‘She’s not obese, she’s a normal 5-year-old and she keeps up with the other kids’: families’ reasons for not attending a family-based obesity management programme

Abstract

Aims: To discover the reasons behind invited families’ lack of engagement with a family-based childhood obesity programme in a deprived area. Methods: Interviews were conducted with 10 families who were invited to join the programme, but declined to engage. There were two distinct subgroups of participants: those who had no interest in attending the programme and those who showed initial interest yet did not continue attending. The two subgroups were analyzed separately using inductive thematic analysis, and then compared. Results: Analysis identified eight themes overall. For both groups, when the service was perceived to be not needed (‘I didn’t see how that would help’), the families disengaged with it. For both groups, this perception was partly related to the perceived appearance of their children: either that they were not obese (‘I didn’t think my son was overweight’) or that they were growing into their size. There was also a similarity in both groups that they perceived that they were already following healthy lifestyles. In addition, several of the themes arising from the families who had no initial interest were related to the impact of the letter that parents received detailing the result of their child being weighed and measured at school. This angered parents (‘I was disgusted’), and there was a feeling that the approach was too generic. Conclusion: This study identified a number of potential reasons behind why families may decline to engage with a childhood obesity programme in a deprived area. Across all families, if the programme was perceived as not needed, they would disengage. For those who did not engage at all, the initial communication of the child’s body mass index (BMI) is crucial. Recommendations include taking a more personal and tailored approach for the initial communication and shifting the focus of the programmes onto healthier lifestyles.

Public health nurses’ experiences following up children with overweight and obesity according to national guidelines. A qualitative study

“…Parental concern and engagement regarding the child’s weight are crucial for a weight change (Ames et al, 2020 ; Melbye & Hansen, 2015 ). Povey et al ( 2020 ) also found that when help was perceived as not needed by the parents, the families disengaged in the obesity management programme. By not considering their child obese, the parents did not see the point of attending the programme (Povey et al, 2020 ).…”

“…Povey et al ( 2020 ) also found that when help was perceived as not needed by the parents, the families disengaged in the obesity management programme. By not considering their child obese, the parents did not see the point of attending the programme (Povey et al, 2020 ). To be positioned to help the family, how the PHN communicates the result to the parents may be crucial.…”

Does adjusting for biological maturity when calculating child weight status improve the accuracy of predicting future health risk?

“…Most families receiving a referral to children's weight management services do not accept the offer, which is commonly attributed to denial or lack of recognition that a child is overweight [35]. Parental recognition of a child's weight status is poor even following confirmation of measurement from school nurse-led programmes [36], as some parents do not believe these weight classifications, often citing the failure to account for biological maturity within the measurement process as a reason for not trusting them [33,34,[37][38][39]. This suggests that the costs in lost opportunity for support among adolescents reclassified by the present approach is very low.…”

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“…avoid being aided by educational programs to promote their children's health (Kranjac & Wagmiller, 2020;Povey, Cowap, Scholtens, & Forshaw, 2020). Many of the studies described above report on the children's actual nutritional knowledge and declared preferences (Lewis, 2017;Eilat-Adar et al, 2011;Pirouznia, 2001).…”