Health care | Obesity | Report

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Introduction:
The incidence of obesity among children has increased significantly in the past few years.
According to the World Health Organization (2020) report, 40 million children aged above the
age of 18 years were found to be overweight or obese in 2018 and more than 340 million
children and adolescents aged 5-19 years were obese in 2016. Other reasons for concern is that
obesity is not associated with increase in medical co-morbidities, but also an accumulation of
body fats and progressive decline in physical activity (Ceschia et al., 2016). Hence, there is high
likelihood of impaired physical fitness due to deleterious effects of obesity in children. Due to
various links between childhood obesity and physical activity, the aim of this literature review is
to investigate about the relation between physical exercise and obesity in children. The literature
review will focus on evaluating the efficacy of exercise on reducing BMI and reducing adverse
consequences.
Literature review:
As the rate of childhood obesity in increasing, the Hong Kong government has taken the
initiative to foster lifestyle habit in children and prevent obesity by creating a favourable
environment for physical activity in child care centres and pre-primary institutions (Hong Kong
Government Department of Health., 2018). The main focus on physical activity has emerged
because physical inactivity has been identified as major risk factors for obesity in children
(Jelalian & Sato, 2012). Lee and Yoon (2018) established the link between physical activity and
obesity prevention by exploring about key risk factors. Lee and Yoon (2018) explained about the
imbalance between caloric intake and physical activity as the cause behind childhood obesity.
For example, high consumption of food and sugar sweetened beverage is directly linked to

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childhood obesity epidemic. In addition to diet, other behavioural risk factors included lack of
physical activity. This was confirmed by citing evidence for decrease in obesity risk by
engagement in one hour of moderate level physical activity per day. In case of children, the
scope of supervised physical activity was explained. Compared to this study, the study by
Remmers et al. (2014) explain about the link between physical activity and obesity by measuring
changes in BMI post PA. By conducting a prospective study with 470 children, the study
revealed decrease in BMI due to increase in moderate to vigorous physical activity. Thus,
physical activity can become a major tool for improving BMI in younger children. The strength
of the study by Remmers et al. (2014) is that it had large sample size and it included valid tool
for measurement of PA. However, no evidence for statistical significant relation between PA and
BMI was found. Thus, to generalize the findings, evaluating more studies with different workout
regimen for children is necessary.
With the increase in public health efforts towards increasing physical activity to reduce
childhood obesity, various studies have been conducted to explore the effectiveness of different
exercise or workout regimen on children. According to Dudziak et al. (2018), it was found that 8
week work out for children aged 9 to 12 years was associated with decrease in percentage body
fat, reduction in visceral fat and decrease in BMI. Through these outcomes, positive changes in
body composition through the effect of exercise were seen. Tan et al. (2017) found that 10 weeks
of supervised moderate intensity exercise training in 5 year old obese and lean children
significantly decreased BMI, percentage of body fat and body mass. Along with improve in body
compositions like BMI, the beneficial effect of physical activity were found on systolic blood
pressure level and heart rate composition. This study revealed moderate intensity exercise as a
safe intervention for children. In contrast to the above two study, Kondiboyina et al. (2020) gave

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insight into the skeletal benefits of physical activity intervention for children. After the exercise
intervention, the bone mineral density and whole body mineral content of patients were
evaluated and the study revealed small changes in lean mass or bone mineral density. Despite the
positive effects of exercise on children, the gap in these papers was that the fidelity or efficacy of
physical exercise training on real setting is not confirmed. This is because of limitations like
small sample size and single centre study. For example Dudziak et al. (2018) conducted the
study only with 47 children, whereas Tan et al. (2017) used only single centre. To confirm the
fidelity of the findings, there is a need for studies that confirms similar results in children coming
from diverse cultural background and done in diverse settings.
To ensure generalization of findings and overcome the limitation found in above studies,
it is necessary to review evidence that explore the benefits of exercise in other cultural and racial
groups too. The study by Guerrero et al. (2017) is significant in this regard as it explored about
the association between PA and obesity status among minority groups US children. Through the
analysis of data from the 2011–2012 National Survey of Children’s Health, contrasting results
were found for PA and obesity in racial groups. Compared to the study by Guerrero et al. (2017)
which revealed positive effects of exercise training on normal body mass, the study by Tan et al.
(2017) revealed a different outcomes for White children and Black and Latino children. In case
of White children aged 10 to 17 years, inverse relationship between daily exercise and
overweight or obesity was found. However, the same relation was not found for Latino children.
Mixed findings have been found for the same in research literature. For example, León,
González-Martí and Fernández-Bustos (2018) revealed no association between moderate
vigorous physical activity and BMI among African Americans. There are limited studies
exploring independent effect of exercise and obesity on children from diverse racial groups.

