Young teenagers’ perceptions of their own and others’ bodies: A qualitative study of obese, overweight and ‘normal’ weight young people in Scotland

Weight development from childhood to motherhood-embodied experiences in women with pre-pregnancy obesity: a qualitative study

BACKGROUND

Pre-pregnancy obesity increases the risk of perinatal complications. Post-pregnancy is a time of preparation for the next pregnancy and lifestyle advice in antenatal care and postpartum follow-up is therefore recommended. However, behavioral changes are difficult to achieve, and a better understanding of pregnant women's perspectives and experiences of pre-pregnancy weight development is crucial.

METHODS

We used a qualitative design and conducted semi-structured interviews with 14 women in Norway with pre-pregnancy obesity 3-12 months postpartum. Data were analyzed using thematic analysis.

RESULTS

Four themes addressing women's experiences and understanding of their weight development were generated: (1) Unmet essential needs, (2) Genetic predisposition for obesity, challenging life course transitions and turning points, (3) Under a critical eye: an ever-present negative bodily awareness, and (4) Wrestling with food. Parents' inability to meet children's essential needs caused weight gain through an unbalanced diet, increased stress, and emotional eating patterns. Body criticism and a feeling of not belonging led to negative body awareness that influenced behavioral patterns and relationships. Participants reporting having had a good childhood more often described their weight development as a result of genetic predisposition, challenging life course transitions and turning points, such as illness and injuries. Nevertheless, these participants also described how eating patterns were influenced by stress and negative emotions.

CONCLUSIONS

Healthcare providers should pay attention to the insider perspectives of pre-pregnancy weight development. An open and shared understanding of the root causes of these women's weight development can form a basis for more successful lifestyle guidance.

Perceived teacher's support and engagement among students with obesity in physical education: The mediating role of basic psychological needs and autonomous motivation

Grounded in self-determination theory, this cross-sectional study aims to explore the multiple mediating roles of perceived teachers' support for students with obesity and their engagement in physical education. The study included 322 Chinese high school students with obesity (mean age, 16.84 [±0.147] years; 219 [68%] male, 103 [32%] female). Mplus 8.3 software was used to test the multiple mediating effects. After controlling for grade and gender, teacher support was found to neither directly affect students' engagement nor directly stimulate their autonomous motivation; however, it could affect their engagement through the two pathways of 1) basic psychological needs and 2) the chain mediation of basic psychological needs and autonomous motivation. Results suggest that not all teacher support, but only teacher support meeting students' basic psychological needs, can promote engagement in PE by students with obesity. Future research should explore strategies according to the physical and mental characteristics of students with obesity, to enrich and innovate the theoretical system of teacher support in physical education. Furthermore, teacher support interventions to promote engagement among students with obesity should be developed.

The Meaning and Factors That Influence the Concept of Body Image: Systematic Review and Meta-Ethnography from the Perspectives of Adolescents

Community care nurses educate adolescents about body image, but their interventions appear to be ineffective. Body dissatisfaction predicts unhealthy behaviors among adolescents. This study aimed to understand the meanings and factors that influence the concept of body image through a systematic review and meta-ethnography of qualitative studies from the perspective of adolescents. Ten studies published from 2009–2019 were identified by a search of relevant systematic databases between September and December 2019. The review followed the seven steps of meta-ethnography developed by Noblit and Hare, including a line-of-argument. The synthesis revealed six themes: self-perception of body image; opinions of friends and colleagues; opinions of family; specific features of the school environment; expectations perceived across the mass-media; and strategies, practices, and self-management of body image. An explanatory model was developed that showed adolescents’ development of body image and the path towards its establishment. In conclusion, these results should be considered to implement strategies to promote a healthy body image in adolescents by community health and mental health nurses.

Assessment of nationally representative dietary studies in the Gulf Cooperation Council: a scoping review

BACKGROUND

Obesity is at a record high in Gulf Cooperation Council (GCC) countries and is expected to continue increasing. Diet is a major contributor to this disease, but there is inadequate nationally representative dietary research from these countries. The aim was to quantify the number dietary studies using food frequency questionnaires (FFQs) that have been conducted in individual GCC countries and to assess the quality of eligible studies.

METHODOLOGY

Four databases (PubMed, Web of Science, MEDLINE, and DOAJ) were searched for keywords; records were screened for eligible studies and data were abstracted on study characteristics (publication year, geographical locations, sample size, units of measurement, number of foods examined, number of Arab foods and key findings). Quality was assessed using an adapted Newcastle-Ottawa Quality Assessment Scale for cross-sectional studies.

