Introduction Health professionals have, for a long time, known the consequences of being overweight and obesity in adults.

Over the course of the past three decades, there has been increased concern and attention regarding the issue of childhood obesity. There are varying opinions about what factors contribute to increased childhood obesity. Main contributors range from genetic predisposition to sedentary lifestyles. A number of disciplines have developed approaches to address these concerns. However, these approaches seem to only address one facet of a problem that is multifaceted. Applied separately, these approaches still leave us with the problem of a steady rise in childhood obesity. As such, perhaps a holistic approach to address childhood obesity would be more effective. There are many health factors that are directly attributable to maintaining a body weight and body mass index in excess of acceptable parameters. But how is overweight or obesity defined? According to the National Center for Health Statistics (1999), Body Mass Index, or BMI, is calculated by dividing weight (kg) by height (m squared). Overweight or obesity, which is used interchangeably, is defined as having a Body Mass Index (BMI) above the 95th percentile on the sex specific BMI growth charts. The marked increase in childhood obesity can be seen in the statistical analysis conducted by the Department of Health and Nutrition. Researchers took a comparison of the rate of obesity in children and youth between 1963-1965 and 2007-2008, and found that:

Obesity in children ages 2 to 5 increased from 5.0% to 10.4%. Obesity in children ages 6 to 11 increased from 6.5% to 19.6%.

Obesity in adolescents ages 12 to 19 increased from 5.0% to 18.1%.

Researchers also noted differences between gender and race in the increase in childhood obesity.

Obesity in non-Hispanic Caucasian males increased from 11.6% to 16.7%. Obesity in non-Hispanic African-American males increased from 10.7% to 19.8%. Obesity amongst Mexican American males increased from 14.1% to 26.8%. Obesity in non-Hispanic Caucasian females increased from 8.9% to 14.5%. Obesity in non-Hispanic African American females increased from 16.3% to 29.2%. Obesity in Mexican American females increased from 13.4% to 17.4%. Although research into the causes of childhood obesity has not been as extensive as the

research with overweight adults, significantly increased health related issues in obese children have been noted. Short-term health issues may include hyperinsulinemia, asthma, hypertension, and obstructive sleep apnea (Berg, 2004). Pervasive health issues such as type II diabetes, high blood pressure and coronary heart disease; diagnoses once reserved for adults, are now being made more and more with children (Deitz, 2004). Additionally, obese youth are more likely than youth of normal weight to become overweight or obese adults, and as a result are more at risk for associated adult health problems, including osteoarthritis, stroke, heart disease, type II diabetes, stroke, and various types of cancer, (Freedman, Zuguo, Srinivasan, Berenson, & Deitz, 2007). Because of the steadily increasing numbers of children clinically determined to be obese and the ever increasing rates in which children are being diagnosed and treated for what use to be adult only maladies, health professionals and researchers alike have begun to regard this
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increasing phenomenon as a pandemic; not just for the United States, but for industrialized countries all over the world. The possibility has been raised that the pervasiveness and severity of childhood obesity may significantly, and for the first time, negatively affect what has historically been the steady increase of life expectancy; with youth today on average living shorter and potentially less healthy lives than their parents (Daniels, 2006). Not only are health related issues of serious concern with childhood obesity, but also the psychological and social implications that naturally follow. According to the Surgeon General, social discrimination is considered one of the greatest problems overweight children and adolescents may face (USDHH, 2001). Being taunted, teased, shunned, and ridiculed may be daily occurrences for children struggling with their weight; and oftentimes as a secondary result, obese children are reportedly suffering with less psychosocial well being, low self-esteem and more depression than their average size peers (Mellin, Neumark-Sztainer, Story, Ireland, & Resnick 2002). A comprehensive research study found that overweight and obese adolescent girls were less likely to have a social network, and more likely to be depressed and experience mental and emotional problems, as well as more likely to attempt suicide than their non-obese counterparts (Falkner, Neumark-Sztainer, Story, Jeffrey, Beuhring, & Resnick, 2001). There has been a great deal of speculation as to what has contributed to such an increased and disproportionate number of children suffering with obesity. Some of the main contributors to childhood obesity have been identified as genetic predisposition, unhealthy eating habits, and sedentary lifestyles (Ballard & Alessi, 2004). The notion of genetic predisposition as a contributing factor to the staggering rise in childhood obesity may be attributable, in part, to environmental changes that affected prior generations, now manifesting itself in this generation.

