Content uploaded by Mary Rudolf
Author content
All content in this area was uploaded by Mary Rudolf on Feb 17, 2015
Content may be subject to copyright.
WATCH IT: Obesity management for children: A qualitative exploration of the views of parents
Abstract
Childhood obesity has become a major concern of public health over the last decade. Obesity prevention programmes show limited success and the evidence base is weak. Experience with school-based obesity prevention research in Leeds highlighted the felt needs of children who were already obese, and a project was set up to attempt to meet those needs. WATCH IT has been running since 2003 and has involved 94 children. The quantitative data has been reported elsewhere, and this paper presents qualitative data from focus groups and interviews with participating children and their parents. These data show that WATCH IT has been successful in recruiting and retaining children, that children enjoy attending, and that it meets their emotional needs. Parents and children reported reduced self-harm, depression and better results at school for their children. The data also illustrate the effect of obesity on the family and that parents have a range of emotional and practical needs, which are partly being met by the programme. There needs to be a more systematic attempt to evaluate projects such as WATCH IT so that this can be added to the existing patchy evidence base. The data point to the importance of whole-family approaches.
... The need for learning skills that can be applied in the home environment through programmatic material and trainings or "sources of authority" such as trained staff was present in the literature; and parents sought training and support on how to change child habits in the home and manage changes while avoiding punishment and conflict. 32,40 Other practical skills included hands-on activities such as family cooking nights or community field trips to learn about resources for walking trails in the area. These types of practical sessions have been shown to improve attendance and reduce attrition in childhood obesity prevention interventions. ...
... This theme is echoed in the literature, where rural families express concern that options for family-based, physically active opportunities were scarce due to limited resources. 40 A recent review of barriers and facilitators to attendance for childhood obesity prevention programs characterized the importance of child enjoyment or fun as a motivator for parents to support continued participation even in the face of personal or logistical challenges. 31 Findings from our study extend this concept into the home environment; and parents described child-initiated activities as a main force for engagement in health promotion activities in the home. ...
Background. Obesity rates are disproportionately high among rural and American Indian (AI) children. Health behaviors contributing to child obesity are influenced by parents at home. Engaging parents remains a challenge, particularly among low-income and ethnic minority families. Aims. The aim of this study was to learn how AI parents living on a rural AI reservation support and engage with their children’s nutrition and physical activity behaviors at home. Methods. Parents with children ages 6 to 12 years living on one, rural AI reservation participated. Focus groups and interviews were conducted, using a 14-question moderator’s guide. A systematic, iterative content analysis was applied to the transcripts. Results. Twenty-five parents (52% AI or Alaska Native) participated in 3 focus groups (n = 17) and interviews (n = 8). Themes related to enhancers included role modeling and whole family and child-initiated activities. Barriers included resources, child safety concerns, driving distances, and competing family priorities. Themes related to strategies for change included opportunities for peer learning from other local families, creating fun, program support for all supplies and incentives, and incorporation of storytelling and multicultural activities. Discussion. This study advances knowledge to promote parental engagement with child health behavior in the home, including unique themes of inclusiveness, culture-focused, and intergenerational activities. Conclusion. Results may inform interventions seeking to engage parents living in rural and AI reservation communities in home-based child behavior change efforts.
... Because of its long-term adverse effects, the prevention and management of childhood obesity have received the full World Health Organisation (WHO) recognition (Demattia et al., 2006). WHO has encouraged many countries to focus more on strategies to tackle this pandemic as a public health priority (Balakrishnan et al., 2008;Dehgham et al., 2005;Dixey et al., 2006). ...
... When participants in our study were asked about the intervention ending, the overwhelming response was that they wanted the support to go on for longer. Some children did express confidence in maintaining changes, but it must be noted these children were still early in the intervention and it has been reported elsewhere (Dixey, Rudolph, & Murtagh, 2006) that children may lose their motivation over time (when attendance becomes more of a social event). Parents/carers, however, feared they would relapse when the intervention finished. ...
Objectives
For the effective treatment of childhood obesity, intervention attendance and behaviour change at home are both important. The purpose of this study was to qualitatively explore influences on attendance and behaviour change during a family‐based intervention to treat childhood obesity in the North West of England (Getting Our Active Lifestyles Started (GOALS)).
Design
Focus groups with children and parents/carers as part of a broader mixed‐methods evaluation.
Methods
Eighteen focus groups were conducted with children (n = 39, 19 boys) and parents/carers (n = 34, 5 male) to explore their experiences of GOALS after 6 weeks of attendance (/18 weeks). Data were analysed thematically to identify influences on attendance and behaviour change.
