Abstract
BackgroundChildren with overweight or obesity are at greatly increased risk of experiencing obesity in adulthood but for reasons generally unknown some attain a healthier adult weight. This qualitative study investigated individual, social and environmental factors that might explain diverging body mass index (BMI) trajectories. This knowledge could underpin interventions to promote healthy weight.MethodsThis 2016 study included participants from three adult follow-ups of children who (when 7–15 years) participated in the 1985 Australian Schools Health and Fitness Survey and provided BMI data at each time point. Trajectory-based group modelling identified five BMI trajectories: stable below average, stable average, increasing from average, increasing from very high and decreasing from very high. Between six and 12 participants (38–46 years) from each BMI trajectory group were interviewed (n = 50; 60% women). Thematic analysis guided by a social-ecological framework explored individual, social and environmental influences on diet and physical activity within the work setting.ResultsA distinct approach to healthy behaviour was principally identified in the stable and decreasing BMI groups – we term this approach “health identity” (exemplified by “I love having a healthy lifestyle”). This concept was predominant in the stable or decreasing BMI groups when participants explained why work colleagues seemingly did not influence their health behaviour. Participants in the stable and decreasing BMI groups also more commonly reported, bringing home-prepared lunches to work, working or being educated in a health-related field, having a physically active job or situating physical activity within and around work – the latter three factors were common among those who appeared to have a more distinct “health identity”. Alcohol, workplace food culture (e.g. morning teas), and work-related stress appeared to influence weight-related behaviours, but generally these factors were similarly discussed across all trajectory groups.ConclusionWork-related factors may influence weight or weight-related behaviours, irrespective of BMI trajectory, but the concept of an individual’s “health identity” may help to explain divergent BMI trajectories. “Health identity” and its influence on health behaviour warrants further exploratory work.
Highlights
Children with overweight or obesity are at greatly increased risk of experiencing obesity in adulthood but for reasons generally unknown some attain a healthier adult weight
These participants were drawn from the Childhood Determinants of Adult Health (CDAH) study a prospective quantitative study which has involved three adult follow-ups of a nationally representative cohort who completed the 1985 Australian Schools Health and Fitness Survey (n = 8498) (Fig. 1) [30,31,32]
We present the findings relevant to the work setting only
Summary
Children with overweight or obesity are at greatly increased risk of experiencing obesity in adulthood but for reasons generally unknown some attain a healthier adult weight. This qualitative study investigated individual, social and environmental factors that might explain diverging body mass index (BMI) trajectories. In 2013, nearly one third of adults and children worldwide (~ 2 billion) were estimated to be living with overweight or obesity [1] This is of public health significance because weight and comorbidity are positively correlated, resulting in substantial personal and societal cost [2]. The complex causal contribution of individual, social and environmental factors to overweight and obesity likely explains its commonly intractable nature and highlights the importance of avoiding unhealthy weight gain trajectories [14]
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