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.
Highlights
Childhood obesity is a relatively recent but growing public health issue in South Africa, and many other African settings [1,2,3,4]
The aim of this study is to describe how parents or caregivers of young 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 live
As described by Braun and Clarke [27], a contextualist application of thematic analysis is influenced by critical realist theory that “acknowledge[s] the ways individuals make meaning of their experience, and, in turn, the ways the broader social context impinges on those meanings, while retaining focus on the material and other limits of ‘reality’.”(p.81) Essentially, what people say is taken to be a reflection of the reality that they are living and experiencing, and where possible, individual accounts are contextualised by providing a rich description of the environment in which study participants live, and any relevant interactions between the individual and other levels of the social-ecological model of health [28], such as family circumstances or community characteristics
Summary
Childhood obesity is a relatively recent but growing public health issue in South Africa, and many other African settings [1,2,3,4]. In the Southern African region, the prevalence of obesity among under 5-year-olds is estimated to be 13%, which is more than double the mean prevalence for the entire continent [1]. In South Africa, a national survey from 2013 suggests an even higher combined prevalence of overweight and obesity in 2-5-year-old children at 22.9%. Funding from the Research Councils UK Newton Fund to the University of Cambridge (ES/N013891/1) and from the National Research Foundation to the University of the Witwatersrand (UID:98561) is gratefully acknowledged. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript
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