Results
Initial attendance came about through targeted referral (from health care professionals and letters in school) and was influenced by motivations for a brighter future. Once at GOALS, it was the fun, non‐judgemental healthy lifestyle approach that encouraged continued attendance. Factors that facilitated behaviour change included participatory learning as a family, being accountable and gradual realistic goal setting, whilst challenges focussed on fears about the intervention ending and a lack of support from non‐attending significant others.
Conclusions
Factors that influence attendance and behaviour change are distinct and may be important at different stages of the family’s change process. Practitioners are encouraged to tailor strategies to support both attendance and behaviour change, with a focus on whole family participation within and outside the intervention.
... 9 Seeking parents' input is also consistent with the philosophy of family-centered care and aligns with best practices in pediatric weight management. 10 Some studies have reported parent perspectives related to pediatric weight management, but the feedback solicited was to evaluate specific intervention approaches, 11,12 barriers to treatment, 13,14 and reasons for attrition. [15][16][17][18][19][20] . ...
Objective:
Although parents are uniquely positioned to offer first-hand insights that can be used to improve health services for managing pediatric obesity, their perspective is under explored. Our objective was to characterize parents' recommendations for enhancing tertiary-level health services for managing pediatric obesity in Canada.
Methods:
Semi-structured, one-on-one interviews were conducted with parents of children who initiated treatment at one of four Canadian tertiary-level, multidisciplinary weight management clinics. Parent perspectives were elicited regarding the strengths and weaknesses of the health services they received as well as areas for potential improvement. Interviews were audio-recorded and transcribed verbatim. We used qualitative description as the methodological framework and manifest content analysis as the analytical strategy.
Results:
Parents (n=65; 88% female; 72% Caucasian; 74% with at least some post-secondary education; 52% >$50,000 CDN household income) provided a range of recommendations that were organized according to health care (i) accessibility, (ii) content, and (iii) delivery. The most common recommendations included increasing scheduling options (44%, n=29), tailoring services to families' needs and circumstances (29%, n=19), placing greater emphasis on physical activity (29%, n=19), altering program duration (29%, n=19), incorporating interactive elements (25%, n=16), information provision (25%, n=16), and providing services at sites closer to participants' homes (24%, n=15).
Conclusions:
Parents' recommendations to enhance health services for managing pediatric obesity concerned modifiable factors related accessibility, content, and delivery of care. Further research is needed to evaluate whether implementing suggested recommendations improves clinically-relevant outcomes including attrition, quality of care, and success in weight management.
... According to Borra, Kelly, Schierreffs, Neville, and Geiger (2003) as well as Fennig and Fennig (2006), children and parents need to learn how to work together to promote weight loss with parents providing encouragement for each small step towards weight loss in order to maintain the child's motivation. Dixey, Rudolf, and Murtagh (2006) reported that children on a weight loss program called "Watch it" felt better than before, had increased self-esteem and improved school results. Holt, Bewick, and Gately (2005) also found that adolescents who participated in a weight loss camp experienced support from others and made new friends, leading to increased self-esteem. ...
Islam is not a religion of worship only but claims a complete code of life which provides guidance regarding all spheres of life to its believers. Food is one of the most important necessities that is needed for the existence of the human body. Therefore, Islam provides complete and clear concepts regarding lawful and unlawful things for human life. The concept of Ḥalal food given by Islam is getting more importance worldwide with regard to its recognition as pure, hygienic, healthy and of standard quality. Keeping in view the importance of Ḥalal food for Muslims, the current study intends to highlight the Islamic concept of Ḥalal food with reference to Qurʼān and Sunnah. In this regard, several Questions are raised as to what is the Islamic concept of Ḥalal food. What are the benefits of Ḥalal food on humans? How can one determine the Ḥalal food in light of Sharīʻah? What is the role of the family in instilling the concept of Ḥalal food in early childhood? To answer these questions, a Qualitative research methodology is adopted. The study concludes that providing awareness to children at an early age is important, and the family plays a vital role in this regard. The study will be helpful for the parents and families in recognizing their duties to make their children aware of Ḥalal food at an early age.