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Taking cues from these evidences, it is paramount to find out why cultural factors and beliefs
influence this relationship. This study also gives practical implications suggesting the need to
take different strategies for obesity prevention in different population.
Research studies in the past have explored possible challenges in implementing PA
intervention in people coming from different cultural and racial background. This is mainly
because of diverse beliefs and perception about body image. According to Guerrero et al. (2017),
the strong influence of the obesogenic environment on food pattern is the cause behind
consumption of poor nutrient and energy dense foods. However, in case of minority
communities, it has been children from minority communities are disproportionately exposed to
such obesogenic food environment. For this reason, the study justified that changes in physical
activity cannot influence weight status of children in this group unless broader changes to the
food environment are made. Thus, this study gave implications for the role of policy related to
access to high nutrient foods on obesity. In contrast, Martin (2015) used a different approach to
explore relationship between PA and weight gain or loss issues. This study used ethnographic
research design to explore perception related to body shape among children in Malta. Through
the analysis of lived experience of young children in Malta and the exploration of understanding
regarding body shape, the study revealed marked difference in perception among children aged 5
years and children aged 10 years. For example, body shape shifted from source of joy for young
children to the cause of poor social esteem and social disadvantage in 10 year old children. Thus,
the difference in perceptions related to body shape is clearly understood from this paper.
However, systematic review by León, González-Martí and Fernández-Bustos (2018) reveals
mixed results regarding the role of impact of body image of self-esteem on young children.

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The review of research literature showed relation between obesity and PA in children.
Although positive effects of PA intervention on children were found, however these studies
could not be generalized because of low sample size and lack of heterogeneity in samples. As
children from different racial groups also suffer from obesity, the research literatures could not
reveal similar results like those found in children from other groups. Thus, this study gives the
implication that PA alone does not influence weight gain and activity alone, instead it is
influenced by multi-factorial factors. In the context of children from diverse racial group, their
environment, their culture and their socioeconomic status strongly influence outcome of PA
intervention. For example, the strength of the study by Martin (2015) was that the difference in
findings was explained by exploration of aesthetic preferences and food consumption habits of
their parents.
Conclusion:
To conclude, from the literature review on relation between obesity and PA, the study
revealed significant impact of obesity on PA. As PA is one of the risk factors of obesity and
accumulation of body fat further decreases engagement in PA, the effects of several PA
interventions on BMI and body fat of children was explored. Although positive outcome of PA
on obesity was found, however any final conclusion could not be made because of small sample
size and lack of diverse population group in the study. In contrast, during review of studies with
children from minority groups, great difference in outcome as well as perception was found.
Thus, this literature review findings gives the insight to explore more about determinants of
health status in minority pediatric population and plan appropriate health interventions
accordingly. As perceptions related to body weight strongly influence PA levels, considering
cultural aspects while implementation educational interventions with parent is suggested.

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References:
Ceschia, A., Giacomini, S., Santarossa, S., Rugo, M., Salvadego, D., Da Ponte, A., Driussi, C.,
Mihaleje, M., Poser, S., & Lazzer, S. (2016). Deleterious effects of obesity on physical
fitness in pre-pubertal children. European Journal of Sport Science, 16(2), 271-278.
https://doi.org/ 10.1080/17461391.2015.1030454
Dudziak, T., Czubek, Z., Grabowski, M., Urbanski, R., & Sawczyn, S. (2018). Changes in body
composition of children aged of 9 to 12 years with excess body weight under the
influence of eight-week workout. Baltic Journal of Health & Physical Activity, 10(3), 89-
95. https://doi.org/ 10.29359/BJHPA.10.3.10
Guerrero, A. D., Flores, M., Vangala, S., & Chung, P. J. (2017). Differences in the Association
of Physical Activity and Children’s Overweight and Obesity Status Among the Major
Racial and Ethnic Groups of U.S. Children. Health Education & Behavior, 44(3), 411-
420. https://doi.org/ 10.1177/1090198116667719
Hong Kong Government Department of Health. (2018). Physical Activity Guide for Children
Aged 2 to 6. https://www.startsmart.gov.hk/files/pdf/physical_guide_en.pdf
Jelalian, E., & Sato, A. (2012). Physical Activity as Treatment for Obesity. In Meyer, A. L., &
Gullotta, T. P. (Eds.), Physical Activity as Treatment for Obesity (pp.121-138). New
York : Springer.
Kondiboyina, V., Raine, L. B., Kramer, A. F., Khan, N. A., Hillman, C. H., & Shefelbine, S. J.
(2020). Skeletal Effects of Nine Months of Physical Activity in Obese and Healthy

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Weight Children. Medicine & Science in Sports & Exercise, 52(2), 434-440.
https://doi.org/10.1249/ MSS.0000000000002148
Lee, E. Y., & Yoon, K. H. (2018). Epidemic obesity in children and adolescents: risk factors and
prevention. Frontiers of medicine, 12(6), 658-666.
León, M. P., González-Martí, I., & Fernández-Bustos, J. G. (2018). Perception of body size and
dissatisfaction in children aged 3 to 6: a systematic review. anales de psicología, 34(1),
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Martin, G. M. (2015). Obesity in question: understandings of body shape, self and normalcy
among children in Malta. Sociology of health & illness, 37(2), 212-226.
Remmers, T., Sleddens, E. F. C., Gubbels, J. S., De Vries, S. I., Mommers, M., Penders, J.,
Kremers, S. P. J., & Thijs, C. (2014). Relationship between Physical Activity and the
Development of Body Mass Index in Children. Medicine & Science in Sports & Exercise,
46(1), 177-184. https:// doi.org/10.1249/MSS.0b013e3182a36709
Tan, S., Chen, C., Sui, M., Xue, L., & Wang, J. (2017). Exercise Training Improved Body
Composition, Cardiovascular Function, and Physical Fitness of 5-Year-Old Children
With Obesity or Normal Body Mass. Pediatric Exercise Science, 29(2), 245-253.
https://doi.org/ 10.1123/pes.2016-0107
World Health Organization (2020). Obesity and overweight. Retrieved from:
https://www.who.int/news-room/fact-sheets/detail/obesity-and-overweight