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Running head: COORELATION OF CHILDHOOD OBESITY AND TYPE II

DIABETES

Correlation of Childhood Obesity and Type II Diabetes


Terresa L. Roulhac
National University

COORELATION OF CHILDHOOD OBESITY AND TYPE II DIABETES

Effects of Obesity and wound healing


Introduction
Children are our future. It is important that we keep our kids healthy so that they
can carry on our legacy in the hopes of making the world a better place for future
generations to come. Children have become more overweight and obese which is making
them more susceptible to diseases that once only affected adults. The Center for Disease
Control (CDC) defines obesity as a BMI at or above the 95th percentile for children of
the same age and sex. (Basics About Childhood Obesity, n.d.) Understanding patterns or
behaviors in a child early can identify potential risks of him or her becoming overweight
or obese in the future. Children that are overweight and obese are more susceptible to a
number of physical and emotional complications and diseases. For example, metabolic
syndrome, high cholesterol, asthma, sleep apnea, nonalcoholic fatty liver disease, early
puberty or menstruation, and type 2 diabetes are all physical complications that can be
seen in children who are obese. The emotional complications can range from low selfesteem and bullying, to depression and behavior and learning problems. (Mayo Clinic,
n.d.).
Today type 2 diabetes is becoming more prevalent in children that are obese and
overweight than seen in past years. There are number of risk factors associated with the
disease that can be seen in children with it. For example, being overweight, family
history of the disease, certain demographic groups are more susceptible. As well as
unhealthy eating patterns, heredity, level of physical activity, and in some rare cases there
could be linked to a medical condition or problem with hormones to type 2 diabetes in

COORELATION OF CHILDHOOD OBESITY AND TYPE II DIABETES

children (WebMD, n.d.). The Mayo Clinic defines type 2 diabetes in children as a
condition that affects the way glucose is processed in the body and the risk increases with
lack of proper exercise and obesity. (Mayo Clinic, n.d.)
Parent child interaction can help prevent childhood obesity and type 2 diabetes.
Studies have been done demonstrating how parenting styles and child personality plays a
part on whether a child becomes overweight or obese. Studies have also shown that obese
and/or overweight children more likely to be raised in homes where feeding practices are
problematic and often non-consistent in nutritional value. (Boles, Reiter-Purtill, & Zeller,
2013)
Research question
In order to determine whether a correlation exist between two variables, a
research question must be proposed. For this study; the proposed question is whether or
not there is a correlation between childhood obesity and type 2 diabetes among African
American children between the ages of 5 -10? What barriers can be seen in a family
where one or more child is obese and or overweight that has the disease, and does single
parent or two parent homes make a difference in the prevalence of obesity and type 2
diabetes.
Null hypothesis and alternate hypothesis
Ho is childhood obesity (r) = type 2 diabetes
Ha is childhood obesity (r) type 2 diabetes
Literature review
Reviewing completed research can help guide future studies on a particular issue
or population. The first article to be reviewed Persistently Obese Youth: Interactions
Between Parenting Styles and Feeding Practices With Child Temperament, was written

COORELATION OF CHILDHOOD OBESITY AND TYPE II DIABETES

by Richard Boles, Jennifer Reiter-Purtill, and Meg Zeller on December 1, 2013. The
study was designed to review the interaction of children and parents during mealtime
practices. It was a longitudinal study that assessed the baseline and follow-up of the
participants. The study included a total comparison of 84 non-overweight and obese
childrens behavior, eating habits, parenting styles and mealtime interactions. The study
explains how there is a firsthand link between behavioral developments in children and
parenting. Obesity risk factors include mealtime functioning and adolescent depression
has been linked to self-reported positive mealtimes. There where two aims in the study
that included the determination of the relationships of parents that reported unfavorable
behaviors in their children and feeding habits. The second aim was to examine behaviors
in relationship to habits during mealtime. (Boles, Reiter-Purtill, & Zeller, 2013)
The study conducted was a secondary study from a larger study about
psychosocial functioning of children who were obese and being treated with peers that
were not obese that shared demographics. The measures that the study used were
demographics and anthropometrics. The study used a questionnaire with 31 items that
asked parents their beliefs, attitudes, and child feeding practices. A second outcome
variable that was used addressed parents concerns about their child during mealtimes.
Along with outcome variables, the study also looked at one moderating variable which
was the Parents-Revised Parental Behavior Inventory. Recruitment came from a young
peoples management clinic and a BMI in 95th percentile was required for participation.
The results that came from the study included a correlation among parenting, feeding
behavior and the temperament among children and explains how adolescent weight is
developed over time. The study also indicates a need to further investigate physical