Specifically, gestational diabetes and diabetes during lactation caused by maternal obesity may promote a repeat pattern in subsequent generations (Heimberger, Allison, Goran, Heini, Hunter, & Hensrud, 2003; Rogers, 2003). In Addition, Body Mass Index (BMI) or adiposity has a heritable component, or the ability to be passed through lineage. This finding is well supported by clinically researched testing, including animal breeding studies, human twin, family, and adoption studies, with an estimated heritability of approximately 65% (Allison, Pietrobell, Faith, Fontaine, Gropp, & Fernandez, 2003). Rossner (2002) has identified childhood obesity as the disease of the 21st century because of the consumption of unhealthy quantities of dietary fat and lack of regular exercise that earmarks the behaviors of obese children and adolescents today. Substantial contributors to the sedentary lifestyle so many young people have adopted today can be directly related to advancements in technology (Sallis, Mckenzie, Conway, Elder, Prochaska, Brown, Zine, Marshall, & Alcaraz, 2003). According to the most recent A.C. Nielsen rating for 2010, children and youth spend approximately 1,680 minutes or 70 hours per week watching television (Television & Health, 2010). Whereas children and youth spend roughly 900 hours per year in school, more than 1500 hours per year are spent in front of the television. According to William H. Deitz, pediatrician and prominent obesity expert at Tufts University School of Medicine, "The easiest way to reduce inactivity is to turn off the TV set. Almost anything else uses more energy than watching TV." In addition to the inactivity of children and adolescents associated with the television, is the noted elevation of inactivity due to engagement in video gaming technology, computers, and cell phones. Very little physical activity is required, and some experts speculate that this pervasive inactivity can even lower a childs metabolism (Zametktn, Zoon, Klein & Munson, 2004).
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The seemingly unyielding rise in childhood obesity has not only caused a marked increase in health problems for the children who suffer with this issue, but there has also been a considerable impact on health care. According to the 2003 report by the Department of Health and Human Services, obesity accounts for approximately 10% of total direct health care costs; with 37% higher Medicare costs for an obese individual as opposed to a non-obese individual. With an estimated annual cost of between $69 and$117 billion, given the current trend, healthcare costs related to obesity directly and indirectly are expected to continue to rise. Today, engagement in physical activity is primarily relegated to physical education in school. However, there are only two states, Illinois and Massachusetts, that require physical education for children and adolescents in grades kindergarten through 12th. Further, a recent Center for Disease Control (CDC) study indicates that less than 4% of elementary schools, less than 8% of middles schools, and a little more than 2% of high schools require daily physical education for all students all year. Even though National Association of Sports and Physical Education (NASPE) have recommended an increase in physical activity from 30 minutes to 60 minutes for children ages 2 to 5, many school gym facilities are being used for multiple purposes, limiting the opportunity for children to actually take advantage of the PE time allotted (2010 Physical Activity Report). As children spend more and more time after school in front of the television, on the cell phone, or playing computer games, less and less time is spent engaged in physical activity. Research reports indicate that a students participation in school based sports programs, physical education, or extracurricular activities greatly reduce the risk of obesity (Burke, Milligan, Thompson, Taggart, Dunbar, Spencer, Medland, Gracey, Vendogen, & Beilin, 1998). Interestingly, however, there has been a nationwide trend towards cutting or eliminating
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team-based sports in elementary and middle school (Elkins, Cohen, Koralewica, & Taylor, 2004). Much of the noted reduction has been attributed to the new, No Child Left Behind law. Due to increased pressure for academic performance from the Elementary and Secondary Education Act (ESEA), or No Child Left Behind law, many elementary, middle, and secondary schools have suffered weighty budget cuts that have drastically reduced funding for physical education classes, extracurricular sports, and athletic programs. School boards across the United States have to determine whats most important: retaining funding for academics, or ensuring children receive the allotted number of hours of physical education per week. With its emphasis on getting children to pass standardized tests by bringing low performing students to proficiency, the ESEA is literally forcing the hands of schools to take already limited resources and primarily, if not exclusively, divert them to academic performance. Physical education is a critical part of a complete education and every student deserves to be physically educated, says Charlene Burgeson, the Executive Director of the National Association for Sports and Physical Education. However, contradictory to what schools are doing to increase academics by reducing or eliminating physical education and extracurricular activities is the clinical research indicating that children who are suffering with negative physical, social, emotional health as a result of obesity may perform poorer academically (Ballard & Alessi, 2006). A comprehensive research study conducted with obese adolescent girls showed lower IQs, an increased dropout rate, and a higher rate of being held back a grade (Falkner, et al., 2001). Another comprehensive study of 11,192 kindergarteners revealed that overweight children were more inclined to have lower standardized test scores, particularly in math and reading, than their non-obese counterparts (Ballard & Alessi, 2006). Dr. Robert P. Pangrazi and Dr. Charles B. Corbin, lead authors of the
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recently revised study, Physical Activity for Children: A Statement of Guidelines for Children Ages 5 to 12, advise, We now know that making time for physical education and physical activity does not reduce academic learning, it may actually increase it. Childhood obesity continues to rise despite the various preventative methods that are available. To increase the effectiveness of existing programs, this research study will evaluate some of these programs to determine if they take into consideration all factors that impact the child. Such factors include the social, cultural, emotional, psychological and socioeconomic make-up of the child. This study will propose that holistic prevention and interventions that are multi-faceted and comprehensive are best apt to addressing childhood obesity. Statement of the Problem Over the course of the past 30 plus years, instances of childhood obesity have been on the rise. Children and adolescents are manifesting illnesses and medical conditions typically reserved for adults. Although there has been extensive study on the contributing factors and the consequences for overweight adults, far less scholarly research has been done to determine the causal factors and consequences for obesity in children and youth. A number of disciplines have developed intervention and prevention programs to address this growing concern. However, few if any programmatic interventions provide a holistic approach to addressing obesity in children and adolescents. Prevention and intervention services designed to address obesity in children should be holistic, i.e. multifaceted in their approach; taking into consideration the social, cultural, emotional, psychological, and socioeconomic factors that impact the child. All major stakeholders including the child, parents, teachers, school, community, and society at large should be included in a comprehensive approach to addressing, and possibly remedying, the seemingly unyielding rise in childhood obesity.
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Purpose of the Study There are a variety of research methodologies to be considered when determining the appropriate method for a particular study. A qualitative approach using phenomenology will be used to carry out the research study.

