obesity crisis must be acknowledged as quick as practicable.

Obesity had already arose as nothing more than a public health risk crisis of enormous proportions. This condition, which was once thought to be a rare condition considered only for the wealthy earlier, has become more common amongst some of the economically disadvantaged and much less knowledgeable categories. Aside from the fact that numerous risk variables for obesity have had been outlined, a greater grasp of how such variables cooperate has been unable to be ascertained. The availability of highly extracted, high-calorie food through significant sections and even at a lower cost, as well as lack of physical activity as well as steadily increasing internet addiction, playing computer-based games, do seem to be important predictors and contributors towards the rising obesity epidemic. Countless people have developed obesity as a result of all these changes in the environment, which combine genetic or even epigenetic frameworks to monitor and control adiposity. Although reversing the obesity epidemic will require additional interventions throughout many stages and over a significant period of time, the AMA as well as other organisations’ proclamation of obesity as just a disorder will be the first phase.

Obesity within the year as a depiction of belonging to the high class has transformed into a major crisis or epidemic involving even the low class. The condition rather than being caused by the lack of physical activity has been linked to molecular mechanisms as well as intricate cellular pathways in humans. The question stands similar to earlier focused statements, those are:

1. In the United Kingdom what would be the prevalence and causative factor involved with obesity for the age group 5 to 15 (child to adolescent).
2. The above-stated factors, as linked with obesity, how much do these factors along with obesity affects the concerned aged group in question.
3. Considering the causative factors, how to reduce obesity in the aged group within the age 5 to 15.

These questions are the fundamental questions points to be considered in the dissertation, the statistical data would be varying since more research are being focused on the topic. Since obesity statistical data could change each year to every month, those areas would be rounded up in the methodology section.

Since 1980, the global prevalence of overweight, as well as obesity, has almost doubled, with approximately one/third of the planet’s population presently categorised as obese (Global Burden of Disease Study 2015 2017). The cumulative indirect, as well as the indirect cost of obesity as well as overweight within Europe, has been roughly comparable to 0.47 to 0.61% of GDP (Pineda et al. 2018; Bellis et al. 2019). Overweight as well as obese is defined by the World Health Organization (WHO) as abnormal fat accumulation that presents a danger. The body mass index (BMI) would be a simple criterion being used to demonstrate the overall physical amount of body fat (WHO 2021). This is computed by dividing the overall body weight in kg by the square of the height in metres. Rates of overweight and obesity mostly in the United Kingdom have continued to rise analogously ever since the 1980s, and this figure is expected to rise. According to the Health Survey for England 2019, 28.0% of people in England have become obese, while 36.2% have been overweight but just not obese (Health Survey for England 2020).

Research philosophy is considered a vast topic and is linked with knowledge, assumption and nature of the research. It especially deals with the development of knowledge. This aspect needs to be addressed as different researchers have different assumptions related to the truth, concepts and philosophy that help in understanding the assumptions. There are four types of research philosophy in research, positivism, realism, interpretivism and pragmatism (Hürlimann 2019). The positivism philosophy is highly structured in nature that involve a large number of samples and is usually used to measure quantitative studies but can be used in the case of qualitative ones. Realism is a philosophy where the method is chosen that fit the subject matter and is used in the case of qualitative or quantitative. In the case of interpretivism, small samples are used that are interpreted in an in-depth manner, especially in the case of investigative studies or qualitative ones (Žukauskas et al. 2018). In the pragmatism philosophy, a mixed-method is used and can be applied in a qualitative or quantitative study. In this case, the use of interpretivism philosophy was used as the size of the sample used was small and in a systematic review, an in-depth evaluation of each article was done that required an investigative outlook.

Figure 5: Types of Research Philosophy

Source: (Žukauskas et al. 2018)

The prospective research question with respect to the study is as followed:

• In the United Kingdom, what is the prevalence and cause of obesity in the age group 5 to 15?
• How has obesity affected the health of children in the age group?
• How to reduce obesity and bring back the aged group of 5 to 15 in the healthy BMI range.

Reliability and validity are two concepts that are used for the evaluation of the quality of particular research. Thus, they indicate how well the method, technique or test help in measuring the relationship of variables. The reliability is related to the consistency of a measure and validity is the accuracy of the test (Andrade 2018). In the case of published data, there is a possibility of making judgments by observing provenances such as whether; it was from the government or a reputable commercial source. As it can be found, the five articles that have been chosen were either government sources or obtained from a highly reputed journal that indicates that the source was reliable in nature. One of the influential issues with secondary data is to measurement involved. These are not the same in all cases as some can be distorted in a deliberate manner or different in different countries. In case the measurement is inexact, it is important to understand the issue and how to address it.

