"Just say no"..... the journey of families with clinically obese children

Abstract

Paediatric overweight and obesity are at epidemic proportions in both developed and developing countries around the world. The health issues for overweight and obese children are a significant concern to health professionals as they grow into chronic conditions as the child transitions to adulthood. Despite a plethora of literature highlighting the determinants of paediatric obesity, there has been little success in our ability to slow down the escalation of the condition. The gold standard to reduce weight in overweight and obese children is to decrease energy intake and increase expenditure to cause weight loss. The application of a simplistic approach based on eating less and moving more is outdated and unrealistic to fix a complex and multifaceted condition. Furthermore, health professionals expect necessary changes to be achieved by asking parents to engage in lifestyle changes that focus on behavioural changes, nutritional adjustments and encouraging physical activity for their families. This approach has resulted in limited successful outcomes for the parents of overweight and obese children, who lack insight and understanding into the complexity of their child’s condition. There is a need to conduct more investigations to understand why parents are unable to help their children lose weight using lifestyle approaches that employ a simple eat less and move more concept based on behaviour modification. This thesis investigated the experiences in particular of mothers who were raising obese children and explored the challenges they face when asked to get their children to eat less and move more in our contemporary obesogenic environment. Eighteen families were recruited from a private dietetic clinic providing treatment for overweight and obese children. Families were invited to participate in a mixed method research project which included both quantitative and qualitative components. My thesis argues that despite our current understanding that paediatric obesity is a multifaceted and complex condition, current treatment regimens do not consider the multi-determinants of health. Despite being framed as “family” interventions, they are based on individualistic approaches which simply includes advising mothers to get their obese children to eat less and move more. The exploration of the mothers’ experiences, when raising and obese child/ren and trying to decrease their weight, has highlighted the need to rethink our current practice. I argue that for effective treatments, attention needs to be given to the following three considerations: first, we need to move away from the simplistic eat less, move more theoretical underpinnings of our treatments; second, we need to move away from solely focusing on the child’s weight as the pivotal point to be addressed and instead, meaningfully address the multiple characteristics that obese children present with; third, we need to rethink our family-centred approaches which fail to recognise that “the family” in fact means the mother and that it is impossible for one person to have the skills, time and emotional energy required to navigate the complexity of the current obesogenic environment. Our understanding that there are multiple determinants that contribute to paediatric obesity is neglected when our focus is only on the mothers. Increased support and understanding are paramount for mothers who are struggling to raise obese children in a biased and stigmatised obesogenic environment that deflects the responsibility to mothers. This can be likened to the health issues associated with cigarette smoking where for decades the person was consistently blamed for their addiction. However, they were being enticed by cigarette companies to partake in an addictive practice that was promoted as fun and exciting. Existing obesogenic environments support the increased consumption of negative foods, and technological advances encourage decreased physical activity that causes weight gain in children. The development of overweight and obesity in paediatric populations evolved over several decades due to enormous and unprecedented environmental advancement and changes. Consequently, there is no single treatment or approach that can solve paediatric obesity. Therefore, the narrow individualist approach of targeting mothers needs to be addressed urgently because current obesogenic environments negate all parental attempts to make the necessary adjustments for their obese children to lose weight. We need to heed advice from the literature such as the World Health Organization’s Report on Ending Childhood Obesity, 2016: “Obesity prevention and treatment requires a whole-ofgovernment approach in which policies across all sectors systematically take health into account, avoid harmful health impacts, and thus improve population health and health equity (WHO, 2016, p.VI). Furthermore, the WHO also states that “No single intervention can halt the rise of the growing obesity epidemic” (WHO, 2016a, p.VI). Within the hierarchy structure of the determinants that contribute to paediatric obesity, we can identify that the top-level stakeholders appear to lack in their contributions that would support lower-level efforts. I argue that an all-inclusive approach, including all aspects of paediatric overweight and obesity, is paramount if this pandemic is to be stopped.