Dr. Geoff Ball, University of Alberta
What do these adolescent kids and their parents expect of an obesity program? What are the barriers they face in terms of improving their lifestyles? What issues are relevant at the level of the family, peers, the health care system, and a policy and program level?
These are questions addressed by Nicholas Holt and colleagues from the University of Alberta, in a study just out in Qualitative Health Research. For this study led by Geoff Ball (picture), data were collected via 41 interviews with parents and children from the wait-list of the pediatric weight-management clinic and analyzed using grounded theory methodology.
While the study provides numerous insights into the familial and other circumstances faced by these families, I believe the following quotes from the paper speak for themselves:
On parental overprotection:
“Ever since [our daughter] was little, being the first grand daughter in the family . . . everybody watched her like a hawk. We were so afraid, like all of us, not just [my wife] and I . . . but it was the whole extended family . . .because she [daughter] was the first . . . we were so afraid that she’d get hurt . . . it’s probably that we have sheltered her a bit too much . . . [from physical activity].”
or
“I have been extremely overprotective [of my son] . . . like [I tell him], ‘Don’t go out in the cold.’ I don’t want him outside. We haven’t encouraged him that way [to be physically active].”
(not exactly a helpful recommendation in a city like Edmonton, where Winter lasts 5 months a year.)
On family meals:
“My husband has just changed jobs; he’s on shift work. So, sitting down together at 5 o’clock doesn’t happen at our house anymore . . . I go sit at the counter top and he’ll sit in front of the TV and eat and I’ll sit in front of the other [TV] and eat.”
On the importance of TVs in general:
“I think we have like five TVs in our house and four of them are just . . . well two of them are movie player ones. OK, there’s one in my brother’s room and it’s one that’s a DVD and movie player, but that’s all. And then the one in my dad’s room you can, it’s watching satellite from downstairs. And then there’s one downstairs and it’s a big screen TV and it’s just a satellite. And then we have two TVs in our toy room. And one of them is supposed to be for “GameCube” and the other one is supposed to be for “PlayStation.” But for some reason both of them are hooked up to one TV. And then we have a computer . . . well, we have two computers . . . a laptop and a computer.”
On how not watching TV cripples social life:
“[My daughter’s schoolmates] all get together and talk about . . . oh there’s One Tree Hill, Gilmore Girls, um Grey’s Anatomy . . . and they almost have one everynight that they could look at. . . . I don’t know about cutting back [TV time] much more . . . I don’t know. That would be hard . . . she’d still be able to talk about some of the shows . . . it wouldn’t cripple [her social life] . . . well [it might].”
On medical care:
“Usually the medical community, you know, they do the thyroid test and those type of things and then very little else happens, and then so it’s rested on [our] shoulders.”
Anyone interested in pediatric and adolescent obesity needs to read this fascinating study on what actually happens in families challenged by obesity and the obstacles they face in trying to change behaviour.
I can only agree with the authors, who conclude: “It is fundamentally important for program planners and health care providers, the individuals who are charged with developing and providing the best service possible, to be mindful of the personal experiences of overweight children and their families who seek weight management care.”
As with adults, overeating and “undermoving” are symptoms of underlying familial, cultural, societal and environmental challenges faced by kids, adolescents and their families. Simply telling them to “eat less and move more” is about as effective as telling them to “have a great day”.
AMS
Edmonton, Alberta
In The News
September 3rd, 2008 at 8:12 am
As someone who was treated for overweight as a kid (unsuccessfully, I suppose, as I’m a fat adult) I wish this had been better appreciated/understood by my pediatrician, who seemed only to see my weight as the problem, not the alcoholism, domestic violence and depression going on in my family.
Thank you for this post, I will certainly want to read the study.
September 8th, 2008 at 11:14 am
I am a dietitian who is reading an excellent book by Ellyn Satter MS RD LCSW BCD “Your Child’s Weight - Helping without Harming, Birth through Adolescence.” I recommend for all parents, regardless of the weight of your child, and for health professionals who counsel parents about their child’s health. It explains why traditional counselling of just eating healthier foods is not adequate to resolve excess weight gain in children.