“It’s a balance of just getting things right”: mothers’ views about pre-school childhood obesity and obesity prevention in Scotland

BMC Public Health

Geraldine McNeill¹  Jonina Campbell¹  Leone Craig²  Julia Clark²  Flora Douglas¹ 

[1] Public Health Nutrition Research Group, Rowett Institute of Health and Nutrition, University of Aberdeen, Polwarth Building, Foresterhill, Aberdeen AB25 2ZD, Scotland, UK;University of Aberdeen, NHS Grampian, Aberdeen, Scotland

关键词: Scotland;    Qualitative research;    Weight management;    Mother’s views;    Obesity;    Young children;   

Others  :  1126613
DOI  :  10.1186/1471-2458-14-1009

 received in 2014-05-19, accepted in 2014-09-16,  发布年份 2014

【 摘 要 】

Background

The high prevalence of childhood obesity is a concern for policy makers and health professionals, leading to a focus on early prevention. The beliefs and perspectives of parents about early childhood obesity, and their views and opinions about the need for weight management interventions for this age group are poorly understood.

Methods

A formative qualitative focus group study with parents of pre-school children took place in eight community-based locations throughout North-East Scotland to explore their ideas about the causes of early childhood obesity, personal experiences of effective weight management strategies, and views about the format and content of a possible child-orientated weight management programme. Study participants were recruited via pre-school nurseries.

Results

Thirty-four mothers (median age 37 years) took part in the study, but only two believed their child had a weight problem. Participants (who focussed primarily on dietary issues) expressed a strong sense of personal responsibility to ‘get the balance right’ regarding their child’s weight, and were generally resistant to the idea of attending a weight management programme aimed at very young children. At the same time, they described a range of challenges to their weight management intentions. These included dealing with intrinsic uncertainties such as knowing when to stop ‘demand feeding’ for weight gain, and judging appropriate portion sizes - for themselves and their children. In addition they faced a range of extrinsic challenges associated with complex family life, i.e. catering to differing family members dietary needs, food preferences, practices and values, and keeping their ‘family food rules’ (associated with weight management) when tired or pressed for time.

Conclusions

The findings have important implications for health professionals and policy makers wishing to engage with parents on this issue, or who are currently developing ‘family-centred’ early childhood weight management interventions. The challenge lies in the fact that mothers believe themselves to be the primary (and capable) agents of obesity prevention in the early years – but, who are at the same time, attempting to deal with many mixed and conflicting messages and pressures emanating from their social and cultural environments that may be undermining their weight management intentions.