This study will examine the experiences of children who suffer with obesity. It is important to understand what factors have contributed to their current condition; and how their condition has impacted their academic, social, and emotional lives.

Based on the insight gained, it may be possible to identify trends and recommend improvements in identifying and understanding the condition; thereby developing more holistic approaches and, as a result, more effective strategies and interventions.

Importance of the Study This study will serve to inform with regard to the historical trends in childhood obesity; the current state of scholarly literature, the psychosocial, emotional, physical, societal, and socioeconomic implications for children suffering with this condition, and the gaps in prevention and intervention services provided to this segment of the population; in order that a more comprehensive and holistic approach to addressing childhood obesity can be developed. Literature Review Levy and Pettys 2008 study, Childhood Obesity Prevention: Compelling Challenge of the 21st Century cites the significant public attention of childhood obesity in the recent past. They note that there have been no definitive effective policies or programs to prevent childhood obesity; noting particularly that, programs are scarce, less than optimal, or nonexistent.
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Several identified contributing factors in the global rise in childhood obesity were noted, to include: sedentary time spent on video games, television, computer technology and other media; marketing of unhealthy foods and drinks directly to children; hurried, stressed, single, dual-career, working parent families with little to no time to cook healthy meals or supervise physical activity; and nonexistent or decreased recess time and physical education in schools. The authors note the cost childhood obesity has on society, and societys contribution to obesity found in the children and youth. They posit that this has been especially true in lower socioeconomic ethnic communities in the United States (pg. 611). Suggested theoretical frameworks to address obesity in children include the ecological model posited by Bronfenbrenner (1979). This model is advanced as it would integrate, address, and facilitate the exploration and identification of how the family, community, and culture affect the development of obesity in children. This contextual approach for understanding childrens development takes into account proximal (near the center) and distal (farther from the center) environmental factors. These noted environmental factors include, but are not limited to, peers, parents, teachers, schools and neighbors. Additionally, the beliefs, values, laws and resources of the society in which the child lives are also factors that must be considered when addressing the issue of childhood obesity. Another theoretical framework that is postulated is Banduras Social Cognition Theory (SCT) (1986, 1989, and 2001). Social Cognition Theory offers a comprehensive framework for furthering the knowledge base regarding obesity in children. SCT characterizes behaviors as being triadic, dynamic, and reciprocally interacting with personal factors, behavior and the environment. The concept of reciprocal determinism suggests that a dynamic interplay exist in behavior that takes into account actions, thoughts processes, as well as the environment. Levy
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and Petty (2008) suggest that prevention strategies must be addressed through a multipronged approach involving the overweight child and the various stakeholders in the childs life: parents, teachers, schools, medical community, and society at large. The role of each stakeholder is critically important in childhood obesity prevention; and prevention must consider the childs physical, emotional, and social development (Wang & Deitz, 2002). The authors posit that parents are critical stakeholders for children suffering with obesity, as children dont have the capacity to demonstrate full control and responsibility for their food intake and/or physical activity. Parents must model good behavior for their children and be empowered through education and guidance to recognize the impact they have on their childrens lifelong eating and activity habits (pg. 613). Essential strategies to addressing childhood obesity include providing healthy food choices; encouraging and making available developmentally appropriate physical activities for the child to engage in; reducing sedentary time with technology; monitoring the childs exposure to advertising, particularly around food and drink consumption, and taking a proactive role in the childs life. School based prevention initiatives must involve curriculum that incorporates appropriate nutritional and culturally relevant physical components (Huettig, Rich, Engelbrecht, Sanborn, Essery, DiMarco, Velez, & Levy, 2006). The community at large must develop policies that are supportive of children suffering with obesity; the regulation and control of television advertisement particularly targeted to children should be considered. Further, it is suggested that the medical community should consider addressing the issue of childhood obesity in medical school curricula and continuing education, as there have been noted deficiencies in providing information to doctors about the