RESULTS

Only seven studies were eligible from four of six GCC countries (Saudi Arabia, Bahrain, Kuwait and Qatar). All eligible studies used FFQs, but only 29% used a validated questionnaire, one being in Arabic, and none of the studies used any additional tools to measure diet. Fifty-seven percent of studies made an effort to include local foods. The majority of studies (71%) either measured frequency or quantity of food consumed, but only 29% attempted to account for both frequency and quantity.

CONCLUSIONS

The quality of studies varied and major weaknesses of FFQ validity and adaptability have been highlighted. More dietary investigations are needed using validated FFQs that have been adapted to the local GCC diets. Using reference tools will allow for better dietary estimations.

Mediating role of body-related shame and guilt in the relationship between weight perceptions and lifestyle behaviours

INTRODUCTION

A substantial proportion of individuals with overweight or obesity perceive themselves as 'too heavy' relative to 'about right'. Perceiving one's weight as 'too heavy' is associated with lower levels of physical activity and higher levels of sedentary behaviour. However, the mechanisms underpinning the associations between weight perception and lifestyle behaviours have not been identified. Based on theoretical tenets and empirical evidence, the self-conscious emotions of shame and guilt may mediate these associations.

METHODS

Participants were young adults (n = 618, Mage = 24.0 ± .6 years) who provided data on weight, weight perception, body-related shame and guilt, physical activity and screen time.

RESULTS

Mediation analyses using the PROCESS macro indicated that shame and guilt significantly mediated the relationships between weight perception and physical activity and shame significantly mediated the relationship between weight perception and screen time.

CONCLUSIONS

These findings provide preliminary evidence that self-conscious emotions may be mechanisms by which weight perception influences physical activity and sedentary behaviour in young adults. However, longitudinal investigations of this mechanism are needed.

Patients' autonomy as a negotiated order: an ethnographic perspective on the clinical management of childhood obesity

The principle of patients' autonomy has assumed a central place in healthcare. Patients are encouraged to play an active role in the management of their health, especially when they are affected by chronic illnesses that require long-term follow-up. In this article, we analyse patients' and professionals' conceptions of patients' autonomy in the context of childhood obesity management. Based on the results of an ethnographic study that we conducted within a paediatric hospital in French-speaking Switzerland, we put into perspective the discourses that professionals, parents and children construct around their experiences of the therapy. Our study reveals that the conceptions that these three different actors have of patients' autonomy converge on several points, but they also diverge on many others. While the rise of autonomy in healthcare has mostly been analysed as a form of empowerment of patients, our results show that this principle also introduces new forms of social control over patients' lives, and it creates new tensions for patients who are unable to match with the normative expectations of professionals in terms of self-management and self-care.

Parents' concerns regarding the growth characteristics of their adolescents: a qualitative inquiry in Iran

In recent times, parents have become increasingly concerned, both subjectively and objectively, about their adolescents' body height/weight growth. Parent-adolescent interactions about this issue and the potential socio-psychological consequences of such interactions should be considered as an important influencing factor on the future of adolescents' sexual and reproductive health. To achieve a greater understanding of such concerns, it is necessary to further elucidate parents' experiences on this topic, so as to expand the existing literature. This study aimed to explain the perceptions of parents' concerns regarding their adolescents' growth characteristics in the socio-cultural context of Iran as a transitional society. This paper is part of a larger qualitative study designed using the Constructivist Grounded Theory Methodology (CGTM). We conducted open-ended intensive interviews with eleven parents individually and recruited them through purposeful and theoretical sampling from a teaching hospital, community, and a primary school in Tehran with theoretical sampling variation in terms of teenagers' age, sex, and birth order, place of residence, parents' occupation and education, and the self-reported socio-economic status. Using the analytical procedures of the CGTM, we performed analyses. In the findings, the concept of 'living with constant sense of uncertainty' emerged from the subcategories including 'feeling existing and potential concern about expected minimum and maximum bio-positions of growth,' 'feeling potential concern about biological health consequences,' 'feeling potential concern about the emergence of early/late maturity signs,' 'feeling potential concern about adolescent's emotional threat,' 'feeling concerned about future employment, education, marriage, and fertility,' and 'feeling potential concern about the society's view'. These findings suggest that parents are living with a constant sense of uncertainty about their teens' growth characteristics throughout the transition from adolescence. All stakeholders including parents, health-care practitioners and policymakers, and anthropologists/sociologists should be focus on such concerns, in order to manage them and their possible socio-psychological burdens.