【 授权许可】

   
2014 Douglas et al.; licensee BioMed Central Ltd.

【 参考文献 】

• [1]Voigt K: Childhood obesity and restrictions of parental liberty. A response to“ paternalism, obesity, and tolerable levels of risk”. Democracy and Education 2012, 20(1):8.
• [2]Merry MS: Paternalism, obesity, and tolerable levels of risk. Democracy and Education 2012, 20(1):3.
• [3]Maher J, Fraser S, Wright J: Framing the mother: childhood obesity, maternal responsibility and care. J Gend Stud 2010, 19(3):233-247.
• [4]Brún AD, McCarthy M, McKenzie K, McGloin A: “Fat is your fault”: Gatekeepers to health, attributions of responsibility and the portrayal of gender in the Irish media representation of obesity. Appetite 2012, 62:17-26.
• [5]Coveney J: Food, Morals and Meaning: The Pleasure and Anxiety of Eating. 2nd edition. London: Routledge; 2006.
• [6]Robertson C: Scots Children Taken into Care Over Fears of Rising Weight as Childhood Obeisty Crisis Spirals out of Control. 2014. Available at: http://www.dailyrecord.co.uk/news/scottish-news/scots-children-taken-care-over-3200568 webcite
• [7]Doyle J: More than 70 morbidly obese children taken into care due to concerns over their health. 2014. Available at: http://www.dailymail.co.uk/news/article-2569922/More-70-morbidly-obese-children-overfed-parents-taken-care.html#ixzz3EoHoQQu5 webcite Accessed 30th September, 2014
• [8]Information Services Division Scotland; [Primary 1 Body Mass Index (BMI) Statistics School Year 2012/13] Available at: https://isdscotland.scot.nhs.uk/Health-Topics/Child-Health/Publications/2014-02-25/2014-02-25-P1-BMI-Statistics-Publication-2012-13-Summary.pdf?20780581236 webcite. Accessed March 3rd, 2014
• [9]Scottish Government: HEAT Target. 2013. Available at: http://www.scotland.gov.uk/About/Performance/scotPerforms/partnerstories/NHSScotlandperformance/childhealthyweight webcite
• [10]Tones K, Green J: A Systematic Approach to Health Promotion Planning Chapter 4. Health Promotion: Planning and Strategies London: Sage Publications; 2004:105-142.
• [11]Best A, Stokols D, Green L, Leischow S, Holmes B, Buchholz K: An integrative framework for community partnering to translate theory into effective health promotion strategy. Am J Health Promot 2003, 18(2):168-176.
• [12]Green LW, Kreuter MW: Health Promotion Planning: An Educcational and Ecological Approach. 3rd edition. Boston: Mayfield; 1999.
• [13]De Leeuw E: Health policy, epidemiology and power: the interest web. Health Promot Int 1993, 8(1):49-52.
• [14]Rittel HW, Webber M: Dilemmas in a general theory of planning. Policy Sciences 1973, 4:155-169.
• [15]Schubert L, Gallegos D, Foley W, Harrison C: Re-imagining the ‘social’ in the nutrition sciences. Public Health Nutr 2012, 15(2):352-359.
• [16]Strauss A, Corbin J: Basics of Qualitative Research: Techniques and Procedures for Developing Grounded Theory. Thousand Oaks: Sage; 1998.
• [17]Ritchie J, Lewis J: Qualitative Research Practice. 1st edition. 2003.
• [18]Greener J, Douglas F, van Teijlingen E: More of the same? Conflicting perspectives of obesity causation and intervention amongst overwieght people, health professionals and policy makers. Soc Sci Med 2010, 70:1042-1049.
• [19]McPhail D: Resisting biopedagogies of obesity in a problem population: understandings of healthy eating and healthy weight in a Newfoundland and Labrador community. Critical Public Health 2013, 23(3):1-15.
• [20]Vereecken C, Rovner A, Maes L: Associations of parenting styles, parental feeding practices and child characteristics with young children’s fruit and vegetable consumption. Appetite 2010, 55(3):589-596.
• [21]Rodgers RF, Paxton SJ, Massey R, Campbell KJ, Wertheim EH, Skouteris H, Gibbons K: Maternal feeding practices predict weight gain and obesogenic eating behaviors in young children: a prospective study. Int J Behav Nutr Phys Act 2013, 10(1):24.
• [22]Birch LL, Fisher JO: Mothers’ child-feeding practices influence daughters’ eating and weight. Am J Clin Nutr 2008, 71(5):1054-1061.