COORELATION OF CHILDHOOD OBESITY AND TYPE II DIABETES

activity, nutritional intake and its role in childhood obesity. (Boles, Reiter-Purtill, &
Zeller, 2013)
Trends can be an indicator of how a community is heading in one direction or the
other. The second article Prevalence and Trends in Overweight Among US Children and
Adolescents, 1999 2000, takes a look at how there has been an increase in the amount
of overweight children in America. In this proposal NHANES , a series of crosssectional, nationally representative examination surveys conducted by the National
Center for Health Statistics for the Centers for Disease Control and Prevention (Ogden,
Flegal, Carroll, & Johnson, 2002), was used a measurement that included weight and
height measurements for over four thousand youth and children under the age of 19
years. (Ogden, Flegal, Carroll, & Johnson, 2002)
The data was analyzed using the t-test and showed the differences by age group,
sex, and ethnic background. Statistical significance was drawn between the three most
recent surveys. The significance was lower in non-Hispanic whites than among nonHispanic (blacks) and Mexican Americans from the ages of twelve to nineteen that were
overweight. The study indicates that children are becoming more overweight and obese in
the United States and links is to poor nutrition and lack of the right amount of physical
activity. There was a large disparity showing that black females were less active than
white females and males in general. Several disorders were also connected to childhood
obesity. For example, type 2 diabetes mellitus was seen more in ethnic minorities now
than in past years. Also, family history showed that type 2 diabetes was seen in families
where children were also diagnosed with the disease. Food portions have increases over
the years, and more children are consuming foods that are high in fat. Another variable
that see in the study shows that children are more sedentary than in years past. The study

COORELATION OF CHILDHOOD OBESITY AND TYPE II DIABETES

was not clear on interventions that would help lower the rate of obese and overweight
children in the United States. The study encourages researchers to pay more attention to
ways to reduce the prevalence of obesity in children. The link was made between
nutrition and activity level. Other factors such as socioeconomic status, and environments
also contribute childhood obesity. (Ogden, Flegal, Carroll, & Johnson, 2002)
A number of variables can be contributed to both childhood obesity and type II
diabetes. Many studies look at more than just those two variables when determining the
health related qualities of children who are morbidly obese. The third article, HealthRelated Quality of Life of Severely Obese Children and Adolescents, written by authors
Schwimmer, Burwinkle and Varni study obese children and adolescents health-related
quality of life. In this study 57 male children between the ages of 5 to 18 years of age
where chosen who were referred to pediatric gastroenterology or nutrition clinics in San
Diego, California. Group comparison was made between healthy children from private
practices and a secondary comparison with children and adolescents with cancer
diagnosis receiving chemotherapy. Height and weight were used as measurement to
define BMI and those in the 95th percentile or higher were classified as obese.
Recommendations from expert committees performed laboratory evaluation, physical
examination, and collected medical history. The results included conditions that are
directly related obesity. For example, fasting hyperinsulinemia, polycystic ovary
syndrome, and nonalcoholic fatty liver disease. The study also included information
obtained from the pediatric QOL. the QOL was self-administered for legal guardians and
parents of children from the ages of eight to eighteen. The survey was provided in both
English and Spanish. Demographics, school impact and socioeconomic status were
determined from the results. (Schwimmer, Burwinkle, & Varni, 2003)