Adolescents' perspectives on everyday life with obesity: a qualitative study

Purpose: This study aimed to gain an in-depth understanding of the perspectives and life experiences of adolescents living with obesity. Methods: Five adolescents living with obesity were involved in repeated interviews, and qualitative content analysis was performed. Results: Three themes emerged: obesity as a multi-faceted and difficult to solve condition; obesity as a shameful and vulnerable subject; and bullying and fragile social relationships. Adolescents living with obesity described everyday life challenges as difficult to interpret and solve. Adolescents living with obesity perceived causes for obesity differently, and those who emphasised familial determinants seemed to face greater challenges. Lack of support from parents, trusted friends and health-care providers and bullying, shame, guilt and self-blame represented threats that decreased motivation for help seeking and successful life-style changes. The adolescents were ambivalent regarding disclosing their concerns and seeking help. The adolescents feared that health care providers would demand too much from them, and peers were perceived as a possible source of support. Conclusion: Care providers need to be skilled in assessing each individual’s resources and interpretations of their condition, to be able to communicate in a respectful, patient-centred manner and to assist adolescents to explore their ambivalence and set their own realistic goals. More research is needed.

Understanding physical (in-) activity, overweight, and obesity in childhood: Effects of congruence between physical self-concept and motor competence

Both the physical self-concept and actual motor competence are important for healthy future physical activity levels and consequently decrease overweight and obesity in childhood. However, children scoring high on motor competence do not necessarily report high levels of physical self-concept and vice versa, resulting in respective (in-) accuracy also referred to as (non-) veridicality. This study examines whether children’s accuracy of physical self-concept is a meaningful predictive factor for their future physical activity. Motor competence, physical self-concept and physical activity were assessed in 3^rd grade and one year later in 4^th grade. Children’s weight status was categorized based on WHO recommendations. Polynomial regression with Response surface analyses were conducted with a quasi-DIF approach examining moderating weight status effects. Analyses revealed that children with higher motor competence levels and higher self-perceptions show greater physical activity. Importantly, children who perceive their motor competence more accurately (compared to less) show more future physical activity. This effect is strong for underweight and overweight/obese children, but weak for normal weight children. This study indicates that an accurate self-perception of motor competence fosters future physical activity beyond single main effects, respectively. Hence, the promotion of actual motor competence should be linked with the respective development of accurate self-knowledge.

Overweight adolescents' views on physical activity - experiences of participants in an internet-based intervention: a qualitative study

BACKGROUND

Overweight and obese adolescents are reported to be less physically active than their peers. Research-based knowledge about their views may contribute to a better understanding of key factors that may foster or undermine motivation for physical activity, and provide knowledge for the future development of interventions. This paper explores experiences of physical activity among overweight adolescents, age 13-14 years, participants in Young & Active, a web-based controlled trial intervention to increase physical activity (ClinicalTrials.gov NCT01700309). The theoretical perspective is based on Self-Determination Theory.

METHODS

Two qualitative post-intervention research interviews, with a nine-month interval, were conducted with 21 adolescents, 15 girls and 6 boys to study short-term and long-term changes. The informants were recruited from a total of 84 participants from the Young & Active intervention group. Data were analyzed using qualitative content analysis.

RESULTS

The participants associated physical activity with organized sports and physical education classes at school, and as a means of promoting good health and attractive bodies. A majority of the adolescents said that they experienced their health as poorer than other youths, and expressed worries about their fitness and future health. Mastering a physical activity, being together with friends and having fun promoted motivation to perform sports. Not mastering an activity, or not knowing the others made them less motivated. None of the adolescents highlighted the importance of informal active living when asked about their understanding and experiences of physical activity. Consistency was found between the first and second interviews.

CONCLUSION

This study adds to limited research on overweight and obese adolescents' experiences of physical activity. The participants' views reflect opinions in society about physical activity, and its importance for health. Viewing physical activity as conducted within organized sports makes it necessary to look into how these are organized, structured and led, and what can be done to support self-esteem, autonomous motivation and participation. The ability to choose among available, affordable and desirable physical activities, together with friends, may promote participation and maintenance.

A Nurse-Led and Teacher-Assisted Adolescent Healthy Weight Program to Improve Health Behaviors in the School Setting

Adolescents with overweight and obesity are at risk for future health problems. The purpose of this study was to examine the feasibility and initial efficacy of a weight management intervention to help adolescents develop healthy nutrition and physical activity behaviors and improve their anthropometrics. This study used a single-group repeated measures design in a small school in Durham, North Carolina (NC). The intervention consisted of a nurse-led and teacher-assisted nutrition and physical activity education and exercise classes that met twice each week for 45–60 minutes for 7 weeks. Data were collected at Time 1 (baseline), Time 2 (after intervention completion), and Time 3 (after 3 months on their own). Interview feedback, low cost, and successful completion of all planned activities indicated that all stakeholders found the project beneficial and suitable for their school. This study suggests that a weight management intervention for adolescents was feasible in the school setting.