Figure 6: Errors and issues in secondary study

(Source: Andrade 2018)

The method through which the study is being carried out is by implementing the research question as well as the objective focus of the study. The most concerning question separating the study from other studies is obesity. Though obesity is a prevalent condition in every age group, and since obesity has significantly risen in the aged group as per reports as well as records in the aged group 2 till the aged group 19, differentiating them form an adult aged group. The focus question here is the aged group from 5 to 15, a concerned age segment which in general has never been the prime focus of study.

The paper’s method of study would be accessing the relevant data recorded by researchers around the world, with the main region being the United Kingdom. The age group which is the concern of the study would be from the age of 5 to the age of 15. The criteria for search would be inclusion and exclusion criteria, meaning, the relevant articles, and papers would be searched on the electronic databases, such as Google Scholar, EMBASE, CINAHL, PubMed, and Cochrane Library for the search of secondary information. Simultaneously data from articles belonging to government sites, which publishes data after a survey on the concerned topic, would also be accessed. The terms mainly being used in the study as well as the data from secondary as well as the primary paper and articles would be selected after selective measurement (Table 1).

Criteria	Terms
Inclusion	“obesity in children”, “childhood obesity”, “obesity in 5 to 15 years old”, “prevalence of obesity in 5 to 15 year old”, “obesity impact in children and adolescents”, “casual factors of obesity in children between 5 to 15”, “initiatives to reduce obesity in children and adolescents”, and “The United Kingdom”, “England”, “Wales”, Ireland, and Scotland. Also, papers studying the “nutrition”, “diet”, “core foods”, “non-core food”, “survey on the diet in the UK”, “ Public health England”.
Exclusion	“Obesity in adults”, “obesity above 15 years old”

Table 1: Criteria for the terms required for the study with respect to the objectives as well as the aim

The sample size of the study was 5 where data collection from various researchers had been based on the collection of data from the age group of beginning from 5 years to 15 years. The data analysis was based on a systematic review where the narrative aspect was chosen to conduct the review. This includes evaluation and review of each article that has been chosen for the study.

The concerns in the case of secondary use of data pose potential harm to the individual subjects and there is an issue related to the return of consent. Tomalin et al. (2021) opined that secondary data is variable with respect to the amount of identified information. In case the data do not contain identifying information or is completely devoid of information or is coded that the researcher does not have codes, it does not need full review by the ethical board. The researcher needs to explain choosing such sources. Privacy and confidentiality need to be protected and informed consent from the author needs to be taken. In case, the data is available freely on the internet, the permission of its use and evaluating it. In this case, the ownership of the original data needs to be acknowledged in the research. Tan et al. (2021) opined that secondary studies are affected by publication bias, as it is dependent on the result of the published sources. Some studies do not publish their result and the research needs to be reviewed at the risk of being incomplete and biased.

As the results on the association of obesity in the aged group have been assessed based on various assessment and evaluation methods. The limitations in the studies have been the dietary intakes, food based on the core as well as non-core food which leads to the gaining of weights or how they could be linked with the prevention in the formation of obesity in aged groups from 1 to 5 or 8 to 19 years old or in age group. The studies so far have not evaluated the health consequences in the aged group as in general or understood the underlying conditions in the aged group of 5 to 15 years old. Further, the study would also look into initiatives, which could target obesity in the 5 to 15 years old, based on the factors as well as the impact on their health. One limitation to be recording the observation is the limited size group, for certainty, the comparisons for the study over the period would have their very own limitation making the study impossible to be conducted. 

Obesity is stated to be a principal health issue and has ranked fifth critical reason for deaths in the world. Both overweight and obesity are considered as one of the major reasons for lifestyle illness that lead to further health issues and are responsible for contributing to numerous chronic diseases such as cancer, diabetes, cardiovascular disease and metabolic syndrome. According to the World Health Organisation, it has been predicted that 30% of the deaths in the world will be caused by lifestyle disorders in 2030 and can be curbed by identifying and addressing the risk factors and behavioural issues associated with it. Therefore, it can be stated that detection and diagnosis of obesity at an early stage is one of the critical steps. Obesity is typically found to possess a BMI of 30 or higher. Overweight is defined as having a BMI somewhere around 25 or 30. According to the National Child Measurement Programme (NCMP), 9.9% of receiving aged children throughout England (ages 4 to 5) had been obese in the year 2019/20, with just an additional 13.1% overweight. Those same percentages had been significantly greater for the year six children (ages 10 to 11), with 21.0% obese as well as 14.1% overweight (National Child Measurement Programme 2021).