COORELATION OF CHILDHOOD OBESITY AND TYPE II DIABETES

The results of the study showed that there was a significant relationship with
impaired health-related QOL and severe obesity in children between the ages of eight and
eighteen. The study mentions that dyslipidemia and hyperinsulinemia can lead to diabetes
and cardiovascular disease. One of the limitations was the lack of participants with
obesity. Also, only children being referred for evaluation were entered into the study,
therefore limiting the population to participants actively seeking help. (Schwimmer,
Burwinkle, & Varni, 2003)
Correlation studies can predict a number of possible consequences that can arise
between two variables. The forth article written by William H. Dietz wrote the article
titled, Health Consequences of Obesity in Youth: Childhood predictors of Adult
Disease in 1998 that showed that children who are obese are at a larger risk of adult
diseases. In this article, Dietz explains, that children who are overweight and obese
become targets and victims of discrimination. Also, self-image and self-esteem is not
change until children become adolescents. Parental messages that children get helps
develop how they will perceive themselves as adolescents. One point that was made in
the reading, was the disparity of the height and weight of overweight children and the
perception that adults think that they are older than they really are based on their height
and weight. Adults will interact with these children thinking that they are in one age
group based on that disparity. These children often feel like failures for not being able to
respond to the adult in the way that the adult sees them. (Dietz, 1998)
The article looked at a number variables to determine what health consequences
that overweight and obese children would be affected by. Adult interactions and social
interactions with children helped to link why some obese children feel isolated from
society. The National Longitudinal Survey was used to understand how obesity in

COORELATION OF CHILDHOOD OBESITY AND TYPE II DIABETES

adolescence affected social achievements in young adulthood. Ten thousand participants


between the ages of sixteen to twenty four years of age were surveyed. Questions were
asked about education levels, household income, marital status and the information was
compared to peers that were not obese. Results suggested that there was a prevalence of
obesity in lower economic areas. (Dietz, 1998)
A second cross-sectional study was performed for children between the ages of
seven to thirteen and showed how weight was a concern in half of the participants. Girls
were more concerned with their weight than their male peers. But, black girls seemed to
be less concerned about weight than their white peers. It was unclear in the study whether
reduction in weight was affected by abnormal eating behaviors. The author suggests
more studies to be conducted on black females and increased body weight because of the
acceptance of larger weight standards among the black community. (Dietz, 1998)
The consequences that were described in the article were that children that are
overweight tend to be taller and mature earlier than children who are not overweight. In a
longitudinal study, after a child gains excessive weight there was also an acceleration in
height gain seen. (Dietz, 1998) Another issue seen in obese children is hyperlipidemia.
MedicineNet.com defines hyperlipidemia as, Elevated lipid (fat) levels in blood. (n.d.)
Hyperlipidemia is not the only disease that is being seen more in obese and overweight
children. The reading states that in 1994 there was an increase in diabetes mellitus cases
among children and adolescents in Cincinnati, but suggests that more studies should be
conducted to determine measurements of total body fat and visceral fat. Other
consequences of obesity that are less common in children are hypertension, pseudotumor
cerebri, sleep apnea, a variety of orthopedic complications, and polycystic ovary disease
(PCOD) . (Dietz, 1998) The article concluded with suggestions that more resources

COORELATION OF CHILDHOOD OBESITY AND TYPE II DIABETES

should be allocated to treatment and studies of obese and overweight children and
adolescents. (Dietz, 1998)
As children are becoming more obese and overweight they are becoming
susceptible to diseases and illness that are linked more to adults. In the fifth reviewed
article written by Chris Woolston, Type 2 Diabetes and Kids: The Growing epidemic,
the question the question raised was whether or not children could get adult-onset of
diabetes. The article explains that adults are not the only ones with the disease and that
the majority of the children with the disease are adolescents. Chris suggests that obese
children are more susceptible to get diabetes when they are older based on eating habits
and their level of activity. (Woolston, 2014)
The article provided data from a secondary source (CDC) that predicted in 2000
that type 2 diabetes would be more prevalent in children that were not very active and
had poor eating habits. Also, along with type 2 diabetes, kidney disease and
cardiovascular problems were other complications seen in overweight and obese children
and adolescents. More than 80% of children and adolescent with type 2 diabetes were
overweight, and 40 % were clinically obese. The link between obesity and type 2 diabetes
was seen when scientist found that, certain fat cells were metabolically active and
secrete chemicals that raise inflammation levels in the body and contribute to increased
fat in liver, which is a risk factor for insulin resistance a precursor for type 2 diabetes
(Woolston, 2014). The article also suggested that location of fat storage makes a
difference in the type of obesity present in the body. If the fat is stored around the midsection or belly then the risk of diabetes is higher. Also, diets that are low in fiber and
high carbohydrates seem to be a problem believed by some experts. Activity level is a

