Childhood Obesity in Australia: An Immigrant Perspective Study

This report investigates the complex issue of childhood obesity in Australia, with a specific focus on children of immigrants from low- and middle-income countries. The study is motivated by the observation that these children often experience a reversal of the health advantage seen in their parents, exhibiting higher rates of obesity compared to their peers, despite initially arriving in Australia with better health profiles. The research aims to estimate the prevalence of childhood obesity and its relationship with socioeconomic status (SES) using a cohort study design, drawing data from the Longitudinal Study of Australian Children (LSAC). The study will analyze the impact of factors such as duration of stay, cultural influences, and family dynamics on childhood obesity. The report includes an introduction outlining the motivation, objectives, and ethical considerations, followed by a review of relevant journal articles, including studies by Hardy et al. (2018), Mihrshahi, Gow, and Baur (2018), and Li et al. (2017). The methodology section details the cohort study design and sampling techniques. The findings suggest that there is a need for targeted community programs to address the varying needs of different subpopulations.

Australian Childhood Obesity 1
AUSTRALIAN CHILDHOOD OBESITY
By (Student’s Name)
Professor’s Name
College
Course
Date

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a. TITLE: THE PARADOX OF CHILDHOOD OBESITY IN IMMIGRANTS CHILDREN
FROM LOW-AND-MIDDLE –INCOME COURTIERS
b. Table of Contents
a. Title: The Paradox Of Childhood Obesity In Immigrants Children From Low-And-Middle –
Income Courtiers.............................................................................................................................2
c. Introduction:.................................................................................................................................3
Motivation....................................................................................................................................3
Study Objectives..........................................................................................................................4
Ethical Constraints.......................................................................................................................5
d. Journal Reviews...........................................................................................................................5
e. Study Design................................................................................................................................9
f. Material and Methods.................................................................................................................10
g. Presentation................................................................................................................................14
h. Products.....................................................................................................................................14
i. Required Resources....................................................................................................................15
j. Referencing.................................................................................................................................16

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c. Introduction:
Motivation
Low-and-middle-income economies immigrants to Australia show low obesity besides
better health when they arrive in Australia than their high-income countries’ immigrants to
Australia. Nonetheless, such a health advantage reverses within on generation kids of
immigrants, thrive on having a disproportionately more childhood obesity risks as opposed to
their colleagues in host population, even where rates of childhood obesity have since plateaued
in several European as well as upper-income English-speaking nations like Australia. Childhood
obesity substantially surges risks of long-lasting health conditions, including cardiovascular
illness and diabetes that upsurges early mortality besides cost of health as early as four to five
years of age. Approximately 33% of Australian youngsters are of immigrants; nearly 50% of the
33% is from low-and-middle-income economies. Nonetheless, extremely diminutive is known
regarding the prevalence as well as sources of childhood obesity in this group of immigrants’
children, as they develop. This is the motivation of this study to find out the causes of childhood
obesity amongst the children of low-to-middle-income immigrants despite their better health on
arrival.
Better immigrants’ health from the low-to-middle-income nation when they arrive in
Australia is attributed to low prevalence of obesity in their respective nations of origin, screening
of obesity on immigration as well as immigrants self-selection where the wealthiest and
healthiest people migrate. Nonetheless, such a health advantage never extend to immigrants’ kids
who get born in the upper-income economies. The evidence from the high-income economies
with a vast population of immigrants remains questionable on such a health advantage reversal.
Deterioration of immigrants’ health within such a short while is regarded to be significant

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because of the interrelationships of environmental, cultural, and socioeconomic risk factors in
Australian society. For instance, western-diet, as well as inactive lifestyle and the risks factors
carried forward from the economies of origin like cultural favorites for huge body sizes
alongside low PA.
Family and ethnicity SES indicated by education, income, alongside occupation of
parents showcase complicated association with childhood obesity. The SES association with
childhood obesity ranges per economic development as well as health or nutrition changeover
phases of immigrants origin nations. An indirect association between obesity amongst children
and poverty in the upper-income economies is often detected; however, in low-and-middle-
income economies, such associations become reversed. In several low-and-middle-income
economies, childhood obesity stays extensive amongst families with upper-income because of
the global market expansion, globalization, and exposure to media that has popularized high-
calorie as well as low-exercise Western lifestyle. Whereas efforts have already been made to
explore the effects of SES as well as childhood obesity in immigrants’ children, small sample
sizes, as well as the inconsistency of SES measures, has led to equivocal evidence. This is
another motivation for the current study to use large sample and consistent SES measures to get
rid of such ambiguous evidence. Further, a period of stay in the host nation, environmental,
cultural as well as family dynamics also impacts the relationship between obesity among
children and status of immigrants. With the rising immigrant population, an approximation of
childhood obesity risk amongst the immigrants’ children remains imperative to propel age as
well as culture-particular health preventive alongside promotion policy.
Study Objectives