La méthode qualitative est en plein essor en médecine et particulièrement en psychiatrie, où la place du sujet, et ses représentations de la maladie et du soin sont centrales dans la prise en charge. Dans le champ de la santé de l'adolescent, de grands travaux permettent des avancées importantes dans la compréhension de la souffrance et les propositions de soins. Les méthodes qualitatives sont pourtant souvent critiquées de par leur contextualité et leur manque de pouvoir de généralisation. Une façon d'améliorer ces deux aspects consiste à appareiller les études traitant la même problématique de manière à en synthétiser les principaux résultats. Cet exercice de synthèse, notablement différent de celui de méta-analyse propre à la recherche quantitative, est réalisé depuis longtemps dans le champ des sciences humaines. Il s'agit de la métasynthèse, ou meta-ethnography. L'exercice de synthèse de la littérature est aujourd'hui de plus en plus codifié en recherche scientifique. Pourtant, certains points sont toujours en discussion - critères d'inclusion des études, critères de qualité des études-. De plus, aucune équipe psychiatrique ne s'est approprié l'outil de la métasynthèse pour l'adapter à la discipline. Ce travail décrit les étapes de la construction et de l'adaptation, à partir du corpus existant, d'une méthode rigoureuse, effective, simple à transposer et enseigner, permettant la métasynthèse de données de la littérature dans le domaine du soin psychique de l'adolescent. Il s'agit d'une part d'une réflexion théorique, épistémologique et méthodologique sur les métasynthèses et leur adaptation au champ de la clinique psychiatrique. Il s'agit d'autre part d'une construction pratique, réalisée à partir de métasynthèses effectuées sur des thématiques du soin psychique de l'adolescent. Les deux premiers articles sont deux travaux de métasynthèse. Le premier concerne l'obésité de l'adolescent. Les résultats obtenus mettent en lumière les limites de la méthode utilisée. Le deuxième article s'intéresse à la question des comportements suicidaires à l'adolescence. Les enseignements méthodologiques du premier article ont permis de perfectionner la méthode de métasynthèse. Enfin, le troisième article propose une description détaillée des étapes de la méthode construite. En discussion, nous proposons de resituer la méthode de la métasynthèse dans le contexte historique du niveau de preuve scientifique. Nous illustrons avec les articles les plus récents les liens toujours plus forts qui se construisent entre la méthode de la métasynthèse, aujourd'hui appelée Qualitative Evidence Synthesis, et la médecine fondée sur les preuves. La métasynthèse est une méthode moderne, qui montre tout son intérêt dans la recherche médicale. Notre méthode appliquée à la psychiatrie de l'adolescent est rigoureuse et fiable, et permet d'accroître la connaissance scientifique et d'améliorer la prise en charge des patients.
To incorporate the perspectives and experiences of family caregivers of children with obesity, the KidFit Health and Wellness Clinic, a paediatric weight management programme, embedded feedback opportunities into various stages of programme development. Caregivers were eligible to participate if their children had completed initial 4-week group-based pilot programming or were currently receiving treatment in 10 or 12 week group-based programming. Data were collected through feedback session discussions, audio-recorded, transcribed verbatim and analysed thematically. In total, 6 caregivers participated in the pilot group feedback session and 32 caregivers participated in the structured group feedback sessions. Caregivers reported that healthy lifestyle strategies first communicated by clinic staff to children during group sessions provided expert validation and reinforcement when discussing similar messages at home. Caregivers reported feeling isolated and blamed for causing their children's obesity and appreciated the supportive forum that group-based programming provided for sharing experiences. Since experiences of blame and isolation can burden caregivers of children with obesity, paediatric weight management programmes might consider including peer support opportunities and discussion forums for ongoing social support in addition to education about lifestyle change.