Intra-gastric balloon as an adjunct to lifestyle support in severely obese adolescents; impact on weight, physical activity, cardiorespiratory fitness and psychosocial well-being

BACKGROUND

Severe adolescent obesity (body mass index (BMI) >99.6th centile) is a significant public health challenge. Current non-invasive treatments, including community-based lifestyle interventions, are often of limited effectiveness in this population, with NICE guidelines suggesting the use of bariatric surgery as the last line of treatment. Health professionals are understandably reluctant to commission bariatric surgery and as an alternative, the use of an intra-gastric balloon as an adjunct to a lifestyle programme might offer a reversible, potentially safer and less invasive option.

OBJECTIVES

Explore the use of an intra-gastric balloon as an adjunct to a lifestyle support programme, to promote weight loss in severely obese adolescents. Outcomes included weight loss, waist and hip measurements, psychosocial outcomes including health-related quality of life (HRQoL) and physical self perceptions, physical activity and cardiorespiratory fitness.

METHOD

Non-randomised pilot study.

RESULTS

Twelve severely obese adolescents (5 males, 7 females; mean age 15 years; BMI >3.5 s.d.; puberty stage 4 or more) and their families were recruited. Mean weight loss at 12 months (n=9) was 3.05 kg±14.69; d=0.002, P=0.550, and a BMI Z-score (n=12) change of 0.2 s.d.; d=0.7, P=0.002 was observed at 6 months with a large effect, but was not sustained at 12 months (mean change 0.1 s.d.; d=0.3, P=0.146). At 24 months (n=10), there was a weight gain from baseline of +9.9 kg±1.21 (d=0.4; P=0.433). Adolescent and parent HRQoL scores exceeded the minimal clinical important difference between baseline and 12 months for all domains but showed some decline at 24 months.

CONCLUSION

An intra-gastric balloon as an adjunct to a lifestyle support programme represents a safe and well-tolerated treatment approach in severely obese adolescents, with short-term effects on weight change. Improvements in psychosocial health, physical activity and cardiorespiratory fitness were maintained at 12 months, with varying results at 24 months.

Stigma in Practice: Barriers to Health for Fat Women

In this paper, we explore barriers to health for fat people. By shifting the focus from what fat people do or do not do, neoliberal principles are replaced by a focus instead on structural and institutional policies, attitudes, and practices. This includes the impact of stigma on the health treatment and health-seeking behavior of fat people. For example, we consider the role that provider anti-fat attitudes and confirmation bias play in the failure to provide evidenced-based healthcare to fat patients. This is an autoethnographic paper, which provides the opportunity to read research from the perspective of fat scholars, framed by questions such as: can fat people have health? Is health itself a state of being, a set of behaviors, a commodity, a performance; perhaps the new social contract? As a co-written autoethnographic paper, one aspect of the evidence provided is the recorded experiences of the two fat authors. This includes writing from notes, journals, compiled and repeated experiences with medical professionals, family, and the community. Framed by feminist standpoint and supported by literature drawn from Fat Studies, Public Health, Obesity Research, and other interdisciplinary fields, this is a valuable opportunity to present an extended account of fat discrimination and the impact of the stigma fat people face through the medical profession and other sectors of the community, written by fat individuals. The paper concludes by considering the health pathways available to fat people. Special attention is paid to whether Bacon and Aphramor's Health at Every Size paradigm provides a path to health for fat individuals.

'Now I care': a qualitative study of how overweight adolescents managed their weight in the transition to adulthood

OBJECTIVES

A qualitative study of recalled experiences of early adolescent overweight/obesity revealed low levels of weight-related concern. This further analysis aimed to explore weight-related concern and weight-loss efforts as participants transitioned into adulthood.

DESIGN, PARTICIPANTS AND METHODS

Participants were 35 young adults from a population-based cohort study who had body mass index (BMI) >95th centile between ages 11 and 15 and participated in semistructured interviews aged 24. At age 24, they were categorised as: 'slimmers' (N=13) who had lower BMI Z-scores at 24 than their adolescent peak and were not obese (BMI<30 kg/m²); 'relapsers' (N=8, of whom 2 were morbidly obese (BMI>35 kg/m²) at age 24); 'stable' (N=3, of whom 1 morbidly obese); and 'gainers' (N=11, of whom 5 morbidly obese). Themes were identified and coded using NVivo qualitative data analysis software, blind to participants' current weight status.

RESULTS

Contrasting with the lack of concern recalled in respect of earlier adolescence, weight-related concerns and/or desire to lose weight generally increased around the time of school leaving and almost all participants described some form of exercise (formal/informal) and dietary weight-control strategies. Among 'slimmers', there was some (subtle) evidence of more consistent use of exercise, self-monitoring of diet and exercise and of lifestyle changes becoming habitual and/or part of identity. Few participants had accessed professional support. Diet clubs seemed to have been used most by 'gainers', some only recently. Labour-market and housing transitions were strong influences, described as facilitating weight losses by some, but increases by others. For some participants, it appeared that weight loss was simply a by-product of these transitions.