• [23]Lang T, Rayner G: Overcoming policy cacophony on obesity: an ecological public health framework for policy makers. Obes Rev 2007, 8(Suppl. 1):165-181.
• [24]Gard M: Obesity and Public Policy: Thinking Clearly and Treading Carefully. Edinburgh: Scottish Council Foundation; 2007.
• [25]Swinburn BA, Sacks G, Hall KD, McPherson K, Finegood DT, Moodie ML, Gortmaker SL: The global obesity pandemic: shaped by global drivers and local environments. Lancet 2011, 378(9793):804-814.
• [26]Puterbaugh JS: The emperor’s tailors: the failure of the medical weight loss paradigm and its causal role in the obesity of America. Diabetes Obes Metabol 2009, 11:557-570.
• [27]Butland B, Jebb S, Kopelman P, McPherson K, Thomas S, Mardell J, Parry V: Tackling Obesities: Future Choice – Modelling future trends on obesity and their impact on health. Government Office for Science; 2007.
• [28]Pagnini D, King L, Booth S, Wilkenfeld R, Booth M: The weight of opinion on childhood obesity: recognizing complexity and supporting collaborative action. Int J Pediatr Obes 2009, 4(4):233-241.
• [29]Southwell O, Fox JR: Maternal perceptions of overweight and obesity in children: a grounded theory study. Br J Health Psychol 2011, 16(3):626-641.
• [30]Jones AR, Parkinson KN, Drewett RF, Hyland RM, Pearce MS, Adamson AJ: Parental perceptions of weight status in children: the Gateshead millennium study. Int J Obes 2011, 35(7):953-962.
• [31]Parkinson K, Drewett R, Jones A, Adamson A: Mothers’ judgements about their child’s weight: distinguishing facts from values. Child Care Health Dev 2012, 39(5):722-727.
• [32]Jain A: Treating obesity in individuals. BMJ 2005, 331:1387-1390.
• [33]Chaimovitz R, Issenman R, Moffat T, Persad R: Body perception: do parents, their children, and their children’s physicians perceive body image differently? J Pediatr Gastroenterol Nutr 2008, 47(1):76-80.
• [34]Mathieu M, Drapeau V, Tremblay A: Parental misperception of their child’s body weight status impedes the assessment of the child’s lifestyle behaviors. Int J Pediatr 2010, Article No 306703 1-9.
• [35]Towns N, D’Auria J: Parental perceptions of their child’s overweight: an integrative review of the literature. J Pediatr Nurs 2009, 24(2):115-130.
• [36]Zhu D, Norman IJ, While AE: Nurses’ misperceptions of weight status associated with their body weight, demographics and health status. Public Health Nutr 2013, 17:1-10.
• [37]Guthman J: Fatuous measures: the artifactual construction of the obesity epidemic. Crit Publ Health 2013, 23(3):1-11.
• [38]Peretti J: Fat Profits: How the Food Industry Cashed In On Obesity. 2012. Available at: http://www.theguardian.com/lifeandstyle/2013/aug/07/fat-profits-food-industry-obesity webcite
• [39]Nutbeam D, Harris E: Theory in a Nutshell: A Practical Guide to Health Promotion Theories. Sydney: McGraw-Hill Companies; 1999.
• [40]Levitsky DA, Pacanowski CR: Free will and the obesity epidemic. Public Health Nutr 2011, 15(1):126.
• [41]Chandon P, Wansik B: Does food marketing need to make us fat? A review and solutions. Nutr Rev 2012, 70(10):571-593.
• [42]Brownell KD, Horgen KB: Food Fight: The Inside Story of the Food Industry, America’s Obesity Crisis and What We Can Do About It. Chicago: Contemporary Books; 2004.
• [43]British Heart Foundation: Portion distortion. How much are we really eating?. 2013. Available at: http://www.bhf.org.uk/default.aspx?page=16552 webcite
• [44]Schwartz C, Madrelle J, Vereijken CMJL, Weenen H, Nicklaus S, Hetherington MM: Complementary feeding and “donner les bases du goût” (providing the foundation of taste). A qualitative approach to understand weaning practices, attitudes and experiences by French mothers. Appetite 2013, 71(0):321-331.
• [45]Coughlan S: Children ‘more active’ in homes with dogs. 2013. Available at: http://www.bbc.co.uk/news/education-11389454 webcite
• [46]The Scottish Government: Ministerial Resonsibilities. 2013. Available at: http://www.scotland.gov.uk/About/People/14944/Scottish-Cabinet/Scottish-Cabinet/Health webcite