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major factor in preventing both obesity and type 2 diabetes and children who are less
active have more of a chance of the disease. (Woolston, 2014)
Understanding the warning signs can help catch a problem early on. The article
gives many warning signs to look for with type 2 diabetes. Increase urination, extreme
thirst, increase appetite, weight loss, and acanthosis nigricans. (Woolston, 2014)
WebMd.com defines acanthosis nigricans as, a skin disorder that results in velvety, lightbrown-to-black markings that occur in areas including the neck, armpit, groin, and under
the breasts (n.d.). Acanthosis nigricans is a skin disease also associated with type 2
diabetes and seen in 70% of children. (Woolston, 2014)
There are a few consequences for children with type 2 diabetes that include,
headache, blurred vision, dry, itchy skin, more long term problems like renal failure and
possible amputations. (Woolston, 2014)
Prevention is the best way to avoid any disease and the article provided a number
of suggestions. Suggestions to prevent both obesity and type 2 diabetes include
encouraging foods that have more fiber, increase the amount of vegetables and fruits and
avoid foods that are high in saturated fats and sugars. (Woolston, 2014)
Proposed Method
Sample
A total of 100 African American children will be chosen based on their
geographic location in San Diego (between the ages of 5 -10 years age). Regular
stratified sampling will be used to ensure that there will be equal amounts of males and
females in the study, and cluster-stratification to guarantee that every county in San
Diego is represented. One school in each county will be selected. Informed consent will
be required from parents or legal guardians, and incentives will be given to all
participating individuals so that those chosen for the study will want to be apart of the

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study and sign the informed consent paperwork. A primary data analysis will be used and
collected from surveys and focus groups. Socio-economic status, health status, activity
levels, and two parent or single parent home will be included.
Data Collection
The data will be collected in person via surveys. The surveys will be designed to
gather information on demographics, eating and activity levels of participants. See
Appendix A. Permission will be requested and information about the study will be
decimated to the public. The survey will take 25 minutes and will include 30 questions
that will be geared towards both the parents perceptions of theirs childs health, and
eating habits as well as the activity level of their child. Guardians and parents will sign an
Informed Consent prior to the start of the 30-minute focus group. The focus group will
give information to parents and guardians on healthy eating and positive affects of
increased activities for their children. A cross-sectional study will be used to determine
the correlation between obesity and type 2 diabetes in African American children between
the ages of 5 -10. Once the children chosen for the study have been selected, height and
weight measurements will be collected and Body Mass Index (BMI) will be determined
according to CDCs formula and calculations.
The children will have a separate monitored 20 minute focus group, where they
will describe their perception of healthy eating habits, and how much physical activity
they should get. A 5-minute survey will be provided to them after the focus that will have
pictures of different food types and which one they usually eat on a daily basis as well as
which physical activities they usually engage in. See Appendix B.
Methods

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Gender, age, height, and weight will be used to determine BMI for the study. A
correlation will be determined for those children that are obese and have type 2 diabetes.
The mean age of children with obesity and diabetes will be determined. Also,
socioeconomic status, and demographics will be used to determine whether the
prevalence of obesity and or type 2 diabetes is seen more in one are versus another.
Data Analysis
The groups will be broken into two equal groups of boys and girls. The first group
will consist of ages 5-10, and the second group will incorporate the ages 6 -15. The plan
would be to have a total of 100 children from the San Diego County. Plans include taking
the mode, median and mean of the ages and look at the ages of diabetes onset and
diagnosis of weight status. Children with type 2 diabetes that are not obese will be
removed from the study. Those children that are overweight and obese with the disease
will be further researched. The average age a child has been diagnosed with Type 2
diabetes will be determined. Other factors could play a part, such as what types of after
school activities the children are involved in, as well as how often healthy food choices
are made available to them, mental status, and other family members in the home that are
also overweight and obese.
The data will either prove that there is a relationship between childhood obesity
and type 2 diabetes or that there is no correlation between the two variables. I will use
Confidence Interval and T-test to analyze my inferential statistics.
Confidence Interval will be used to predict the value of children in the study
based on the score in my sample.
The T-test will help me compare the means of the two groups of children in the study.
Ethical Considerations

