Poverty And Childhood Malnutrition

Rebecca Dover Dr. Zemel Nutrition 302 11 March 2008 Poverty and Food Insecurity: The Impact on Childhood Nutrition Poverty is a problem in our world with numerous ramifications, but the poor nutrition resulting from this situation is an issue always at the forefront. Poverty has almost always been associated with malnutrition, which is the basis for the well-known issue of world hunger. As developing nations, and even the most powerful nations, continue to change and grow, forgetting to put a strong enough emphasis on awareness and education, the nutrition problem in poverty has begun to shift towards a paradoxical issue involving obesity. Solving this poverty-obesity paradox is of utmost importance because the health issues poor people are beginning to face have detrimental effects on children. The major problem in both of these results of poor nutritional situations is that impoverished children are helplessly born into the situation, and provided with a nutrition lifestyle that will be harmful to them for the rest of their lives. This paper will address more fully the problems arising from food insecurity involving malnutrition in impoverished people and how this is affecting children daily, the new evolving paradoxical issue of food insecurity in poverty and obesity, the ramifications for childhood obesity, and what is being done to solve these modern crises. Poverty has been a primary reason for hunger in our world for all of modern time. Food insecurity is a state in which many financially lacking people cannot help but fall into. There are many approaches to assessing this institution of poverty. One assessment used by the researchers

Dover 2 writing for The Lancet is that poverty is measured by the lack of basic needs and availability of services. Surveys performed in 45 developing countries reported that 37% of children lived in absolute poverty (1). In general, poverty is equated with inadequate food, poor sanitation and hygiene, and these things commonly lead to increased infections and stunted growth and development in children. Poor parental education is also typical in this situation, as well as high stress and depression for parents, leading to a lack of encouragement and leadership in health, education, and development for children from the home (1). These factors have very negative effects on child development and in turn result in poor school achievement, made worse by inadequate schools typical in poor communities. According to an article on childhood development and poverty in The Lancet, “We have made a conservative estimate that more than 200 million children under 5 years fail to reach their potential in cognitive development because of poverty, poor health and nutrition, and deficient care” (1). There are obviously widespread effects of poor nutrition from poverty, and many children in our world suffer from this specific side effect- stunted development- because of this matter. As researches have feverishly sought to study and find answers to these problems of world hunger, though, other major issues have arisen. The impoverished situation found in countries all over the world, both in developed and developing countries, has actually shown a rise in rates of obesity, overweight, and chronic disease. As problems of hunger and malnourishment are fiercely combated, these equally serious health problems have sprung up on the other side of the spectrum. The idea of food insecurity, as mentioned before, obviously results in undernutrition, but also in overnutrition. “The paradox within these intertwined social and economic relationships is that poverty causes food insecurity, yet one of the overwhelming outcomes of food insecurity is obesity” (2). This is a strange idea

Dover 3 due to the fact that less money logically seems to result in less food, and therefore malnutrition. That is where the coined “paradox” term becomes necessary as the only way to describe this phenomenon. According to The State of Food Insecurity in the World, there is a growing body of evidence suggesting that it is the poor who are most at risk of diabetes, obesity, and hypertension- instead of only hunger and micronutrient deficiencies (3). Many research studies have been performed to test the credibility of this poverty-obesity paradox in recent years. A research study implemented by the Medical Center of the University of Arkansas sought to assess the association of household and child food insecurity with childhood overweight status (4). The study used The National Health and Nutrition Examination Survey and a nationally representative sample of US citizen children. The conclusion of this particular research study was that in many demographic categories of children, household and child food insecurity are actually associated with being at risk for overweight status (4). A national research study performed in the United States made an assessment of preschooler’s diet quality, its sociodemographic predictors, and its association with body weight status. The results stated: On average, preschoolers consumed suboptimal levels of whole grains, fruits, vegetables, and dairy. Overall diet quality decreased with increasing age, but improved with increasing family income… Childhood obesity prevalence decreased significantly with increasing diet quality (5). In other words, the wealthier a preschool aged child, the better off in terms of body weight due to an increase in quality of his or her diet. The lower income children consuming poorer quality food proved a higher incidence of obesity. The conclusion of this research experiment is that the diet quality of preschool aged children needs to be improved in order to help prevent early

Dover 4 childhood obesity (5). Both of these studies show the correlation between poverty and obesity, and make it clear that this is definitely a problem we are facing in this modern world. Another article entitled “Poverty, obesity, and malnutrition: an international perspective regarding the paradox” expounds on why these lower income level families generally have lower quality diets. “When food insecurity exists in a community, sufficient or even excessive energy may be provided by the limited foods available, but the nutritional quality and diversity of the foods in the diet may not support a healthy nutritional status” (2). Food insecurity typically results in compromising the quality of the family diet. Compromising food quality results in consuming high fat and high carbohydrate foods that are energy-dense, but not nutrient-dense (2). Energy-dense foods are less expensive, proving to be the basis for this lack in diet quality. Foods such as whole grains, fresh fruits, and fresh vegetables are more expensive and therefore not necessary in the minds of impoverished families (2). Even though there is a correlation between poverty, food insecurity, and malnutrition, it should not be surprising that food insecure families also have the greatest occurrence of obesity and the highest body mass index. The effects of obesity early in life, specifically in children, are detrimental. “It is estimated that by the year 2015 noncommunicable diseases associated with overnutrition will surpass undernutrition as the leading causes of death in low-income communities” (2). Malnutrition and food insecurity are major causes of death in impoverished children. This is a major effect of this epidemic, but there are also many minor effects. According to Nutrition Through the Life Cycle, 22% of US children live in poverty, and approximately 18% of US children suffer from hunger or food insufficiency (6). The health implications of the situation these children are growing up in are primarily malnourishment and obesity as stated before. Childhood obesity causes children to enter puberty earlier, due to an increase in fat composition