From 1996 to 1999 an auxologist (JW) measured children in 10 primary schools in Leeds participating in a health promotion programme.3 Children in years 3 and 4 (age 7-9 years) were measured in July 1996 and again in July 1997 and 1998. These children were marginally more advantaged than average for Leeds, with 1-42% of pupils from ethnic minorities and 7-29% entitled to free school meals (a measure of social disadvantage). Height was measured to 0.1 cm with a free standing Magnimeter stadiometer (Raven, Dunmow). Weights were recorded to 0.1 kg without shoes or jumpers. The mean of three triceps measurements was taken.4 Body mass index (weight (kg)/(height (m)2)) was calculated and converted to standard deviation scores using the revised 1990 reference standards5 and the Tanner Whitehouse (1975) standards for skinfold thickness.4 The following conventional cut-off points were applied: body mass index standard deviation score greater than 1.04 (85th centile) for overweight and greater than 1.64 (95th centile) for obesity. Using these definitions the expected percentages were 15% for overweight and 5% for obesity, relative to British children in 1990. Observed levels were compared with expected levels using χ2 goodness of fit test. All but 21 children agreed to participate. Overall, 608 children were measured in 1996, 540 in 1997, and 499 in 1998 (some of whom were not measured in 1997). In addition 86 new children joined the study in 1997 and 1998. In total 694 children were measured, resulting in 1762 measurements. The table shows the proportion of children with body mass index and triceps measurements above the 85th and 95th centiles according to age. A significant increase in the proportion of overweight and obese children was observed in those aged 9, 10, and 11 years. Body mass index scores and triceps skinfold measures in Leeds primary school children. Values are numbers (percentages) unless stated otherwise
The increasing prevalence of obesity in many countries means that it should now be considered a pandemic.1 One estimate from Australia suggests that over the past decade the average adult has been adding 1 gram a day to body weight.2 This has occurred in the face of increasing knowledge, awareness, and education about obesity, nutrition, and exercise. It has been suggested that a paradigm shift is necessary if future progress is to be made.3
Traditionally, weight gain was thought of as caused by eating too much or exercising too little, or both (changes in weight=energy intake-energy expenditure). This led to the search for small deficiencies in energy metabolism such as a reduced thermic effect of food to explain obesity.4 Treatment was dominated by calorie counting, and public health messages extolled people to balance their intake and output. This paradigm has changed with the increasing understanding of the dynamic relations between energy stores, appetite mechanisms, and energy metabolism and of the wider recognition of nutrient partitioning.5 6 From studies which have shown that fat balance is equivalent to energy balance,7 the fat balance equation was developed (rate of change of fat stores=rate of fat intake-rate of fat oxidation).5 This equation is more dynamic than the original static equation and reflects energy balance under normal conditions of free access to foods. Because fat intake and oxidation are not closely balanced,8 this approach does not need metabolic abnormalities or genetic mutations to explain weight gain. Indeed, the differences in body fat between people living in the same environment could be better described as normal physiological variation. This paradigm is more helpful in explaining changes in body fat within an individual over time, but it does not account for the wider influences within and around individuals …
Childhood obesity has essentially no consequences at the community level and therefore presents a dilemma. On the one hand, communities should be dealing with those health matters that place a real burden on their resources. On the other hand, childhood obesity places almost no immediate burden on resources. However, the burden of adult obesity is highly significant and is predicted by the prevalence of untreated childhood obesity. The medical complications for the vast majority of obese children occur beyond the childhood years. Emotional suffering, which is common, could take up resources, but mental health services are so inadequate across the country that the troubled child is infrequently seen. The community does have a great responsibility to address the problem of childhood obesity, and I propose to address its potential role across the three areas of prevention, treatment, and monitoring.
Objective: This brief report identifies the factors that distinguish girls who have begun dieting recently from those who have never dieted using Huon and Strong's (International Journal of Eating Disorders 23:361-369, 1998) model of dieting. Method: Sixty-two initiating dieters were carefully matched with 62 never dieters, according to school, grade, age, language spoken at home, and country of birth. Both groups completed a battery of questionnaires that assessed their dieting status, perceived social influence to diet, conformity disposition, assertiveness, and familial context. Results: A discriminant function analysis showed that initiating dieters and never dieters could be distinguished most clearly by their levels of peer and parental influence. Initiating dieters conformed and complied more to their parents. They were also more competitive with their peers than were the girls who had never dieted. Perceived supportiveness of fathers was also found to set apart those girls who had never dieted. Discussion: Girls who are just beginning to diet differ from those who have never dieted, predominantly in terms of their perceived social influence. The forms of parental influence that distinguish the two groups differ in nature from the type of influence exerted by peers. (C) 2000 by John Wiley & Sons, Inc.
Presents results of focus group discussions held with 300 nine-to-11-year old UK children. Questions were asked about whether it matters if someone is fat or thin; whether a fat child should take any action; what problems they might have; and the relationship between fatness, thinness and health. Considerable complexity emerged; children divided fat children into those for whom it was natural and those for whom it was self-inflicted. They showed a great deal of sympathy for “naturally” fat children. However, they also felt that fat children would be bullied. Girls seemed less able than boys to resist the pressures to be thin, but also showed considerable ability to distance themselves from media images of thin women. Although children had learned the orthodoxy surrounding health, fat and overweight, they did not believe that “thin is good, fat is bad” and did not tend to link weight control with exercise.
Restricting children's access to palatable foods may appeal to parents as a straightforward means of promoting moderate intakes of foods high in fat and sugar; however, restricting access to palatable foods may have unintended effects on children's eating. The efficacy of restricting children's access to palatable foods as a means of promoting patterns of moderate intake of those foods is unknown.