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factors involved in childhood obesity and prevention with children (Levy & Petty, 2008). The authors conclude by suggesting that the catastrophic implications of childhood obesity for children, families, the community, and society have yet to be adequately addressed. Communities have been slow to respond to and institute effective policy. They posit that although childhood obesity is a complex and multi-faceted undertaking, the children are worth the investment. Pauline Bromfield, in her article Childhood Obesity: Psychosocial Outcomes and the Role of Weight Bias and Stigma, addresses the emotionality associated with the societal response to childhood obesity, and Educational Psychology Services (EPS) current response and recommended response to the issue. Bromfield suggests that the psychosocial outcomes and the mediation role of stigma and weight bias have recently experienced heightened attention; and despite the increasing attention, educational psychological services has positioned itself in somewhat of a bystander, with a seemingly disinterested role when it comes to childhood obesity (D.O.H., 2007; NICE, 2006; Puhl & Latner, 2007). The role of educational psychology services is described as delivering the governments agenda to improve educational outcomes for children with special educational needs by: Making the most of the students educational experiences Solving educational and social problems as well as problems arising from childrens differing needs through the application of relevant psychological interventions

Playing a significant role in shaping how educational settings approach a wide variety of educational issues through statutory and non-statutory work on the development of
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curriculum, talented and gifted, generalized and specialized educational needs, and behavioral management

Having sufficient and ever increasing knowledge of child development, support, diagnostic advice, and the ability to identify conditions and intervene quickly

Engaging with parents to help improve the childs educational experience through joinedup learning, developmental, and well-being outcomes that are not just limited to the educational setting but also includes the home (Brooke, 2010).