CONCLUSIONS

In contrast to earlier adolescence, even the heaviest participants tended to show actual weight loss action or preparation for action. The transition to adulthood could thus be a key life stage for interventions.

The role of the "Healthy Weight" discourse in body image and eating concerns: An extension of sociocultural theory

Sociocultural models of body image and eating concerns have highlighted the role of the social discourse in promoting the pursuit of the thin-ideal. Recently, another weight-focused social discourse has gained ground, focused on the goal of maintaining body weight within the boundaries of a weight-range defined as "Healthy." This discourse is somewhat different to the promotion of the thin-ideal; however, it might also be implicated in the development of body image and eating concerns. The present study aimed to extend sociocultural theories of the development of body image and eating concerns by (1) proposing a theoretical model accounting for pressure to maintain a "Healthy Weight", and (2) reviewing the existing evidence for the pathways included in this model. In the proposed model, pressure to maintain a Healthy Weight leads to the internalization of anti-fat attitudes and the need to control weight as well as beliefs in the controllability of weight through diet and exercise. These beliefs may then lead to body preoccupation and disordered eating. The extant literature provides initial support for these relationships; however, empirical testing of this model is necessary to determine its usefulness as an explanatory model and in providing intervention targets for future prevention and intervention efforts.

Negative stereotypes of the Scottish diet: A qualitative analysis of deep-fried Mars bar references in bestselling newspapers in Scotland, 2011-14

The Scottish diet is associated in the UK media and popular discourse with unhealthy deep-fried foods. In addition to the stereotype's negative effects on perceptions of Scottish food, culture and people, there is evidence that the stereotype of the Scottish diet has negative effects on food behaviour and public health in Scotland, having been shown to encourage consumption of deep-fried foods and discourage positive dietary change. The most notorious deep-fried food associated with Scotland is the deep-fried Mars bar (DFMB), arguably invented in Stonehaven (near Aberdeen), and first reported in the Scottish and UK press in 1995. This article reports findings from an analysis of newspaper references to the DFMB in the two highest selling newspapers in Scotland, the Scottish Sun and the Daily Record, between 2011 and 2014. A keyword search ("deep fried Mars bar") using the online media database Lexis Library generated 97 unique records, and the resulting dataset was analysed thematically and discursively. Analysis showed that both newspapers clearly associated the DFMB with Scotland. Further, both newspapers portrayed the DFMB and the broader "deep-fried" Scottish diet stereotype ambivalently (mixed positive and negative associations). However, the Daily Record actively criticised the DFMB stereotype much more often than did the Scottish Sun. These findings suggest that the Scottish population encounters different messages in the press about food and nutrition from people elsewhere in the UK, and that these messages vary depending on choice of media in Scotland. Given the known negative effects of the stereotype, differences in Scottish media discourse should be considered a potential factor in persistent health inequalities affecting Scotland. Educational efforts, and opening discussion with journalists and amongst the Scottish public, may be helpful.

Fatty liver disease and lifestyle in youngsters: diet, food intake frequency, exercise, sleep shortage and fashion

BACKGROUND & AIMS

Fatty liver is associated with alcohol habits and/or overweight/obesity. We challenged several lifestyle features associated with fatty liver and, particularly, with non-alcoholic fatty liver disease (NAFLD). Among them, sleep shortage as a result of nightlife habits and a preference for plus-size fashion were assessed. The latter consists of fashionable plus-sized clothing for actual individuals' size and reflects a frequent attitude of some social or age groups, conceivably indicating more global and widespread trend and behaviour.

METHODS

We studied a group of 708 non-diabetic youngsters, 458 women and 250 men, 21.72 ± 3.71 years old (range 15-35 years), referred for minor digestive ailments for clinical assessment, ultrasound detection of fatty liver and nutritional counselling. Details of personal history regarding lifestyle, food intake frequency and alcohol intake, dietary and physical exercise profile, sleep duration and clothing preferences were recorded.

RESULTS

The prevalence of NAFLD in this cohort of youngsters is 67/708 (9.4%). Even if it is quantitatively very low in both groups, the average alcohol intake, always below 20 g/day, is greater in NAFLD subjects (5.83 ± 4.32 g) vs. subjects with normal liver (2.02 ± 3.20 g). The number of meals/day and adherence to a Mediterranean diet profile are smaller in NAFLD subjects. By multiple regression, BMI, sedentary life, plus-sized clothing for their actual size, sleep shortage and lower frequency of daily food intake are associated with the presence of NAFLD.

CONCLUSIONS

Onset and continuation of fatty liver disease, beyond food and exercise quantity and quality, with their effects on obesity, may also be associated with other aspects of lifestyle.