The age group category for all the surveys carried out by the health organizations studied had been based from 4 to 5 and from 10 to 11 to be more common. The relevant age group being studied here in the dissertation has been placed in the aged group of 5 to 15, meaning at larger age group to develop a better understanding of the occurrence of obesity in children aged at an age of 5 till they become adolescent, being 15. The study based upon the survey by most of the regions in the United Kingdom (England, Wales, Scotland, and Ireland) had reported to be in the limited aged group, and the sample size to be comparatively smaller.

Considering the study conducted by Ziauddeen et al. (2019), studied the dietary intake in children as well as adults based in the UK National Diet and Nutrition Survey Rolling Programme of the year 2008 to 2014, studying the mean total of phenol intake in the age group from 15 to 19. Resulting in the increase of phenol in the age group, comparatively higher in males than females, higher intake of foods was observed in males whereas polyphenol-rich foods were associated with females. Since the polyphenol intakes in the children were analysed they found, consumption of the polyphenols for the children was in little concentrations, though in younger adults the consumption was comparatively greater, as phenol consumption from teas, or coffee in the UK are higher compared to other regions. The concerned age group of the study had higher consumption of foods of potatoes (7%), and other food such as coffee (78%). As the research was evaluated the phenol consumption, it had limited assessment, further evaluation in the region with a link with obesity could be an aspect to be looked into in the 5 to 15 years old.

Another study by Ahmad et al. (2018) highlighted that the epidemic of the disorder in developing countries is linked with poor dietary habits as well as a sedentary lifestyle. In addition to this, the other determinants include education and family income that had contributed to it in these areas. The research evaluated the socioeconomic status (SES) on obesity among 12 years school-going children in Malaysia, The two factors that were included in this case was body weight and height and BMI where a total of 3798 adolescents were considered. From the result, it was known that there was no significant difference in terms of BMI status in the case of boys and girls or case of rural or urban areas. The difference between BMI was observed in terms of household income, gender and SES in the rural areas. In the urbanised location, the difference was noted in terms of gender, parent’s occupation, education, income level and size and SES level. The logistic regression revealed that there were a number of SES factors that were a predictor of obesity that included gender, income, size of household, occupation of father and SES level. At the SES level, each component was found to be associated with the BMI category among school adolescents in urban areas. Thus, it suggested that the implementation of multifaceted approaches needs to be applied to curtail obesity. This study specifically helped in understanding various negative predictors of obesity however, it was concerned about the developing countries only. In addition to this, the specific age of the sample was limiting the scope of the study in this case, as it did not state the factor below or above 12 years.

The prevalence of obesity in the WHO European region and the achievability of halting obesity at the 2010 level by 2025 was studied in the research. This was a generalised study by Pineda et al. (2018) where BMI data was collected from online databases and various literature. The trends were extrapolated to 2025 with the help of a non-linear categorical regression model. From the result, it was known that by 2025, obesity would increase in 44 countries and as per the present trend, 33 out of 53 countries are expected to grow by 20% or more. The highest prevalence will be in Ireland and in the case of Lithuania, the Netherland and Finland; there would be an increase of 2% from 2015 to 2025. The research demonstrated that the quality of BMI in Europe is variable in nature and less than 50% of the countries have measured on a national level data related to obesity that can be stated to be meaningful. The prevalence of obesity in Europe is found to be increasing in most nations due to the health and economic aspects related to associated diseases. Thus, it is one of the concerning factors for the future that pose a burden related to obesity and related non-communicable diseases in the region. Thus, it is important to make greater and continued efforts for the implementation of effective policies and interventions by governments.

A study by Aynalem and Zeleka (2018) stated that diabetes mellitus is associated with cardiovascular disorders are one of the major global health issues. In Ethiopia, the data related to this is scarce thus, it involves assessing the prevalence of diabetes mellitus and its risk factors among 15 years and above. A community-based cross-sectional study was conducted from January to March of 2016 in Mizan-Aman in southwest Ethiopia. It was found that the prevalence of this disease was 6.5% and previously, the cases were undiagnosed, which included 88.5%. The prediabetes prevalence was 15.9% and the significant factors, in this case, were the circumference of the waist, smoking, BMI, total cholesterol level and hypertension. The associated risk factor of diabetes was high and thus, implementation of targeted prevention strategies with respect to modifiable risk facts in order to reduce the prevalence of diabetes and screening among people with high waist circumference, smoking and hypertension. This study was not entirely focused on obesity in children however, it stated diabetes mellitus, one of the associated diseases of obesity. It showed the importance of curbing obesity as it causes various types of disease.