Bromfield maintains that childhood obesity is a special need and therefore demands a more involved and active role by those in educational psychological services. Despite the role that has been clearly identified for EPS providers, and the inconsistencies and uncertainties arising from the current literature, there is some level of consensus that childhood obesity is a potential risk to childrens educational, as well as psychological and emotional well-being, and that vigilance for potential difficulties is a responsible approach to take (Edmunds, Waters, & Elliott, 2001; Lee & Shapiro, 2003). Bromfield argues that part of EPSs hesitancy may be related to the contention that childhood obesity is a medical issue and is best dealt with by medical professionals; and in some cases, clinical psychologists. However, EPSs could position themselves to not only advocate and evaluate, but to also question the ways in which overweight and obesity are socially construed, and for the phenomenon to be addressed as not only a health issue but a diversity issue (Jalongo, 1999). With regard to Jalongos proposed diversity issue in the authors 1999 article, Matters of Size: Obesity as a Diversity Issue in Early Childhood Education, the suggestion is made that size prejudice and obesity can be used to mask racism and classism. He notes that there is an
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increased percentage of overweight and obesity among African American, Hispanics, and Native Americans as opposed to middle, upper middle, and upper class Caucasians (Arfken & Houston, 1996; Kumanyika, 1993; Olivera-Ezell, Power, & Cousins, 1990). The problem of obesity is oftentimes associated with poverty and concomitant factors such as unbalanced diets due to acutely restricted food budgets, poor health care, crowded and overcrowded living conditions, or even parental feelings of hopelessness and powerlessness over their own circumstances (OliveraEzell, Power, Cousins, Guerra, & Trujillo, 1994; Trawick & Smith, 1997). Furthermore, the chief deterrents to physical activity in a study of low-income African Americans, the majority of whom themselves were overweight, were responsibility for housework, family care, lack of finances, health problems, and body image (Datillo, Datillo, Samdahl, & Kleiber, 1994). Bromfield posits that the terms overweight and obese have become euphemisms to substitute for the more negatively connotated term fat (Allon, 1982). There appears to even be some disparity between the euphemisms in that the Department of Health reportedly advises parents to use the term overweight rather than obese when it comes to children (2006). Brownell, in his article, The Social, Scientific, and Human Context of Prejudice and Discrimination Based on Weight, it is suggested that fat is in vogue for some writers due to the negatives attached to terms like obesity, and as an attempt to remove stigma from the word fat by using it openly and in a less pejorative manner (2005). In western society, the term fat has its own connotations that are equated to concepts like being weak-willed, awkward, ugly, gluttonous, lazy, worthless, stupid, and generally lacking self control (Schwartz, Oneal, Chambliss, Brownell, Blair, & Billington, 2003). Bromfield describes weight bias as negative weight related beliefs and attitudes displayed as stigma, rejection, stereotypes, and prejudice towards children suffering with obesity. The bias
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that these children suffer is manifested in a variety of forms, inclusive of, but not limited to, relational victimization, verbal comments, bullying, and intentional social marginalization (pg.205). Obese children experience this weight bias and the associated victimization not only from peers, but also from educators and parents, and it can start at a very early age (Bauer, Yang, Austin, 2004; Davidson, & Birch, 2001; Kraig & Keel, 2001; Piran, 2004; Dejong & Kleck, 1986; Hill & Silver, 1995; Musher-Eizenman, Holub, Miller, Goldstein, & Edwards-Leeper, 2004; Steffieri, 1967). Bromfield maintains that unlike other diverse or minority groups, obese and overweight individuals themselves hold anti-fat bias. Researchers posit that overweight and obese individuals dont appear to maintain favorable attitudes toward in-group members and this kind of in-group devaluation has a significant impact on medical and psychosocial outcomes (Schwartz et al., 2003; Wang, Houshyar, & Prinstein, 2006). Egger and Swinburn (1997) has suggested, and Bromfield agrees, that a shift is needed away from the traditional view of obesity as a personal disorder requiring treatment, and to instead be seen as a normal response to an abnormal pathological environment, with a cure as the focus. The recommendation that schools and community organizations are integral elements in addressing weight bias and the psychosocial implications of childhood obesity through the wider ecological lens, is one supported by Bromfields writings (Barlow & Dietz, 2002; Zametkin et al., 2004). With schools so often seen as the primary setting for the promotion of health among children and young people, identifying any vulnerable individual or group can be counterproductive to inclusion. However, it is necessary to face this challenge head on when it comes to decreasing the social marginalization so many obese children experience (Gott, 2003). The overriding goals and objectives of educational psychological services, as a partner in
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the fight to decrease weight stigma and bias for overweight children, according to Bromfield, includes giving a voice to the concerns and view of this marginalized population (Hill & Lissau, 2002), developing and assisting in the implementation of work with families and partner agencies to diminish the negative and adverse associations between weight status and poor psychosocial outcomes, supporting school programs and settings that reduce the stigmatization culture visa a via inclusion and anti-bullying policies and practices, and conducting and utilizing research to identify factors that enable good psychosocial outcomes, inform practice for improving well-being, and challenge and prevent the one size fits all approaches. Hofferth and Sally, in their article, Poverty, Food Programs, and Childhood Obesity highlight the uncertain ability to acquire acceptable foods because of socioeconomic limitations. Although the incidence of hunger in the United States among children is reportedly less 1%, what appears to be a more prevalent dilemma is the uncertainty in acquiring acceptable food due to food insecurity or lack of money, which is the situation for approximately 17% of Americas families (Nord, Andrews, & Carlson, 2002). According to Hofferth & Ye (2004), the major contributing factor to this condition is low income. According to the authors, in 2001 roughly 46% of children in poor families and approximately 37% of children with family incomes under 185% of the nationally established poverty line were food insecure as compared to 6% of children in families with income at 185% of the poverty line and higher (Nord et al., 2002). Additional characteristics exhibited by foodinsecure families are said to include inability to pay household bills in a timely manner, postponing medical care or major purchases, and needing to borrow money from friends and family to try and sustain from month to month (Hofferth & Ye, 2004). As such, family income is a major factor in a familys ability to purchase desired foods and food preferences.
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Scholarly research has consistently found an inverse relationship between obesity among adult women and income; however, there has been relatively minimal focus on children, and the results of that research have not proven to be consistent or strong (Sobal & Stunkard, 1989). Hofferth and Sally cite two recent studies that examined income and childhood obesity and found an inverse relationship between obesity and income such that Caucasian females from low and moderate income families were more likely to be overweight than Caucasian females from high income families (Alaimo, Olson, & Frongillio, 2001; Kimm, Obarzanek, Barton, Aston, Similo, Morrison, et al., 1996); and the second study reportedly found a significantly similar relationship for Caucasian males (Alaimo et al., 2001). Hofferth and Sally further posit that part of the reason low income children are more likely than high income children to be overweight is the positive relationship between income and obesity shown in developing nations; whereas a negative relationship appears in more developed societies (Sobal & Stunkard, 1989). It is duly noted that high-income families have increased access to more consistent high-quality sources of foodstuff. Unsecure or low income may lead to using lower quality, high-fat food, or binge eating when food is available; potentially leading to increased weight and obesity (Alaimo, et al., 2001; Basiotis & Lino, 2002; Wilde & Ranney, 2000). Hofferth and Sally argue that societal attitudes regarding overweight and obesity may also contribute to, and explain, this causal relationship. In many traditional societies, overweight and obesity is considered desirable, as it is deemed an indicator of wealth and health (Sobal & Stunkard, 1989), whereas in developed countries, pejorative attitudes toward obesity are present beginning at a very young age. Research further indicates an increased desire for thinness with increasing social class, especially among females (Dornbusch, Carlsmith, Duncan, Gross,
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Martin, Ritter, & Siegal-Gorelick, 1984). There are five food programs in the United States designed to provide a secure source of food for children in low income families: the Food Stamp Program, the School Breakfast Program, the National School Lunch Program, the Summer Food Service Program, and the Child and Adult Care Food program. Hofferth and Sally reviewed the guidelines and requirements for the Food Stamp Program (FSP) and found that in order to be eligible for this program, a familys gross income cannot exceed 130% of poverty and their net income cannot exceed the nationally established poverty line (Wilde, McNamara, & Ranney, 2000). In addition to these specifications, there is a limit on assets excluding the home, such as the value of the familys vehicle. As a familys income increases, the amount of food stamp benefit the family is eligible for decreases; therefore, limiting the chance of purchasing excess food. The current research on the dietary quality found in, and the types of foods purchased by participants with the FSP program indicate a higher consumption of meat, added sugars, increased total fat consumption than nonparticipants; however the amounts of fruits and vegetables, grains, and dairy products is approximately the same as nonparticipant families (Wilde & Ranney, 2000). A second food program Hofferth and Sally reviewed was the national School Lunch Program (NLSP), which provides meals to approximately 25 million students every day (Food and Nutrition Service, 2004a). The expectation for school lunches is that they provide one-third of the recommended dietary allowances of Vitamin A, protein, Vitamin C, calcium, iron and calories. Even though one of the goals of the NSLP is to provide meals at a reduced cost to children in families who meet the requirements of gross incomes below 185% of the poverty

