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The views of young children in the UK about obesity, body size, shape and weight: a systematic review.
Rees, R, Oliver, K, Woodman, J, Thomas, J
BMC public health. 2011;11:188
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Plain language summary
Obesity in children is an increasing problem in Westernised societies; obese children are more at risk of poorer health in the short and long term. The aim of the study was to explore the views of children about the meanings of obesity and body size, shape or weight and their own experience of these issues. This systemic review looked at 28 studies done in UK, conducted after 1997 in children aged 4-11. The review’s findings suggest that for children, the health consequences of obesity seemed to be mostly irrelevant. Impact on their social lives was far more important. Also, despite often having healthy body sizes, children continue to dislike their own bodies. This review highlights the need to consider the social aspect of childhood obesity and that children’s perspectives should be used in the policy making process. The authors conclude that the studies did not fully represent children’s diversity and therefore higher quality research is needed to enable relevant interventions to be put into place.
Abstract
BACKGROUND There are high levels of concern about childhood obesity, with obese children being at higher risk of poorer health both in the short and longer terms. Children's attitudes to, and beliefs about, their bodies have also raised concern. Children themselves have a stake in this debate; their perspectives on this issue can inform the ways in which interventions aim to work.This systematic review of qualitative and quantitative research aimed to explore the views of UK children about the meanings of obesity and body size, shape or weight and their own experiences of these issues. METHODS We conducted sensitive searches of electronic databases and specialist websites, and contacted experts. We included studies published from the start of 1997 which reported the perspectives of UK children aged 4-11 about obesity or body size, shape or weight, and which described key aspects of their methods. Included studies were coded and quality-assessed by two reviewers independently.Findings were synthesised in two analyses: i) an interpretive synthesis of findings from open-ended questions; and ii) an aggregative synthesis of findings from closed questions. We juxtaposed the findings from the two syntheses. The effect of excluding the lowest quality studies was explored. We also consulted young people to explore the credibility of a subset of findings. RESULTS We included 28 studies. Instead of a focus on health, children emphasised the social impact of body size, describing experiences and awareness of abuse and isolation for children with a greater weight. Body size was seen as under the individual's control and children attributed negative characteristics to overweight people. Children actively assessed their own size; many wished their bodies were different and some were anxious about their shape.Reviewers judged that children's engagement and participation in discussion had only rarely been supported in the included studies, and few study findings had depth or breadth. CONCLUSIONS Initiatives need to consider the social aspects of obesity, in particular unhelpful beliefs, attitudes and discriminatory behaviours around body size. Researchers and policy-makers should involve children actively and seek their views on appropriate forms of support around this issue.
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Being 'fat' in today's world: a qualitative study of the lived experiences of people with obesity in Australia.
Thomas, SL, Hyde, J, Karunaratne, A, Herbert, D, Komesaroff, PA
Health expectations : an international journal of public participation in health care and health policy. 2008;11(4):321-30
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The obesity epidemic is one of the most pressing contemporary public health problems. The aim of this study was to develop a picture of both lived experiences of obesity and the impact of socio-cultural factors on obesity. The study adopted a qualitative research design (n=76) . A broad interview schedule was developed by the authors aimed at individuals from a broad range of backgrounds and experiences of obesity. Results indicate that: (a) the experiences of obesity are diverse but there are common themes. (b) people living with obesity have heard the messages but find it difficult to act upon them. (c) interventions should be tailored to address both individual and community needs. (d) there should be a different approach towards obesity interventions. Authors conclude that interventions should respond directly to the social and cultural dimensions of communities and clusters of individuals.
Abstract
OBJECTIVE To develop an in-depth picture of both lived experience of obesity and the impact of socio-cultural factors on people living with obesity. DESIGN Qualitative methodology, utilizing in-depth semi-structured interviews with a community sample of obese adults (body mass index >or=30). Community sampling methods were supplemented with purposive sampling techniques to ensure a diverse range of individuals were included. RESULTS Seventy-six individuals (aged 16-72) were interviewed. Most had struggled with their weight for most of their lives (n=45). Almost all had experienced stigma and discrimination in childhood (n=36), as adolescents (n=41) or as adults (n=72). About half stated that they had been humiliated by health professionals because of their weight. Participants felt an individual responsibility to lose weight, and many tried extreme forms of dieting to do so. Participants described an increasing culture of 'blame' against people living with obesity perpetuated by media and public health messages. Eighty percent said that they hated or disliked the word obesity and would rather be called fat or overweight. DISCUSSION AND CONCLUSION There are four key conclusions: (i) the experiences of obesity are diverse, but there are common themes, (ii) people living with obesity have heard the messages but find it difficult to act upon them, (iii) interventions should be tailored to address both individual and community needs and (iv) we need to rethink how to approach obesity interventions to ensure that avoid recapitulating damaging social stereotypes and exacerbating social inequalities.