The neighbourhood built environment has an important impact on the physical activity of children and their body weight. The study An et al. (2019) systematically review the evidence related to such environment on physical activity and obesity in children and adolescents in China. The measure used in this case includes PA behaviours included PA, physical inactivity, sedentary behaviour, active/passive commuting from/to school, and park visits. The availability of green space, parks, sidewalks and recreational areas are linked with increased physical activity, a less sedentary lifestyle and commuting among the population. This study directly focus on the research question and offered specific detail of the factors that may contribute to obesity among children and adolescents. The neighbourhood built environment plays a critical role in the engagement of physical activity and weight consequences in the population and it is important to establish new exercise facilities. The urban designs that include sidewalks, bike lanes, less motorised traffic, walking paths and low residential density would be useful in the promotion of physical activity and prevention of obesity among children. 

Obesity has indeed been classified as a medical illness based on the criteria related to those used to classify other serious illnesses, linked to; loss of body control. It is a mechanism; obesity (or obesities) would be the result of abnormal human biology, which is triggered by environmental parameters trying to act on such a particular genetic susceptibility. A large number of comorbid pathological conditions are exacerbated or accelerated by obesity, and it is linked to a high rate of mortality as well as morbidity, as well as premature mortality. There is a pressing need to pique government and the public desire to participate in allocating more assets, raising awareness, providing education, as well as conducting research to combat the obesity crisis in sizable communities throughout the world. Current obesity research as well as an improved understanding of the fundamental mechanisms have become anticipated to contribute to the creation of therapeutic interventions mostly in coming years. Obesity has been recognised as a chronic illness that necessitates clinical study.

Chapter 5: Conclusion

From the understanding of the result, it can be confirmed that obesity in recent time have affected children to a large extent and caused havoc during their adulthood. The prevalence is high and there is a negative impact on the overall health and wellbeing of the children belonging to the age group of 5 to 15 years. Therefore, it is important to understand various factors associated with it, the predictors that influence it and other associated links by examination of various studies in order to gain a vivid understanding in order to act upon it. This chapter is the conclusion of the research where a general conclusion was drawn along with the conclusion that aligns with each research questions in the study. The recommendations that can be used for mitigating the use was given that include various aspects of the implementation and strategies at personal and government levels. The errors and limitation that has been committed in the study were evaluated and the future scope of the study was recommended.

General Conclusion

There is a growing issue related to childhood obesity that can be slowed down when society will understand and acknowledge the cause of it. There are various components that come into play while understanding childhood obesity where some are considered to be critical as compared to others. It has become a public health crisis all over the world. Either educating the children or their parents about nutrition and the importance of being physically active in nature can reduce the issues. Therefore, the implementation of effective intervention is critical. The data regarding childhood obesity prevalence and impact can be used for making stronger and more effective strategies such as a policy to reduce the future rate of childhood obesity.

The first research question stated the prevalence and causative factor of obesity among 5 to 15 year old children, which was evaluated in a greater depth thus, indicating that there is a high prevalence of the disease in the United Kingdom. The causative factors that are observed in the case of childhood obesity include lifestyle issues such as food with high calories and a sedentary lifestyle. It was found in today’s generation, adults, as well as children, are more prone to fast-food options because of various reasons thus, and it leads to the development of an affinity for unhealthier food options. Another aspect of lifestyle choice is inactivity or less physical activity, which do not lead to the breakdown of calories, which eventually increase the calories intake than used. As a result, the fat in the body increases increasing the weight of the child at a high level. The second research question was how lifestyle factors have an impact on obesity, which was predominant in each of study used for narrative systematic review. The lifestyle factors such as unhealthy diet and inactivity have a proportional relationship as these two factors have a direct impact on obesity. The increase in calories intake results in an increase in BMI as a result, it needs to be controlled in some way or the others. The third research question states the ways of reducing obesity among children where it was found that the intervention of parent, school and community-based programs were recommended. Even though there were recommendations that relate to reducing the weight among children of age 5 to 15 years in most of the studies, however, in the current aspect it can be observed that the prevalence is increasing at an exponential rate. Furthermore, it can be stated that there is a need for the immediate curbing of the rate of increase of obesity in the United Kingdom among children, as it would have a huge impact on the social, economic and health aspects of the country. It is important to identify government-led programs that would help in addressing the issues in a strict manner.