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line, and free to those whose incomes are below 130% of the poverty line, higher income students also benefit from the student lunch program. According to Devaney, Ellwood, and Love (1997), approximately half of student lunches are served to children from low-income families. According to the research, children who participated in the NSLP ate an increased percentage of food energy from fat and saturated fat during lunch over a 24 hour period (Gordon, Devaney, & Burghardt, 1995), and the foods prepared at school are not only higher in fat, but also fiber and calcium when compared with foods prepared at home (Lin, Guthrie, & Blaylock, 1996). The findings suggest food school program participation could be linked to overweight and obesity in children; however, there has been no prior research to establish such a link. Efforts to remediate this perceived problem have been undertaken in recent years; however little had been done by the time the present study was conducted (Lin et al, 1996). The article goes on to say that low-income households may actually be forced to pay more than moderate or high-income households for food of equitable quality, offsetting a propensity to conserve monies by spending less on food. Moreover, low-income households face higher prices on food in their neighborhoods due to a lack of high-volume supermarkets and minimal competition for the food dollar in low-income areas (Kaufman, MacDonald, Lutz, & Smallwood, 1997). Hofferth and Sally conclude that children from poor families are not more likely to be overweight than children from near-poor, working class, or moderate-income families, but neither are children from high-income families. Rather, there seems to be a nonlinear association between childhood obesity, BMI, and the ratio of income to poverty. Children in poor and highincome families are seemingly less likely to be overweight versus children in near poor and working class families. It appears that quantity increases with income to a certain extent
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regarding food expenditures, after which it likely leads to high quality food purchases rather than an increased quantity of food. According to the writers, this would offer an explanation as to the paradox of a low proportion overweight at both the lowest and highest income levels. This nonlinear relationship is still considered clinically significant even after adjusting for food expenditures, demographic characteristics of the family, and participation in food programming. Methodology The purpose of this qualitative phenomenological study is to gain understanding of the experiences of children who suffer with obesity. The qualitative research will explore and describe how factors, which include the social, cultural, emotional, psychological, and socioeconomic make-up of the child contribute to overweight or obesity. The research will employ a qualitative phenomenological design, which is the most appropriate approach for an exploratory study of the experiences of overweight youth. Phenomenology enables researchers to examine everyday human experience in close, detailed ways (DeMarrais & Lapan, 2004, p. 56). The study will use a descriptive phenomenological design because of its exploratory nature, and it will be based upon recorded and transcribed interviews using semi-structured questions to capture the lived experiences of obese youth. The study will provide useful recommendations for future holistic approaches to the prevention/intervention of childhood obesity, as well as insight into the factors that have contributed to their current condition. Design Overview Quality research has a few important features. It tackles matters of actual importance that develop and enhance the knowledge on a specific matter, has a defined population, and generalizes results for use by a wider audience. High quality research focuses on solutions to issues affecting a certain population (Huberman & Miles, 2002). Effective research needs an
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organized principled approach with a clear methodology, which uses thorough preparation in the assessment of variables, careful consideration, and complete disclosure of research methods in order to promote unambiguousness and replication (Anderson & Kanuka, 2003). Creswell (2003) asserted that in qualitative research, claims of knowledge are based upon constructed perspectives from multiple social and historical meanings of individual experiences (p. 18). Phenomenology offers a fitting approach to qualitative investigation by placing the researcher within the study to gather data on participant implication, concentrating on a phenomenon, and adding subjective significance to the research (Osborne, 1994). Patton (1990) outlined three steps to phenomenological research, which involves epoch, phenomenological reduction, and structural synthesis. Epoch is the eradication of bias related to collective knowledge as the foundation for accuracy and representativeness (Moustakas, 1994). Bracketing is a technique, which aids in the removal of researcher bias. A bracketing interview tries to recognize and identify the researchers suppositions, partiality, and opinions that may hinder or restrict understanding (DeMarrais & Lapan, 2004). Moustakas (1994) communicated phenomenological reduction as arising when, Each experience is considered, in and for itself. The phenomenon is perceived in its totality, in a fresh and open way. A complete description is given of its essential constituents (p. 34). Structural synthesis or imaginative variation attempts to understand and describe the essence and structure of an experience or phenomenon being investigated (p. 36). Numerous scholars credit Edmund Husserl with the advancement of the philosophical movement of phenomenology as a pragmatic approach to the study of human understanding through the assemblage of personal experiences (Colaizzi, 1978). Husserl also offered the developing field of psychology with the rational framework to study conscious human

