In the home: By controlling food availability and eating, and physical activity practices, parents play a very important role in shaping their children's home environments, diet, food preferences, and physical activity levels. (27,28) However, because of changes in family structure and employment, children frequently experience disrupted family life and less “quality time” with their parents. (14) Compared with previous generations, today's youth are more likely to live in divorced or single-parent households, have fewer siblings, have an employed mother, spend time in day care, or spend afternoons home alone. (29) For an ever-growing number of children and adolescents, the “latchkey” phenomenon adversely affects psychological development, eating style, physical activity and weight status, and may contribute to lonliness. (29,30)
From 1981 to 1997, the number of families who regularly ate dinner together decreased by 33%. (31) Today, only 1/3 of families dine together daily. 31 An immediate effect of the decline in family meals is that children are spending more time eating outside the home. (32)
Regular family meals are linked to decreased teen risk of psychosocial problems, drug use, risky sexual behavior, and suicidal intention. (31) Children who spend more time eating with their parents have healthier diets. (31,33) By the same token, children who eat alone or outside the home may be at increased risk for malnutrition and overweight. (33)
Today's childhood obesity epdemic mirrors the concurrent adult epidemic. Children with obese parents are much more likely to be overweight than those with normal-weight parents. (35)
In the media: The media influences children's habits, desires, thoughts, and lifestyles. Today, children spend an astounding 40 hours per week consuming media, such as television, Internet, video games, radio, magazines, and billboards at sporting events. (36) Such a constant barrage of images and ideas leaves a lasting influence on kids' eating, exercising, and body image. (21)
By age 18, the average youth has watched 350,000 commercials. (37) Furthermore, kids influence about $250 billion of consumer spending in a single year. (37) Advertising campaigns now link food, beverage, and candy products with enticing add-ons like movie and cartoon characters, video games, toys, and even educational materials. (10)
Food is the most commonly advertised product during peak children's viewing hours. (36,40) Unfortunately, most commercials advertise non-nutritious, high-fat, high-sugar foods. (41)
From 1992 to 1999, spending on child-directed advertising increased almost 2-fold, from $6.2 billion to $12 billion. 36 Paling in comparison, government expenditures on health and wellness campaigns only reach a fraction of a percent of that $12 billion (18): The CDC's “Youth Media (VERB) Campaign” budget was $51 million for FY 2003, and the National Cancer Institute's “5 A Day Program” (promoting fruit and vegetable consumption) currently has a communications budget of $3.5 million. (42)
It is not surprising that the more time a child spends watching TV, the greater his/her risk for high intakes in fat, sugar, salty snacks, soda, and overall calories. (40) Advertising is especially influential among young children, because those under 8 do not understand the “persuasive intent” of commercials. (36)
In the schools: School is an important influence on developing children and adolescents. Given that schools have access to 95% of the nation's youth, changes in education policy and program funding can have broad, sweeping effects – not only on kids' academic and social experiences, but also on their eating habits, physical activity levels, and overall weight status. (9) As education increasingly focuses on academic performance and standardized test scores, non-academic programs like health education, lunchtime, physical education (PE) and recess suffer.
Children and adolescents consume about 35-40% of their total daily calories at school, but they are consuming more and more food from a la carte programs and vending machines. (7) Unfortunately, while free or reduced-price meals offered through the U.S. Department of Agriculture National School Lunch/Breakfast Program must abide by federal nutrition guidelines, the “competitive foods” sold a la carte or in vending machines are not regulated. (7) As a result, the majority of competitive foods are energy-dense, high-fat or high-sugar snacks and beverages, including chips, crackers, hamburgers, ice cream, cookies and snack bars. (7,9)
Because of budget cuts, many schools have turned to private companies for extra funding of school facilities, materials, and extracurricular programs. Increasing numbers of schools are signing away exclusive selling/pouring rights to fast food chains and soda companies. (10) More schools are also broadcasting Channel One, an in-school television network that exposes students to 2 minutes of advertising during its daily 12-minute newscast. (10)
Children are not getting enough exercise through school PE programs. (44) Daily participation in high school PE classes dropped from 42% in 1991 to 32% in 2000. (46) In addition to PE cuts, health education programs have also suffered, leaving many students poorly informed about proper nutrition and healthy eating habits.
In the communities: Conditions in low-income communities and neighborhoods may contribute to overweight and obesity.
Many urban neighborhoods lack supermarkets, outdoor produce stands, and other healthy alternatives to burger joints and corner stores, making it more difficult to purchase fresh, inexpensive fruits and vegetables than to buy fast foods. (25)
The deterioration of inner city neighborhoods has also led to fewer open spaces, more heavily traveled streets, and more violence, pressuring parents to keep their kids inside, in the “safe” environment of TV sets, computers, and video games. (18)
The structure and planning of our cities and suburbs—the built environment—discourages physical activity. (See American Journal of Public Health, September 2003, Volume 93, Issue 9, www.ajph.org/content/vol93/issue9/index.shtml for articles on the effects of the built environment.) Residential neighborhoods are typically designed for dependence on the automobile, without access to public transportation, bike paths, sidewalks, running and walking trails, parks or open spaces. Separation of residential, recreational and commercial activities creates dependency upon the automobile to access workplaces, recreation and shopping.