A combination of diet and physical activity can be conducted in the community with the help of schools that can be useful in the prevention of obesity or overweight issue. The intervention of parents who can enforce a healthier lifestyle at home can be useful in avoiding the issue of obesity. As children learn at home about healthier eating options, making the right nutritional choices and exercising that eventually help them lead a healthy life. Thus, it is the biggest impact on the choice a child makes while selecting food to eat at school or any restaurant and being active. Family bonding is considered a strong structure in the behaviour moulding of a child. Both parents and siblings have an impact on the child’s lifestyle and behaviour. Thus, effective intervention within a family setting can be beneficial to change the habit of overeating or unhealthy choice of food. Children spend most of their time in school and it plays an important role in child development. The intervention related to nutrition-based or physical activity in school can be used for achieving weight control among children.

The local area assumes a significant part in the way of life of youngsters. The term ‘local area’ incorporates the climate around youngsters alongside different variables like geographic area, race, identity, and financial status. This asset can be used to advance sound nourishment and solid conduct. Local area support is important in carrying out intercessions and putting together get-togethers like good food celebrations, reap celebrations, giving sound messages, and teaching and empowering individuals to take on a solid way of life. Subsequently, people groups can assist kids with getting reasonable and open good food choices and empower sound nourishment. Local area associations alongside guardians can advance sustenance and actual work-based programs for kids, eg., stroll to school. Local areas can make the local protected, open to youngsters, and spur them to increment physical activity. Other projects as if giving play bunches safe playgrounds and bicycle ways for youngsters to play outside will diminish their time spent before TVs.  Local areas can furnish youngsters with simply available offices like gyms and regulated actual instruction with procedures like music for proactive tasks. The local areas can impact media or neighbourhood diversion to advance solid instructive projects for guardians and youngsters. Thus, making them mindful of sound intercession programs employing the local area is essential to diminish youth stoutness.

Rather than simply encouraging youngsters what to eat, they can see the value in sustenance related schooling in a superior way with regards to them through fun exercises like messing around. A few nations are utilizing tabletop games for kids to cause them to comprehend about adjusted diet and hence prompting information gain. Intuitive media can be utilized for mediations. Intelligent sight and sound like CD ROM can advance solid nourishment in kids with the assistance of virtual instructive games. At the point when these games are utilized, in actuality, circumstances kids can settle on quality food decisions. They can advance direction and confidence for good dieting conduct. Subsequently, these projects can help and spur youngsters to settle on good food decisions and get the advantages of settling on such decisions. These creative mediations can urge youngsters to have a sound existence. 

One of the limitations of the study was the small sample size that included only 5 articles. This did not include the opinion of a large amount of perspective as a result; the scope of the study was limited. The sample size was insufficient because of which, no statistical analysis could be have been done in this study. There was limited access to data as most of the data were unavailable as free text or other issues as a result, a narrative systematic review was conducted that opined the narration of each study in the review. Time was one of the biggest constraints in this study as due to the limitation of time, statistical analysis was not taken into consideration, which would have helped in understanding various other aspects of obesity among 5 to 15 years children.

The errors of the study include sampling error where the estimation of sampling was done. An arbitrary number was chosen and no calculation was done in the case that have an impact on the reliability of the study. The error in non-responsive can be found to significantly affect the research in numerous ways. It can be stated that when the researcher was accessing various studies for the review, most of the authors were non-response, as informed consent was required to use their study. As a result, those relevant studies were not used in a case that has a negative impact on the systematic review. The scope of the study was limited to the United Kingdom thus; the review includes studies based on the country whereas various countries may have other opinions related to childhood obesity that might be important to understand to develop a new and improved intervention to curb the impact of the disease.

One of the most important future scopes of this study is to use a systematic review using statistical data to understand the outcome of obesity and its impacts on the given population in a more meaningful and fundamental manner. The future study may include data from different countries where primary studies can be included. A primary study includes first-hand data which would allow in offering a more recent and vivid understanding of the scenario related to childhood obesity and ways that can be used to mitigate the challenges. As the time was limited, thus, a narrative systematic review was done however, with more time, a mixed-method can be adopted that would help in increasing the scope of the research. In addition to this, financial aid from the Review Committee Board can be taken into consideration thus; it would help in obtaining more aid in enhancing the scope of the study in a more prevalent manner.

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