Two experiments were conducted to test the hypothesis that restricting access to a palatable food enhances children's subsequent behavioral responses to, selection of, and intake of that restricted food.
Both experiments used a within-subjects design to examine the effects of restricting access to a palatable food on children's subsequent behavior, food selection, and food intake. The first experiment examined the effects of restriction within and outside the restricted context and the second experiment focused on the effects within the restricted context.
In both experiments, restricting access to a palatable food increased children's behavioral response to that food. Experiment 2 showed that restricting access increased children's subsequent selection and intake of that food within the restricted context.
Restricting access focuses children's attention on restricted foods, while increasing their desire to obtain and consume those foods. Restricting children's access to palatable foods is not an effective means of promoting moderate intake of palatable foods and may encourage the intake of foods that should be limited in the diet.
Using a developmental systems perspective, this review focuses on how genetic predispositions interact with aspects of the eating environment to produce phenotypic food preferences. Predispositions include the unlearned, reflexive reactions to basic tastes: the preference for sweet and salty tastes, and the rejection of sour and bitter tastes. Other predispositions are (a) the neophobic reaction to new foods and (b) the ability to learn food preferences based on associations with the contexts and consequences of eating various foods. Whether genetic predispositions are manifested in food preferences that foster healthy diets depends on the eating environment, including food availability and child-feeding practices of the adults. Unfortunately, in the United States today, the ready availability of energy-dense foods, high in sugar, fat, and salt, provides an eating environment that fosters food preferences inconsistent with dietary guidelines, which can promote excess weight gain and obesity.
This brief report identifies the factors that distinguish girls who have begun dieting recently from those who have never dieted, using Huon and Strong's (International Journal of Eating Disorders 23:361-369, 1998) model of dieting.
Sixty-two initiating dieters were carefully matched with 62 never dieters, according to school, grade, age, language spoken at home, and country of birth. Both groups completed a battery of questionnaires that assessed their dieting status, perceived social influence to diet, conformity disposition, assertiveness, and familial context.
A discriminant function analysis showed that initiating dieters and never dieters could be distinguished most clearly by their levels of peer and parental influence. Initiating dieters conformed and complied more to their parents. They were also more competitive with their peers than were the girls who had never dieted. Perceived supportiveness of fathers was also found to set apart those girls who had never dieted.
Girls who are just beginning to diet differ from those who have never dieted, predominantly in terms of their perceived social influence. The forms of parental influence that distinguish the two groups differ in nature from the type of influence exerted by peers.
Editor—In 1992 Singapore's health ministry launched a national programme promoting a healthy lifestyle to address the common risk factors for chronic diseases such as obesity, physical inactivity, and cigarette smoking. Different age groups in the population were targeted, including school children.
The health promotion board of the health ministry works in close partnership with the education ministry on obesity programmes for school children. The education ministry's “trim and fit” programme for primary, secondary, and pre-university schools aims to reduce obesity in school children and improve the physical fitness of the pupils using a mutidisciplinary approach targeting overweight students, parents, teachers, and the school environment. These are comparable to the approaches used in Sahota et al's intervention programme.1,2
Under the programme, nutrition education is integrated into the formal school curriculum. The food and drinks sold in school canteens are subject to control measures, and water coolers are provided in all schools to encourage students to drink more plain water. Schools that achieve good health outcomes will be presented with the trim and fit awards annually.
Special attention is also given to students found to be overweight. At schools they participate in special physical exercise programmes, and messages on healthier nutrition choices are reinforced. Obese students who require further assessment and management are referred to the school health service's students' health centre for more intensive follow up with doctors and dieticians. The health promotion board launched the “championing effort resulting in improved school health” award in 2000. The award recognises schools that continually strive to nurture the physical, emotional, and social health of both students and staff and help them adopt healthy practices through comprehensive and innovative methods. Children are also targeted in the community programmes that promote healthy lifestyle habits in families.
Since the implementation of these obesity programmes, the prevalence of obesity has declined from 16.6% to 14.6% between 1992 and 2000 among primary 6 students (11-12 year olds). A similar decline was seen in secondary 4 students (15-16 year olds) from 15.5% to 13.1% over the same period.3,4 These obesity programmes form a part of the overall push by the government of Singapore to promote health through schools, which has been identified by the World Health Organization as one of the most efficient and effective ways of improving the lives of young people.5 It is also a part of the overarching framework for non-communicable disease prevention and control to reduce premature mortality in the country.