Background: The prevalence of childhood obesity is rising and the UK Government have stated a commitment to addressing obesity in general. One method has been to include indicators relating to obesity within the GP pay-for-performance Quality and Outcomes Framework (QOF) contract. This study aimed to explore general practitioners' and practice nurses' views in relation to their role in treating childhood obesity.

19 Purpose 20A nutritious diet is critical to the health and development of pre-school children. Children in 21 the UK consume much food outside the home yet day-care food provision is unregulated, and 22 informed by disparate and conflicting dietary guidelines. Factors affecting nursery food 23 provision have been much studied, but less is known about food provision in the child-minder 24 setting. This study examined factors influencing child-minders' food provision. 25 26 Design/methods 27Qualitative methods were employed, combining participant observation with semi-structured 28 interviews. Participants were selected via purposive and convenience sampling. Eight child-29 minders from a large town in Yorkshire, England were interviewed. 30 31 32 Findings 33The food provided by child-minders was not consistent with dietary guidelines for young 34 children, following menu plans was reported to be difficult, and knowledge about healthy 35 eating guidelines for young children was various. Child-minders reported limited time for 36 food preparation, and problems catering for fussy children. Some child-minders obtained 37 support through an informal peer network group. Only one child-minder reported availing of 38 professional nutritional advice on healthy food provision. Communication with parents about 39 food was considered important, although there was some evidence of discord between 40 providers and parents in dietary objectives. 41The study was small in size and regionally based. Due to the local nature of the study, it 42is not possible to make generalisations to the wider national context 43 Practical Implications 44Child-minders have a pivotal role to play in the nutritional health and development of young 45 children, and whilst their interest in provision of nutritious food was great, outside support 46 was lacking. Support should include provision of one clear set of authoritative guidelines, 47 practical guidance that accommodates the realities of providing food in the child-minder 48 setting, investment to strengthen support structures at local level and the development of 49 network groups. 50 51 3

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