Growing as a Human Being--Obese Adolescents' Experiences of the Changing Body

The aim of the presented study was to describe how obese adolescents experience themselves and their bodies and how their views changed as a result of participation in a weight loss program. A total of five adolescents were interviewed in this qualitative study. Data were analyzed by means of content analysis. One main theme emerged, "Growing as a human being", which comprised four themes based on 13 sub-themes. Being part of a weight loss program was a time of transition that led not only to weight reduction but also to a higher level of well-being and a feeling of dignity.

Association of adolescents' weight status with life satisfaction: role of self, peers, family and school perception; the CASPIAN-IV Study

BACKGROUND

Although many public health programs have focused on prevention and control of obesity, their efficacy mostly depends on personal factors including perception of weight and personal understanding of the concept of being overweight. This study aims to investigate the association of adolescent's weight status with life satisfaction and explore the role of self, peers, family and school perception in this association.

METHODS

Data were obtained from the fourth school-based survey entitled "Childhood and Adolescence Surveillance and Prevention of Adult Non-communicable Disease" (CASPIAN) Study. This survey was conducted among 14,880 urban and rural students aged 6-18 years. Two sets of valid and reliable questionnaire obtained from Global School Health Survey (GSHS) were completed by students and their parents. The students' questionnaire had several questions including life satisfaction and the perception of weight, peers, family and school.

RESULTS

The study had a participation rate of 90.6% including 50.8% boys and 76% urban residents. Significant differences existed in Body Mass Index (BMI) and in perception of weight among girls and boys. Moreover, the prevalence of depression and being bullied were higher among girls and boys, respectively. Significant association was documented between life satisfaction and all variables including perception of weight, peers, family and school; the only exception was for BMI (P<0.05). In addition, students with normal weight had significantly higher life satisfaction in comparison with their obese counterparts (P<0.05).

CONCLUSIONS

The present study documented significant association between life satisfaction and perception of self, peer, family and school with the exception of BMI in both genders.

Attitudes to weight and weight management in the early teenage years: a qualitative study of parental perceptions and views

BACKGROUND

As most young teenagers grow up in families, parents might be well situated to facilitate and support their weight management and thereby prevent or manage obesity prior to adulthood.

AIM

This paper explores parents' perceptions of, and views about, their teenage children's weight and the factors that influence parents' weight management strategies.

DESIGN, SETTING AND PARTICIPANTS

We conducted two qualitative studies in Scotland, UK, involving in-depth interviews with the parents of overweight/obese and 'normal' weight 13-15 year olds (n = 69).

FINDINGS

Parents' concerns about their own weight provided useful context for understanding their attitudes or actions with regards to their teenage child. Some parents described their teenager's weight as being of concern to them, although puberty often introduced confusion about a child's weight status. Genetic explanations were very often put forward as a way of making sense of teenage weight or body size. Frustration about advising teenagers about weight management was expressed, and some parents worried about giving their growing child a 'problem' if they directly raised concerns about weight with them.

DISCUSSION

Parents' views about their own weight as well as social and moral norms about labelling a teenager as overweight or as needing help with their weight could usefully inform patient-centred service development. Parent/teenage partnerships and supporting parents to create a healthy home in which teenagers can make healthier choices are suggestions for intervention development.

CONCLUSION

The study highlights the importance of taking parents' perceptions into account when developing family-based interventions to address teenage overweight and obesity.

Felt stigma and obesity: introducing the generalized other

People with a big body are tainted in western societies. Although most research on obesity occurs in the medical context, few studies investigate characteristics and effects of feelings and fears related to the fat stigma in the absence of overt discrimination. By linking Norbert Elias's and George H. Mead's theoretical frameworks, this paper offers a different approach to understanding and investigating felt stigma. The study is based on secondary data (25 semistructured interviews with children and adolescents). It explores internalized societal perspectives on overweight and obesity and inquires into the way in which interviewees handle the blame frame of personal responsibility during their interview. The preliminary findings suggest that specific forms of managing one's self-presentation in interviews indicate felt stigma. Consequently, the paper argues for an analytical approach that extends the focus on the content of interviews to include its dynamics.

How adolescent boys perceive their bodies, body parts, and weight: letting adolescent boys' voices be heard

The purpose of this study was to conduct elicitation, semistructured interviews with adolescent boys to document their attitudes, perceived norms, personal agency, intentions, and actions about their weight. The boys indicated that they liked and disliked certain body parts and were in charge of their weight. Almost half of the boys did not want to change their weight. Most of the parents were inaccurate when asked to self-report their sons' heights and weights. A screening procedure that adds adolescents' perceptions of their bodies to BMI classification can aid in the referral and treatment of weight management.

'It's on your conscience all the time': a systematic review of qualitative studies examining views on obesity among young people aged 12-18 years in the UK

OBJECTIVE

To explore the perspectives of young people in the UK on obesity, body size, shape and weight.

