‘Health and happiness is more important than weight’: a qualitative investigation of the views of parents receiving written feedback on their child's weight as part of the National Child Measurement Programme

Abstract

BackgroundThe present study aimed to explore parental perceptions of overweight children and associated health risks after receiving National Child Measurement Programme (NCMP) weight feedback.MethodsFifty-two parents of overweight and obese children aged 4–5 years and 10–11 years enrolled in the NCMP programme in England in 2010–2011 participated in qualitative, semi-structured interviews about their perceptions of their child's weight and health risk after receiving weight feedback. Interviews were audio tape recorded and were conducted either by telephone (n = 9) or in the respondents’ homes (n = 41). Interviews were transcribed verbatim and analysed using interpretative thematic analysis.ResultsParents who received NCMP written feedback informing them that their child was overweight disregarded the results because they viewed ‘health and happiness as being more important than weight’. The feedback was viewed as less credible because it did not consider the individual child's lifestyle. ‘Broad definitions of healthy’ were described that did not include weight, such as reference to the child having good emotional and physical health and a healthy diet. Parents attributed weight to ‘inherited/acquired factors’ such as genetics or puppy fat, or did not regard their child's ‘appearance’ as reflecting being overweight. ‘Cultural influence’ also meant that being overweight was not viewed negatively by some non-white parents.ConclusionsAfter receiving written weight feedback, parents use methods other than actual weight when evaluating their child's weight status and health risks. Parents’ conceptions of health and weight should be considered when communicating with parents, with the aim of bridging the gap between parental recognition of being overweight and subsequent behaviour change.

Randomised controlled trial evaluating the effectiveness and cost-effectiveness of ‘Families for Health’, a family-based childhood obesity treatment intervention delivered in a community setting for ages 6 to 11 years

“…The gap between receiving feedback that their child is overweight via the NCMP and subsequent behaviour change is recognised, helping to explain the disconnect between the number of potential children who were eligible and those who actually came forward to participate in the Families for Health trial. 105 As a consequence of the slow recruitment, some families had a long wait until the number of families randomised to the Families for Health arm was sufficient for their group to run. Some groups also started with a suboptimal number of families, which impacted on the delivery of the programme and group dynamics.…”

Can it be harmful for parents to talk to their child about their weight? A meta-analysis

“…Only one study reported on an intervention for which parent-child communication was the sole focus [41], and thus provides information that clearly addresses the research question. This study was aimed at the prevention of negative body-related selfattributes in [12][13][14] year old girls of all body weights through providing communication training to mothers [41]. Communication training formed only a small part of the content of the remaining three interventions: In two studies the parental component accompanied an intervention delivered to children themselves [42,43], and in two studies the communication component was embedded within a broader parental training package promoting other aspects of obesity prevention such as making environmental changes and goal setting [43,44].…”

“…Parents often decline offers of support for child weight management [9], or react angrily [10,11]. One reason parents give for negative reactions to such weight-feedback is the concern that raising the issue of weight and engaging their child in weight-management activities risks harming their child's physical self-perceptions, wellbeing and could trigger eating disorders [7,8,10,[12][13][14][15][16][17]. That is, the negative impact of tackling weight on a child's wellbeing is perceived to be more of a threat than their being overweight.…”

“I would rather be told than not know” - A qualitative study exploring parental views on identifying the future risk of childhood overweight and obesity during infancy

“…Evidence also suggests that parents lack awareness of the impact of childhood overweight upon health [17] and that a higher value is given to on other attributes such as childhood happiness [18]. …”