Dover 5 resulting in an increase in the hormone estrogen. Obese children grow taller than peers initially, but stop growing early and achieve a shorter height (6). There are also many psychological effects of obesity such as low self-esteem and rejection by peers. In terms of physical health, obese children are more likely to be obese adults. Their risk of high blood pressure, diabetes, respiratory disease, asthma, and atherosclerosis also go up considerably (6). These chronic diseases associated with obesity are detrimental especially for impoverished families because the amount of money required to combat these illnesses is rarely affordable. With so many problems resulting from and related to poverty and childhood malnutrition and obesity, there are numerous solution and awareness efforts being implemented by various organizations. One of the main efforts being put into action is the Millennium Goals Report created by the United Nations. The number one goal of this report is to eradicate extreme poverty and hunger. Since 1990, the number of people living on one dollar a day in developing countries has decreased from 1.25 billion to 980 million in 2004. In developed countries the percentage of people living on one dollar a day went from 31.6% in 1990 to 19.2% in 2004 (7). Another target of this report is to halve the number of people suffering from hunger between 1990 and 2015. According to this report, “Child hunger is declining in all regions, but meeting the target will require accelerated progress” (7). The United Nations is making this progress with their plan due to the implementation of programs to improve education in both children and parents, increasing agricultural productivity in many regions, and increasing aid to these same regions (7). Cutting down on poverty and aiding in the relief of millions of hungry children in this world should in turn reduce the incidence of food insecurity and directly impact the obesity epidemic this world is seeing in all parts of the world. In the United States this obesity problem in poverty stricken families

Dover 6 has been an issue for about two decades. In response, the United States Department of Agriculture (USDA) came up with TEAM Nutrition in 1995 (6). This plan was intended to fight obesity, but to also give awareness to impoverished people of the importance of dietary quality. The goals of this plan are to promote eating less fat, more fruits, vegetables, and grains, and to increase eating a variety of foods (6). Although this plan probably curbed the obesity trend in impoverished communities slightly, it is not drastic enough to see very much difference. Today the World Health Organization (WHO), according to The International Journal of Epidemiology, has become overwhelmed with this poverty-obesity paradox. Even though it began in the United States, the trend has swiftly spread to Europe, other developed countries, and finally to some of the poorest countries in the world (8). The WHO has the challenge of fighting AIDS, malaria, and undernutrition in these underdeveloped areas, but now the additional challenge of obesity induced chronic diseases such as diabetes. “The WHO warns that the greater future burden of obesity and diabetes will affect developing countries, and the projected numbers of new cases of diabetes will run into the hundreds of millions within the next 2 decades” (8). The conclusion of this article’s research on obesity in developing countries pessimistically states that the chronic disease resulting from obesity will continue to spread with the only hope being educational campaigns and awareness efforts to subside the magnitude of the problems (8). Studies make it clear that the paradox concerning the prevalence of

Dover 7 obesity in food insecure impoverished situations is real and present in households all over the world. Children are innocently brought into these situations and are affected for the rest of their lives by poor nutrition. It is also clear that many children go hungry due to a complete lack of food, but as projected, incidence of obesity even in developing countries is continuously escalating and will potentially cause major chronic disease problems in these incredibly poor regions. Whether the children in food insecure households are hungry due to lack of food or obese due to high energy content of the available food, though, the consensus of articles on the subject agree that a solution must be found. Obesity has detrimental effects on all people, but particularly children, and nutritional status not only affects health, but also social, emotional, or psychological well-being. Education is the primary route to curbing this epidemic, and this should start with awareness efforts because parents are the primary teachers in the lives of children. The Millennium Development Goals from the United Nations, the World Health Organization’s progression into action, and even nutritional efforts like TEAM Nutrition from the USDA are all fighting the world hunger/food insecurity issue facing the world today. With more plentiful nutritious varieties of food, people in poverty could potentially ward off numerous diseases and health issues. It is unclear what the future holds for impoverished children, but for now programs are certainly in the works and one day this issue could very likely be resolved if groups continue to step up and take action.

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References 1. Grantham-McGregor S, Cheug YBC, Cueto S, Glewwe P, Richter L, Strupp B. Developmental potential in the first 5 years for children in developing countries. The Lancet 2007 Jan; 369(9555):60-70. 2. Tanumihardjo SA, Anderson C, Kaufer-Horwitz M, Bode L, Emenaker NJ, Haqq AM, Satia JA, Silver HJ, Stadler DD. Poverty, obesity, and malnutrition: an international perspective regarding the paradox. J Am Diet Assoc 2007 Nov;107(11):1966-72. 3. The State of Food Insecurity in the World. 2004. FAO Corporate Document Repository. 4 March 2008.. 4. Casey PH, Simpson PM, Gossett JM, Bogle ML, Champagne CM, Connell C, Harsha D, McCabe-Sellers B, Robbins JM, Stuff JE, Weber J. The association of child and household food insecurity with childhood overweight status. Pediatrics. 2006 Nov; 118(5):e1406-13. 5. Kranz S, Findeis JL, Shrestha SS. Use of the Revised Children's Diet Quality Index to

Dover 9 assess preschooler's diet quality, its sociodemographic predictors, and its association with body weight status. J Pediatr (Rio J). 2008 Jan-Feb; 84(1):26-34. 6. Brown JE, Isaacs J, Wooldridge N, Krinke B, Murtaugh M. Nutrition Through the Life Cycle. 3rd Edition. 2008; 307-52. 7. United Nations. 2007. The millennium development goals report. Retrieved March 4, 2007. . 8. Prentice AM. The emerging epidemic of obesity in developing countries Int. J. Epidemiol., February 1, 2006; 35(1): 93 - 99.