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There are a number of ethical considerations where children are involved. For
example, children and parent (s) or guardians, must be informed of the how the
information will be disseminated, and the storage of the data.
Children are among the vulnerable population and special care must be taken to
protect them.
Also my own personal bias on the subject must not play any parts in the research.
The children will be chosen based solely on whether or not they fit the criteria for the
study.
The research must meet the approval of the IRB, and all information must be
placed in the right form of context for the research.
Determining if participants will be anonymous or known is a factor. With my
study, the children will be anonymous and the information will be secured in a lock room
while the research is being conducted. Once the research is complete all information will
be appropriately destroyed.

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Reference:
Bascis About Childhood Obesity. (n.d.). Retrieved February 27, 2015, from
http://www.cdc.gov/obesity/childhood/basics.html
Boles, R. E., Reiter-Purtill, J., & Zeller, M. H. (2013). Persistently Obese
Youth: Interactions Between Parenting Styles and Feeding Practices With Child
Temperament. Clinical Pediatrics, 52(12), 10.1177/0009922813497091.
doi:10.1177/0009922813497091
Conrey, E. J., Hade, E. M., Norton, A., & Scarpitti, H. (2009). Methods for a
Survey of Overweight and Obesity Coordinated With Oral Health Surveillance
Among Ohio Third-Grade Students. Preventing Chronic Disease, 6(1), A08.
Childhood Obesity Facts. (2014). Retrieved February 9, 2015,
from http://www.cdc.gov/healthyyouth/obesity/facts.htm
Dietz, W. (1998). Health Consequences of Obesity in Youth: Childhood
Predictors of Adult Disease. Pediatrics Official Journal of the American Academy
of Pediatrics, 101, 518-525.
Mayo Clinic Staff. (n.d.). Childhood obesity. Retrieved February 28, 2015,
from http://www.mayoclinic.org/diseases-conditions/childhoodobesity/basics/complications/con-20027428
MedicineNet.com. (n.d.). Hyperlipidemia. Retrieved March 1, 2015, from
http://www.medicinenet.com/script/main/art.asp?articlekey=3838
Ogden, C., Flegal, K., Carroll, M., & Johnson, C. (2002). Prevalence and

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Trends in Overweight Among US Children and Adolescents, 1999-2000.


Retrieved February 28, 2015, from http://jama.jamanetwork.com/article.aspx?
articleid=195387
Schwimmer, J., Burwinkle, T., & Varni, J. (2003). Health-Related
Quality of Life of Severely Obese Children and Adolescents. Retrieved March 1,
2015, from http://jama.jamanetwork.com/article.aspx?articleid=196343
Shubrook, J. (2011). Childhood obesity and the risk of diabetes in
minority populations. Retrieved February 9, 2015, from
http://www.cecity.com/aoa/healthwatch/jan_11/print5.pdf
WebMD. (n.d.). Child Type 2 Diabetes: Symptoms, Causes & Treatments.
Retrieved February 28, 2015, from http://www.webmd.com/diabetes/guide/type2-diabetes-in-children
WebMd.com. (n.d.). Acanthosis Nigricans. Retrieved March 1, 2015, from
http://www.webmd.com/skin-problems-and-treatments/acanthosis-nigricansoverview
Woolston, C. (2014) Type 2 Diabetes and Kids: The Growing Epidemic. Retrieved
February 25, 2015, from http://consumer.healthday.com/encyclopedia/diabetes13/misc-diabetes-news-181/type-2-diabetes-and-kids-the-growing-epidemic644152.html

COORELATION OF CHILDHOOD OBESITY AND TYPE II DIABETES

Appendix A
Childhood Obesity Guardian/Parent survey

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COORELATION OF CHILDHOOD OBESITY AND TYPE II DIABETES


Appendix B
Childhood Self-Perception survey

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