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experience. For Husserl, as for Kant and Descartes, knowledge based on intuition and essence precedes empirical knowledge (Moustakas, 1994, p. 26). Phenomenology has four main phases categorized as Realistic, Constitutive, Existential, and Hermeneutical (Embree et al., 1997). The aim is to construct an animating, evocative description of human actions, behaviors, intentions, and experiences as we meet them in the lifeworld (van Manen, 1990, p. 19). Despite diverse phases and methods to Phenomenology, phenomenologists agree on certain shared features: 1) thought is supported by proof, 2) biological, cultural, and ideals are distinct, 3) investigation centers on encounters, 4) report is prior to description with regard to causation, reasons, or bases, and 5) there is an ongoing debate as to whether epoch and reduction are even possible (Kleiman, 2004; Klein & Westcott, 1994). Role of Researcher Creswell (1994) asserts that preconceptions, ideals, and beliefs of the researcher should be clearly specified in the research report due to the fact that qualitative research is interpretive. Similarly, Marshall and Rossman (1995) believe that, in qualitative research, the researcher is the instrument as via her presence, whether constant, exhaustive or personal such as in in-depth interviews, she ends up becoming part of the lives of the participants. In this study, which implicates intimate communication, collaboration between the researcher and participants is fundamental since participants might be reluctant or uneasy communicating everything that the researcher wants to investigate. Sincerity and a positive manner are advantageous throughout the process. Berg (1995) further explains that rapport should be vigorously pursued and established. Discussion of admittance into this study will be accomplished by writing to the supervisors/organizers of the local Boys and Girls Club requesting consent to do research in the

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organization and describing the purpose of the study. A proposition outlining the reason for the study, with intentions, aim, and approach will be included with the letter. The main reason for doing this is to address any concerns and to offer explanation regarding study details. Marshall and Rossman (1995) emphasize the necessity to receive official agreement and support. However, this demands time and understanding of the regularities and customs of the group. Creswell (1994) also states it is important to gain access to research or archival sites by seeking the approval of gatekeepers. After gaining consent from the parents and assent from the children, the actual participants will be selected by calculating BMI. Those categorized as overweight or obese will be asked to participate. Possible participants will be informed beforehand about the study being conducted, and those parents of the children who wish to participate will fill out the required paperwork. However, before this occurs, the goals and purposes of the study will be outlined to them, in order for them to have a lucid image of the reasons they are going to be taking part in the research. The researcher should abstain from adjudications of worth regarding the opinions and behaviors of the participants, even if they are in direct conflict with those views of the researcher. As if a performer, the researcher should recite her lines, as well as perform procedures and actions appropriately. Thus, besides delivering the interview questions, she must stay observant of the interviewees demeanor and actions during the interview process. She must avoid interjecting before the participant has concluded his or her statement. As a researcher, it is ones responsibility to ensure that the participant feels that they are an important aspect of the research study. Data Collection The researcher will use face-to-face comprehensive interviews as the method of data

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collection. Qualitative comprehensive interviews are more similar to conversations than formal interviews with preset answer types. The researcher will investigate broad themes in order to uncover the participants implication or viewpoint, but otherwise recognizes the participants framing and organization of response. The participants viewpoint on the issue at hand should be revealed as the participant deems it to be so, and not when the researcher finds it most appropriate. The most essential feature of the interviewers overall attitude concerns communicating a stance of acquiescence, that what the participant is conveying is valued and practical (Marshall & Rossman, 1995). Because this will be descriptive research, two interview schedules will be utilized. Interview schedules will include personal interviews with prescreened overweight or obese children as well as with the childs parents. The reasoning behind using two interview schedules is to corroborate and compare the provided information from the two separate interviewees. Data Collection Procedures Data collection procedures in qualitative research design, according to Creswell (1994:148) involve: Setting boundaries for the study. Collecting information through observation, interviews, and documents.

The study will be conducted at the local Boys and Girls Club facility. The subsequent process was followed in devising the interview schedule. It is centered on the framework presented by Maykut and Morehouse (1994). 1. 2. Write out the focus of inquiry. Brainstorming words, phrases, concepts, questions, topics that relate to the focus of
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inquiry. 2. 3. 4. 5. Developing categories of inquiry. Deciding on a format. Prepare a draft of the interview schedule. Practice the interview with a few people who are similar to your intended sample and who will give you feedback on the interview schedule and your skills as an interviewer. 6. 7. Make any necessary revisions in the interview schedule. Begin interviewing.