DESIGN

Systematic review of qualitative studies using thematic synthesis.

DATA SOURCES

Sensitive searches of 18 electronic databases from 1997 to February 2010 supplemented by grey literature searches.

STUDY SELECTION

Studies produced since 1997 using qualitative methods to collect perspectives of people aged 12-18 years in the UK, reporting methods for data collection or analysis. Studies of people with eating disorders and those rated low in reliability and usefulness were excluded.

RESULTS

Searches identified 30 studies involving over 1400 young people from a range of contexts. Young people of all sizes placed considerable emphasis on personal responsibility, and on the social, rather than health implications of being overweight. Young people with experience of obesity described severe, unrelenting, size-related abuse and isolation. Regardless of their own size, young people were judgemental of individuals who were overweight, but those with experience of obesity described an environment that contained multiple barriers to weight loss. Only one study asked young people directly what might support them to have a healthy body size. Study findings were configured under three main themes, labelled with quotes from included studies: general perceptions of size and society's responses ('It's on your conscience all the time'); the experiences of young people who were overweight ('If I had the choice I wouldn't be this size') and these larger young people's experiences of trying to loose weight and suggestions for action ('Make sure, even when it's hard, you've got people there').

CONCLUSIONS

The perspectives of young people in the UK, when synthesised across the spectrum of body sizes, paint a picture of a stigmatising and abusive social world. Research and policy need to engage young people actively so as to address the social implications of obesity.

The weight of the word: knowing silences in obesity research

In this article, we examine the ethical and methodological tensions entailed in doing qualitative research in obesity studies. Framing our own embodied engagements through critical social theory, we consider how cultural meanings associated with obesity are silenced and negotiated in the research process. This negotiation is fraught with linguistic and corporeal challenges, beginning with the decision to use (or not use) the word obesity in research materials. Obesity is a visible stigma, and we argue that silencing language does not erase the tacit judgments that accompany discursive categorization. It is in a broader context of power relations that we examine the relationship between researcher and participant bodies and the ways in which collective knowingness about fat bodies underpins methodological engagement. The simultaneous presence and absence of obesity have a significant impact on the research process, in shaping both participants' experiences and the researcher's actions and interpretations.

Body Weight Perception and Weight Control Practices among Teenagers

Background. Weight-loss behaviours are highly prevalent among adolescents, and body weight perception motivates weight control practices. However, little is known about the association of body weight perception, and weight control practices among teenagers in Mauritius. The aim of this study is to investigate the relationships between actual body weight, body weight perception, and weight control practices among teenagers. Methods. A questionnaire-based survey was used to collect data on anthropometric measurements, weight perception and weight control practices from a sample of 180 male and female students (90 boys and 90 girls) aged between 13 and 18 years old. Results. Based on BMI, 11.7% of students were overweight. Overall, 43.3% of respondents reported trying to lose weight (61.1% girls and 25.6% boys). Weight-loss behaviours were more prevalent among girls. Among the weight-loss teens, 88.5% students perceived themselves as overweight even though only 19.2% were overweight. Reducing fat intake (84.6%), exercising (80.8%), and increasing intake of fruits and vegetables (73.1%) and decreasing intake of sugar (66.7%) were the most commonly reported methods to lose weight. Conclusion. Body weight perception was poorly associated with actual weight status. Gender difference was observed in body weight perception.

Talking about obesity with clients: preferred terms and communication styles of U.K. pre-registration dieticians, doctors, and nurses

OBJECTIVE

To describe trainee healthcare professionals' preferred terms when talking about obesity, their beliefs about initiating discussions about weight, and their confidence about consulting with obese people.

METHODS

A self-completed questionnaire collected data on demographics, preferred terms, beliefs about initiation of discussions, confidence and training needs from 1036 pre-registration dieticians, nurses and doctors.

RESULTS

Participants' preferred terms when raising the issue of obesity with clients were BMI (mean=.96), weight (mean=.71) and unhealthy BMI (mean=.43). When defining a client's bodyweight, students endorsed the euphemism 'your weight may be damaging your health' (67.6%). A proactive, collaborative communication style was preferred by 34.9% of participants. 58.2% of participants felt confident about discussing obesity with clients and 95.1% felt that that more training would be useful.

CONCLUSION

It is reassuring that U.K. trainee healthcare professionals avoid value-laden terms and broadly endorse words preferred by people with obesity. It is, however, concerning that the majority of participants did not favor a proactive, collaborative communication style.

PRACTICE IMPLICATIONS

Educators of tomorrow's healthcare professionals could take advantage of students' desire for more training on how to effectively talk to clients with obesity about their weight. Such training would, however, require the development of clear guidelines on terminology and communication styles.