• [47]Jenkin G, Signal L, Thomson G: Framing obesity: the framing contest between industry and public health at the New Zealand inquiry into obesity. Obes Rev 2011, 12(12):1022-1030.
• [48]Popkin B: The World is Fat: The Fads, Trends, Policies and Products That Are Making Are Fattening the Human Race. 1st edition. London: Penguin Books; 2009.
• [49]Shelley JJ: Addressing the policy cacophony does not require more evidence: an argument for reframing obesity as caloric overconsumption. BMC Public Health 2012, 12(1):1042.
• [50]Nestle M: Food Politics: How The Food Industry Influences Nutrition and Health. London: Universtiy of California Press; 2003.
• [51]Westerterp KR, Speakman JR: Physical activity energy expenditure has not declined since the 1980s and matches energy expenditures of wild mammals. Int J Obes 2008, 32(8):1256-1263.
• [52]Thomas D, Bouchard C, Church T, Slentz C, Kraus W, Redman L, Silva AM, Vossen M, Westerup K, Heymsfield SB: Why do individuals not lose more weight from an exercise intervention at a defined dose? An energy balance analysis. Obes Rev 2012, 13(10):835-847.
• [53]Caudwell P, Gibbons C, Finlayson G, Näslund E, Blundell J: Physical Activity, Energy Intake, and Obesity: The Links Between Exercise and Appetite. Curr Obes Rep 2013, 1-6.
• [54]Swinburn B: Obesity Prevention in Children and Adolescents. Child Adolesc Psychiatr Clin N Am 2009, 18(1):209-223.
• [55]Willmott M, Nelson W: Complicated lives: The Malaise of Modernity. Chichester: John Wiley and Sons, Ltd; 2005.
• [56]Carrigan M, Szmigin I, Leek S: Managing routine food choices in UK families: The role of convenience consumption. Appetite 2006, 47(3):372-383.
• [57]Jabs J, Devine CM: Time scarcity and food choices: an overview. Appetite 2006, 47(2):196-204.
• [58]Jabs J, Devine CM, Bisogni CA, Farrell TJ, Jastran M, Wethington E: Trying to Find the Quickest Way: Employed Mothers’ Constructions of Time for Food. J Nutr Educ Behav 2007, 39(1):18-25.
• [59]Gatley A, Caraher M, Lang T: A qualitative, cross cultural examination of attitudes and behaviour in relation to cooking habits in France and Britain. Appetite 2014, 75:71-81.
• [60]Haworth J: Work, Leisure and Well-being in changing social conditions. In Well-being: Individual, community and social perspectives. 2nd edition. Edited by Haworth J, Hart G. Houndsmills Basingstoke: Palgrave MacMillan; 2012:245-259.
• [61]Kawachi I, Kennedy BP: The Health of Nations: Why Inequalities is Harmful to Your Health. New York: New Press; 2002.
• [62]Patel R: Stuffed and starved: From farm to fork, the hidden battle for the world food system. London: Portobello Books; 2007.
• [63]Skelton J, Buehler C, Irby M, Grzywacz J: Where are family theories in family-based obesity treatment & quest;: conceptualizing the study of families in pediatric weight management. Int J Obes 2012, 36(7):891-900.
• [64]Khandpur N, Blaine RE, Fisher JO, Davison KK: Fathers’ child feeding practices: A review of the evidence. Appetite 2014, 78:110-121.
• [65]Feinberg ME: The Internal Structure and Ecological Context of Coparenting: A Framework for Research and Intervention. Parenting 2003, 3(2):95-131.
• [66]Cooper N, Dumpleton S: Walking the Breadine: The Scandal of Food Poverty in 21st Century Britain. 2013. Available at: http://policy-practice.oxfam.org.uk/publications/walking-the-breadline-the-scandal-of-food-poverty-in-21st-century-britain-292978 webcite
• [67]Griffith R, O'Connell M, Smith K: Food expenditure and nutritonal quality over the Great Recession. 2013. [IFS Briefing Note BN143] Available at: http://www.ifs.org.uk/bns/bn143.pdf webcite
• [68]Conklin AI, Forouhi NG, Suhrcke M, Surtees P, Wareham NJ, Monsivais P: Socioeconomic status, financial hardship and measured obesity in older adults: a cross-sectional study of the EPIC-Norfolk cohort. BMC Public Health 2013, 13(1):1039.
• [69]Katikireddi SV, Higgins M, Smith KE, Williams G: Health inequalities: the need to move beyond bad behaviours. J Epidemiol Community Health 2013, 67(9):715-716.
• [70]Jain A: Treating obesity in individuals and populations. BMJ 2005, 331(7529):1387-1390.