Data Analysis After the data has been gathered, the researcher will then have to analyze it in order to come to conclusions and deductions. In this research study the data will be recorded to paper, then onto a Microsoft Word document. Interviews will be conducted and then analyzed through content analysis. Content analysis denotes a process in which interviews, transcripts, and other data are made yielding to analysis by shortening and making the information methodically analogous (Berg, 1995). The researcher will then read over notes and attempt to identify themes. Discussion Research Implications Presently, there is fairly little understood regarding the central causes of weight disparity within the population. There is indication that genetics play a significant part; however, this doesnt signify effect, only that the etiology is, to some extent, biological. It is fundamental to further realize the process through which inherited disparity affects weight. Research strategies, which explore organic and interactive reactions in persons who have not yet been deemed obese, but differ in their chance of becoming overweight, might reveal causal issues.
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Behavioral treatments have been effective, and may be more so if organized with the intention of assisting children in the selection and manipulation of their surroundings in more advantageous ways. Further treatment approaches could be designated for older children to encourage lasting change. Regarding younger children, examination of family environmental factors, which foster obesity, may also offer beneficial outcomes. Such work would be innovative, with insufficiently established methods in the assessment of vital features of the household setting. If overweight children are theorized as more susceptible to obesity promoting environments, it emphasizes the obligation to discovering new techniques that aid parents in creating less obesity promoting environments, and to further assist children in learning how to withstand such environments as they grow. Recommendations Several elements have been recognized as being significant factors in the childhood obesity pandemic. Recently, professionals have claimed that in order to control this endemic, a multifaceted tactic must be devised and gauged (Institute of Medicine, 2005; Wang & Brownell, 2005). Undoubtedly, work in one area of a childs life cannot be efficacious without the proper backing from other areas Government Recommendations. There exist various avenues in which the government can choose to tackle this matter. The National Alliance for Nutrition Activity advises that the national government contemplate increasing the power of the Secretary of Agriculture to include foods offered in schools (American College of Preventive Medicine, 2003). This would possibly ascertain that foods accessible from vending machines and extracurriculars incorporated healthful choices. This, along with sustained attempts at the control of food quality, may assist in the assurance that children are subjected to an improved regime. The Institute of Medicine

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(2005) also proposes that the government establish suggested dietary guidelines for all foodstuffs sold in schools. The government should also assess national health care programs and expand preventative coverage. Government contribution could further involve the funding of targeted community programs. Studies indicate that communal approaches may help promote heightened physical activity (Saelens, Sallis, & Frank, 2003). Finally, the government ought to support schools in the implementation of wellness guidelines (Institute of Medicine, 2005). Community Recommendations. There exist numerous possibilities in which communities can function as a resource in fighting the obesity pandemic (USDHHS, 2000). It is common for neighborhoods to have recreation centers. These amenities can be employed to present young individuals a chance to participate in more physical activity. Recreation centers can also offer educational opportunities in the area of diet and nutrition. Also, studies have indicated that the neighborhood set-up can affect its members level of physical activity, such as lacking sidewalks for safely walking or riding a bike (Saleans, Sallis, & Frank, 2003). Health Care Recommendations. The American Academy of Pediatrics (AAP, 2003) advocates that health care authorities, identify and track patients at risk for obesity due to genetic or environmental factors; calculate and plot BMI once a year in all children and adolescents; use change in BMI to identify rate of excessive weight gain relative to linear growth; encourage, support, and protect breastfeeding; encourage parents and caregivers to promote healthy eating patterns by offering nutritious snacks, such as vegetables and fruits, low-fat dairy foods, and whole grains; encourage childrens autonomy in self-regulation of food intake and setting appropriate limits on choices; and model healthy food choices. Private and Public Recommendations. Businesses have the ability to create healthier

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products that are more appealing to children (Brownell & Horgen, 2004). Enticements, such as prizes, might be offered for the intake of more nutritionally sound foods. Additionally, the development of corporate affiliations to foster healthier eating patterns (CSPI, 2005) is desired. School Recommendations. Schools offer an occasion for providing healthier food options, affording the opportunity of physical activity, and education concerning such things. Schools ought think about creating a school health plan, which incorporates nutritional objectives, physical activity, and further measures intended to foster child wellness (Weight Realities Division of the Society for Nutrition Education, 2003). The general purpose of a health or wellness plan should be the encouragement of a wholesome diet, enhancement of child wellbeing, and the decrease in childhood obesity (Institute of Medicine, 2005). Parent Recommendations. Parents may also be able to contribute to the development of healthier lifestyles for their children (Birch & Fisher, 1998), as they commonly regulate the food accessible in the home and offer availability of physical activity. Parents also serve as role models (Laessle, Uhl, & Lindel, 2001). Parents behaviors effect how childrens associations with food and physical activity. Conclusions Prevention and treatment of childhood obesity need be a nationwide primacy, which involves numerous parts of society. Modifications in common routine have increased the health risks associated with childhood. The pervasiveness of childhood obesity and its co-occurring conditions have radically increased and moved to endemic extents. Many elements are incorporated and must be harmonized in a multidimensional approach to encourage pediatric wellness. With this arises the obligation to guarantee that protective and intermediation efforts are successful. It is thus crucial that the application of any progressive modifications be

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complemented by equally effective assessments to establish usefulness.

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