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The main objective is to estimate the prevalence of childhood obesity and the relationship
with the SES of families in 2-year intermissions in the cohort of two-eleven-year-old Australian-
born-kid of Australian-mums alongside mothers from both low-and-middle-income and high-
income economies. The study will follow kids as they develop, conjecturing that kids of moms
from economies with low-and-middle-income have extremely high childhood obesity prevalence
at each age, autonomous of SES of families.
Ethical Constraints
Informed consent will be obtained from the child’s caregivers to undertake or participate
in the study. The caregivers will be told the purpose of the research and how the data will be
used and stored. They will be assured of their privacy and confidentiality. They will be informed
that they are free to exit the survey any time they would wish without any repercussions. They
will also be assured of being given the responses to verify and confirm if those are their correct
responses. They will also be told that in case of any change on the purpose of the data collected
from them and the respective children, they will be asked to authorize such changes.
d. Journal Reviews
Journal 1: Hardy et al. (2018)
Summary:
The main objective of this journal was to study the substantial investment in NSW,
Australia aimed at reducing childhood obesity over the past ten to fifteen years via the
interventions in the children between ten and fifteen years. Therefore, this article purposed to
report the alterations in the weight as well as weight-associated behaviors of the five-year-old
children in Australia.

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The study used the cross-sectional survey as the study design carried out in the years
2010 and 2015. The setting of the study was in the NSW schools with the 2010 study’s n=44 and
the 2015 study’s n=41. The study participants included the Australian children in the
Kindergarten with n=1141 and in the 2015 study n being 1150. The primary outcome measures
of this study included the change in the anthropometry alongside the pointers of screen-time,
diet, school-travel, as well as health awareness recommendations. Other outcome measures
included the examination of the 2015 variations in weight-linked behaviors based on the
characteristics of socio-demography.
The result of the study indicated that the childhood obesity prevalence was 2.10 percent
lower (adjusted OR) (AOR) 0.830, 95% CI, 0.0670 to 1.00) and the abdominal obesity stood at
1.70 percent upper (AOR 1.350, 95% CI, 0.930) in the year 2015 as compared to the year 2010.
The Substantial improvement was noted in multiple weight-linked behaviors amongst the
children who consume much junk foods (AOR 0.630, 95% CI, 0.500 to 0.800), compensated for
the healthy behavior via sweets (AOR 0.590, 95% CI, 0.470 to 0.740) and had the Television in
respective bedrooms (AOR 0.650, 95% CI, 0.430 to 0.960).
In the year 2015, children that came from low SES neighborhoods as well as non-English
–speaking upbringings commonly stood less probably to involve in healthier weight-associated
behavior as compared to children from the high SES neighborhoods and economies where
English is spoken. Kids in such demographic groups stood less probable to eat breakfast every
day, consume high junk foods, as well as eat fast-food frequently. The offspring from rural
regions inclined to have better weight-linked behavior compared to those children from urban
centers.

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The Hardy et al. (2018) concluded that there was a significant positive alteration in five-
year-old kids’ weight-associated behaviors, but kids from low SES neighborhoods and non-
English-speaking economies stood extremely likely to involve in unhealthy weight-linked
behaviors as compared to children from high SES neighborhoods and English-speaking
economies. The outcome of Hardy et al. (2018) study demonstrates that there is an urgent need
to improve population-level attempts and guarantee targeted and tailored community programs to
meet the varying subpopulation needs.
Assessment:
The strength of this study is that it used a good study design cross-sectional survey) that
helped meet the objective of the study. Another strength of the study is that it effectively used
statistical analytical tools like SPSS version 22, which adequately accounted for sophisticated
sampling design. In short, key strengths included large representative sample, high response rate
as well as validated measured of weight-linked behaviors. The weakness included the use of
secondary examination of 2 population-oriented surveys; hence, sample size was never
sufficiently large to identify slight variations in childhood obesity prevalence. Another weakness
is that sampling frames were only representatives of NSW kids based on school type, residence
alongside SES, and hence the result might never necessarily be generalizable to all children of
Australia.
Relevance:
The study is relevant to the current protocol since it will be used to build the literature
that demonstrates clearly that immigrants children from low-and-middle income and non-
English-speaking economies are more likely to be obese than immigrant children from high-
income and English-speaking economies.

