“The thing is, kids don’t grow the same”: Parent perspectives on preschoolers’ weight and size in Soweto, South Africa

Abstract

The prevalence of overweight and obesity is high among preschool age (3-5 years) children in South Africa, and children in urban low-income settings are particularly at risk. A better understanding of how parents or caregivers of young children perceive children's weight and size, as well as contextual factors influencing perceptions, is needed to inform interventions. The aim of this study was to examine how parents of preschool children in Soweto, South Africa, view childhood obesity, and to situate these perspectives in the context of the home environment in which preschool age children in Soweto live. Semi-structured in-depth interviews were conducted with 16 parents in four neighbourhoods of Soweto. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis following a contextualist approach. Three themes were developed: growing differently, the 'right' way to be, and weight is not health. These themes capture parents' views on complex and reportedly inevitable causes of obesity, ideas about acceptable and preferred body sizes, and the low priority of weight per se compared to health. The findings suggest that childhood obesity prevention in South Africa needs to be done in a non-stigmatising way that recognises environmental and contextual factors, such as parents' limited sense of agency in relation to their children's health and weight, and concrete resource constraints. Environmental barriers to healthy behaviours need to be addressed in order to overcome the coexisting challenges of childhood undernutrition and obesity in urban low-income South African settings.

Parent perspectives on preschoolers’ movement and dietary behaviours: a qualitative study in Soweto, South Africa

“…Details of recruitment are described in detail elsewhere (28) . In short, recruitment consisted of a combination of purposive (according to inclusion criteria such as being the primary caregiver of a 3-5-year-old child who attends a specific preschool, fluency in English and different socioeconomic situations) and convenience (driven by availability of participants) sampling through four local preschools.…”

“…The two other authors acted as 'critical friends' (33) , supporting the refinement of themes. Table 1 summarises socio-demographic characteristics of the sixteen study participants; further details can be found elsewhere (28) . All participants were Black South Africans and the preschool child's biological parent.…”

“…The interviews were audio-recorded (Philips DVT4010 VoiceTracer) and transcribed verbatim. This process and the materials used are described in more detail elsewhere (28) and in the online Supplementary Material. Interview transcripts were analysed using reflexive thematic analysis according to the process developed by Braun & Clarke (29,30) , and contextualising field notes were used to support interpretations.…”

“…The current study aims to describe how parents of preschool-age (3-5 years) children in Soweto, an urban and predominantly low-income township in Johannesburg, view children's health behaviours and to situate these perspectives in the context of preschoolers' homes and wider environments. Findings regarding parents' perceptions of childhood obesity and preschoolers' size and weight have been published previously (28) , whereas the focus here is on obesity-related behaviours.…”

Perceptions of the South African 24-Hour Movement Guidelines for Birth to 5 Years: A Qualitative Study

“…[13][14][15] While there are constraints to changing these behaviors in low-income, urban households, the findings presented in this paper align with other research, which has found that caregivers of young children in these settings are generally receptive to attempting to implement these changes, particularly if the focus is on child health and development in a more holistic sensenot just obesity prevention. [16][17][18] In terms of potential intervention strategies, CBOs already working with caregivers and practitioners (ECD and health related) to promote any aspect of young children's health and development should be encouraged to incorporate input on screen time and sleep, in order to address these as priority behaviors. Strategies can use the infographic as a visual aid but should not be limited to the mere provision of a printed resource without an explanation and the opportunity to ask questions to stimulate understanding.…”