However, there are generalised concepts and standards that are expected of parents towards their child. Failure to meet these standards may legitimately be considered neglect. Clearly not all obese children are neglected -- indeed, parents of obese children may be very devoted to their child (Alexander, 2009). However, there may be concerns about parenting skills such as lack of parental limit-setting or parental supervision. In 1989, a case series report of children with severe obesity in early childhood observed that, in all cases, parental limit-setting around parent -- child interactions, including eating, was impaired; the authors likened severe obesity in early childhood to the "mirror image of environmental deprivation" (Alexander, 2009). However, recent reports on the possible associations between family characteristics, parenting patterns and childhood obesity do not show definite correlations (Alexander, 2009). What, then, should be done in situations when parents of severely obese children seem unwilling or unable to adhere to weight-loss programs? Should the child and/or parent be considered "non-compliant"? If so, is this non-compliance, whether deliberate or unintentional, a form of medical neglect? At what point does non-compliance constitute a danger to the child? Published reports highlight the quandary of notification to state child protection services when parents fail to follow medical advice in the treatment of their child's illness, whether this is for failure to administer asthma medication to a child with poorly controlled asthma or for parents rejecting treatment for their HIV-infected child (Alexander, 2009).

In cases of failure to thrive and in cases of severe obesity, clinicians may observe immediate health risks as well as longer-term risks, including psychological harm (Alexander, 2009). The "immediate" or "urgent" risks more often associated with failure to thrive will -- for that reason alone -- be seen to be important. However, risks to a child's health that are progressive and have lifelong consequences are also important, even if there is no particular point in time at which they constitute an "urgent" risk of "immediate harm" (Alexander, 2009). In cases of severe pediatric obesity, clinicians will need to decide at what point the longer-term risks are sufficiently important that notifying the case to child protection services is the best thing to do now, even if the circumstances are not "urgent."

Apparently, there are numerous nursing, ethical and legal issues presenting themselves in terms of childhood obesity. However, this issue has significant implications beyond these three categories. Childhood obesity affects overall society in terms of economics, drain on social services and health care delivery and furthermore, there is disparities between rural and urban populations regarding childhood obesity (Alexander, 2009).

Childhood obesity can be viewed within an economic model, specifically the maximization of marginal utility within the construct of increasing obesity. The simplified economic model conforming to this logical construct is relatively straightforward. Calories have become less expensive as competition among food vendors has increased greatly over the past several years. Exercise has become more "expensive," that is individuals view exercise as costing more than the calories they are enjoying. Therefore, according the model of utility maximization, individuals will chose to consumer more calories than increase their exercise, given that calories "cost less" than exercise.

Although this economic model is correct in theory and does explain the increase of childhood obesity in glaring clarity, it is incorrect to assume this model is accurate. There are external costs that are borne by society that has increases in childhood obesity, some of these costs have been alluded to in the other considerations described in this analysis. There are drains on the health care delivery systems of a society as a result of the increasing demand for treatment presented by individuals who are suffering from obesity. Increase in weight lead to a variety of related health conditions. Most notably hypertension, diabetes, cardiac issues and a variety of orthopedic problems. These conditions only add to the demands on an already strained health care system. This drain on health care resources could in turn cause a drain on other social services and increase the burden of non-obese individuals that they must compensate the coffers in order to make up that amount over and above what is normally expended in society.

There are internal costs associated with obesity as well. Individuals may bear a psychological cost resulting in a negative self-image associated with having increased weight gain. This paradigm leads to the vicious cycle of individuals attempting any means necessary to rectify and improve their situation by losing...

As a result, individuals incur significant economic costs to lose weight. According to recent data released by the Chamber of Commerce, individuals spent between $20 and $50 billion in 2009 on various weight loss medications. Economic costs of obesity traverse both rural and urban areas and impact individuals regardless of whether they reside in urban centers or rural locations.
The obesity epidemic is a growing concern in American health care. Obesity is associated with greater risk of serious diseases such as diabetes, heart disease, stroke, and some types of cancer. Being overweight can also result in social problems such as stigmatization and discrimination. Rural communities are now experiencing higher rates of obesity and overweight than urban areas. Rural residents tend to eat diets higher in fat and calories, exercise less, and watch more television, all of which can contribute to unhealthy weight gain. Adding to the challenge, rural communities face barriers to addressing obesity, such as higher poverty levels, less access to settings, foods, and services that facilitate physical activity and healthy eating, and limited school resources to provide nutrition education and physical education.

Rural residents experience higher rates of obesity and overweight than people living in urban areas. Rural demographics may play some role in this difference. Rural residents tend to be older, less educated and have lower income than urban residents, and all of these factors are related to higher obesity levels. Even with other factors held equal, however, rural residents of every racial/ethnic group are at higher risk for obesity, according to a study on rural obesity ("Obesity and Weight Control," 2010).

Unhealthy diet is one culprit in the rural obesity problem. Rural residents in some areas eat a higher fat and calorie diet that the average American ("Obesity and Weight Control," 2010). People in rural areas are often faced with limited selection and higher cost for fresh fruit and vegetables than consumers in more urban areas. Due to distance and limited transportation options, shopping for healthy food can prove difficult for those living in areas not served by a major grocery chain ("Obesity and Weight Control," 2009). People in rural areas may also lack nutrition information that would help them to choose a healthier diet. Nutritionists tend to be less available in rural areas, and fewer school and community nutrition education opportunities exist, compared with what may be available in larger communities.

A lack of exercise also contributes to rural obesity. The popular image of active rural lifestyle is no longer accurate. Rural residents tend to be less physically active than urban residents. Some possible causes include less access to exercise facilities and fewer school physical education classes. Rural areas may also face challenges in terms of the "built environment," which consists of buildings, sidewalks, parks and other physical aspects of a community. People who live in rural areas without sidewalks and public transport may find exercise as a part of daily activity and outdoor exercise to go places much more difficult. Television viewing, which may be higher in rural youth, can contribute both to unhealthy diet and to a lack of physical activity.

Rural clinics and hospitals can offer classes that encourage healthy diet and exercise, such as sessions on nutrition, how to prevent heart disease, controlling diabetes, and similar topics. Hospitals that have exercise equipment for cardio/pulmonary rehabilitation may want to make their workout areas available to the entire community. Primary health care providers can be a good resource for providing information on healthy diet and physical activity to their patients. Because rural areas often have limited access to nutritionists or dietitians, health care providers may benefit from additional training in nutrition. Primary care providers can also benefit from more training in behavioral and preventive sciences concepts and strategies to increase their skills and confidence in motivating patients to change unhealthy behaviors.

Conclusion

Childhood obesity is quickly becoming a national problem within the United States. As obesity increases so to do the ancillary health concerns that develop as a result of obesity. An individual who developes obesity normally is at higher risk than non-obese individuals for developing diabetes, heart disease, hypertension and other orthopedic concerns. In response to this growing epidemic politicians, community organizers and other officials have placed eliminating childhood obesity near the top of the domestic agenda. As stated in the introduction, First Lady Michelle Obama has initiated a "Get Fit" program designed to curb the incidence rates of childhood obesity. As child obesity increases there is a concomitant rise…