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Journal 2: Mihrshahi, Gow, and Baur (2018)
Summary:
The authors carried out a systematic review of secondary data to evaluate the approaches
to preventing and managing pediatric obesity in Australia. The results indicated that Australia
ranks fifth for girls and eight for boys in terms of prevalence out of the thirty-four economies of
Organization for Economic Co-operation and Development. The authors concluded that it is
possible to curb the high prevalence of obesity in Australia via combined smart governance
crossways various sectors, community initiatives, individual efforts supports, and clinical
leadership.
Assessment:
The main strength of this study lies in its comprehensive systematic literature review,
which was made possible by sufficient search criteria. This strength was supported by a review
of a range of paper papers, evidence summaries, reports, and individual studies known to the
authors. They also used credible databases, including Cochrane Library alongside a MEDLINE
search of English language articles. The weakness of the study is that it only used secondary
resources, which might mean that they carried forward the mistakes done in previous articles.
Relevance:
This article is essential to this protocol in explaining the main behavioral risk and in
showing the high prevalence of obesity in Australia. It will be used to support the view that too
much energy-dense consumption, nutrient-inefficient foods alongside a failure to physically
exercise remain the mainstream behavioral factors causing obesity among children in Australia.
Journal 3: Li et al. (2017):
Summary:

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The study aimed at understanding the association between sleep duration and childhood
obesity. The authors undertook a systematic alongside prospective cohort studies’ meta-analysis
to approximate a link between obesity and BMI in children alongside sleep duration. The author
searched PubMed, Cochrane, and Embrace database. The authors estimated pooled RR (relative
risk) and 95% CI for meta-analysis to unearth a link between short-sleep length and childhood
obesity.
The results concentrated on fluctuation in BMI or following status of BMI for review.
The outcomes showed that 12 studies (fifteen population) meeting inclusion criterion in meta-
analysis. Short-sleep length stood linked significantly to obesity (RR: 1.450; 95CI: 1.140 to
1.850). Following exclusion of 2 cohorts which significantly influenced heterogeneity, pooled
outcome held significant (RR: 1.30; 95% CI, 1.2-1420) and the link stood insignificantly
changed in sub-group analysis.
Moreover, the authors summarized twenty-four studies that met the review criteria of the
connection between BMI and sleeping duration. It was concluded that meta-analysis revealed
that short sleep increases the risk of obesity among children. Attempts by public health
encouraging adequate sleep duration can combat obesity.
Assessment:
The Meta-analysis was effective in helping authors get the relationship between obesity
and sleep duration through the computation of RR. The weakness is on the use of only secondary
data.
Relevance:
This study will contribute to the literature review part of the protocol to showcase sleep
duration as an essential risk factor causing childhood obesity.

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e. Study Design
The study will use a cohort study design. The study population will include the data
drawn from birth (B) cohort of continuing Australia countrywide Longitudinal Study of
Australian Children (LSAC) being utilized. LSAC remains an all-inclusive research which
examines Australian family, social, economy surroundings influence on the children’s welfare
alongside development. The eligible children will be acknowledged from the database of
Australian Medicare enrolment that encompassed particulars of a significant proportion of
Australian kids.
A 2-phase clustered-sampling technique will be assumed and used in this study. First, the
postcodes will be selected and subsequently followed by children. Stratification of sample will
then performed for both metropolitan and state or non-metropolitan region. Consequently, the
postcodes will be selected with likelihood proportionate to a size whereby feasible, and with an
equivalent likelihood for the trivial population from the post-codes already chosen, with almost
equal selection probability for every kid (nearly 1 in 25). The sampling weights will be utilized
for adjustment for equal likelihoods of the selections as well as for non-response.
This B cohort is expected to be made up of 5107 kids aged between three and nineteen
months born as well as recruited in the 2017-2018 data. Data will be gathered biannually. The
sample. The sample will be 4606 or ninety percent of youngsters aged between 2 and 3 years,
which is the present study baseline and 4386 or eighty-six percent at four to five years. The
sample will also comprise of 4242 or eighty-three percent children between six and seven years,
4085 or eighty percent at ages between 8 and nine years as well as 3764 or seventy-four percent
children between ten and eleven years of age. It is expected that the latest data will be for
children between ten and eleven years for the current study.

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f. Material and Methods
Procedure:
Trained interviewers will conduct a face to face interview with the stud child’s primary
caregiver using already printed questionnaire. These caregivers are expected to be nearly ninety-
percent cases of biological mother in the respective children homes, following the acquisition of
the informed consent.
Measures:
Children Anthropometry:
The weight, as well as the height of the children, will be measured at every age. The
children will then be weighed while on light clothing to the nearest fifty grams utilizing Slater
Australia bathroom scale with the Code 79985: Springvale, Victoria, Australia. Subsequently,
measurement of height will be performed to the nearest point 1 centimeter utilizing a portable
rigid Stadiometer, specifically Invicta, Leicester, United Kingdom, Model IPO955.
The age, weight, height, alongside sex of the child will be employed to compute age-and-
sex specific scores of BMI as weight/height2 or Kg/m2. Results of this measured factor (status of
child-weight) or the obese/overweight and not obese/overweight will be subsequently classified
per the IOTF age-and-sex-specific criterion that remain anchored on as well as connected to the
conforming BMI cut-offs of adults. The present examination will comprise data of kids aged
between two and three years to ten and eleven years. The data for kids below two years will be
omitted as height or length alongside children’s BMI will never be measured.
Maternal Immigrants Status (MIS):

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The MIS will be based on the birth country’s economic development of the mother’s
parents, which will be the exposure variable. This variable will be derived and constructed in 2
steps, as shown in figure 1 below: