Obese children also are at increased risk for dyslipidemia, both increased low-density lipoprotein levels and decreased high-density lipoprotein levels (Leung & Robson, 1990). Longitudinal data from the Bogolusa Heart Study indicates a significant risk for developing type 2 diabetes for obese adolescents (Srinivasan, Bao, Wattigney, & Berenson, 1996). Among those who were obese as adolescents, 2.4% had developed type 2 diabetes by the age of 30 compared to none in the non-obese population. The detrimental health effects of obesity are pervasive and enduring. Strauss (1999) reported that being an obese adolescent predicted early mortality even more consistently than obesity in adulthood.
The complications related to obesity in youths are not limited to physical health. Obesity in adolescents also has been associated with fewer years of education, higher poverty, lower marriage rates and lower family income (Dietz, 1997; Maffeis & Tato, 2001). However, evidence for an association between overweight and obesity and low self-esteem are inconsistent. Some studies have found no significant relationship (e.g., Gortmaker, 1993; Renman, Engstrom, Silfverdal, & Aman, 1999), while others find that those children and adolescents who are obese exhibit significantly lower self-esteem than their peers (French, Story, & Perry, 1995). Israel and Ivanova (2002) posit that severity of obesity is related to self-esteem with those more severely obese experiencing the most damage to their self-esteem. This hypothesis has been validated in the findings among clinical populations where self-esteem has been significantly related to obesity status (Rumpel & Harris, 1994). The most consistently replicated psychosocial outcomes for obesity relate to negative body image (Israel & Ivanvova, 2002). In addition, clinically significant problems with memory functioning and learning abilities have been found among overweight children. These deficits are seemingly the result of sleep apnea, which has been reported at rates as high as 94% among samples of obese children (Brenner, Kelly, Wenger, Brich, & Morrow, 2001).
5.2 Overview of the proposed program
In light of the pressing and prevalent problems posed by obesity, the researcher has proposed a cardiovascular risk reduction program which aims at assessing the health behaviors of elementary school children and impacting changes on both a school level and individual level. On the school level, the program aims to decrease the fat and sodium content of the lunch received by elementary students during the course of the school day while simultaneously increasing the level of physical activity among those students. On an individual level, the proposed program aims to first and foremost decrease the level of cholesterol in the blood of the students while secondarily impacting psychosocial changes through mandatory self-reporting as well as behavior modification for aversive health maintenance behavior. Essentially, this proposed program examines the efficacy of school and home-based interventions in impacting changes in children's behavior and promotes a lifestyle that will reduce their risk of heart disease. This program will target both the