Qualitative studies among obese children and adolescents: a systematic review of the literature

Childhood obesity is a complex condition involving medical, social, moral and cultural issues. Qualitative approaches are of great value in understanding this complexity. This meta-synthesis of 45 qualitative studies deals specifically with the issue of obesity in children and adolescents from different perspectives--those of obese children and adolescents, of parents, and of health professionals providing support to the family. Our aim was to obtain a coherent view of child and adolescent obesity, focused on clinical and personal experience. The themes derived from the synthesis process fall under three main axes: 'Seeing others, seeing oneself', 'Understanding others, understanding oneself', and 'Treating others, treating oneself'. It emerges that participants in all three groups had equal difficulty in perceiving and labelling obesity, mainly because of their lack of any real common ground. The insufficiency of shared representations destabilizes the therapeutic relationship and its construction: an important issue in the doctor-child-parent relationship in this context is the need to exchange their viewpoints of obesity. Health workers may also expand their understanding of obesity by incorporating the personal experiences of obese children and their parents in order to match treatment plans to their needs and expectations.

'Do I care?' Young adults' recalled experiences of early adolescent overweight and obesity: a qualitative study

OBJECTIVE

Individual behaviour change to reduce obesity requires awareness of, and concern about, weight. This paper therefore describes how young adults, known to have been overweight or obese during early adolescence, recalled early adolescent weight-related awareness and concerns. Associations between recalled concerns and weight-, health- and peer-related survey responses collected during adolescence are also examined.

DESIGN

Qualitative semi-structured interviews with young adults; data compared with responses to self-report questionnaires obtained in adolescence.

PARTICIPANTS

A total of 35 participants, purposively sub-sampled at age 24 from a longitudinal study of a school year cohort, previously surveyed at ages 11, 13 and 15. Physical measures during previous surveys allowed identification of participants with a body mass index (BMI) indicative of overweight or obesity (based on British 1990 growth reference) during early adolescence. Overall, 26 had been obese, of whom 11 had BMI99.6th centile, whereas 9 had been overweight (BMI=95th-97.9th centile).

MEASURES

Qualitative interview responses describing teenage life, with prompts for school-, social- and health-related concerns. Early adolescent self-report questionnaire data on weight-worries, self-esteem, friends and victimisation (closed questions).

RESULTS

Most, but not all recalled having been aware of their overweight. None referred to themselves as having been obese. None recalled weight-related health worries. Recollection of early adolescent obesity varied from major concerns impacting on much of an individual's life to almost no concern, with little relation to actual severity of overweight. Recalled concerns were not clearly patterned by gender, but young adult males recalling concerns had previously reported more worries about weight, lower self-esteem, fewer friends and more victimisation in early adolescence; no such pattern was seen among females.

CONCLUSION

The popular image of the unhappy overweight teenager was not borne out. Many obese adolescents, although well aware of their overweight recalled neither major dissatisfaction nor concern. Weight-reduction behaviours are unlikely in such circumstances.

Adolescents' perception of causes of obesity: unhealthy lifestyles or heritage?

PURPOSE

To evaluate adolescents' perception of the causes of obesity, with emphasis on differences according to nutritional status and socioeconomic position.

METHODS

We conducted qualitative research including 80 adolescents belonging to the 1993 Pelotas (Brazil) Birth Cohort Study, and their mothers. We classified adolescent boys and girls into four groups (girls-obese, girls-eutrophic, boys-obese, and boys-eutrophic) according to body mass index for age and sex, and systematically selected them according to family income at age 15 years. Research techniques included semistructured interviews and history of life. Topics covered in the interviews included early experiences with weight management, effect of weight on social relationships, family history, eating habits, and values.

RESULTS

Low-income obese adolescents and their mothers perceive obesity as a heritage, caused by family genes, side effects of medication use, and stressful life events. However, low-income eutrophic adolescents emphasize the role of unhealthy diets on obesity development. Among the high-income adolescents, those who are obese attribute it to genetic factors and emotional problems, whereas those who are eutrophic mention unhealthy diets and lack of physical activity as the main causes of obesity.

CONCLUSIONS

Perceptions of the causes of obesity in adolescents from a middle-income setting vary by gender, socioeconomic position, and nutritional status. Whereas some blame genetics as responsible for obesity development, others blame unhealthy diets and lifestyles, and others acknowledge the roles of early life experiences and family traditions in the process of obesity development.

Adolescent obesity and life satisfaction: perceptions of self, peers, family, and school

This study contributes to research on adolescent life satisfaction by considering its association with body weight, as mediated by perceptions of self, peers, family, and school. Data from the Health Behaviors in School-Age Children Survey (2001-2002) and OLS regression techniques are used to examine the association between body weight and life satisfaction. We also model these relationships by gender. Results indicate lower life satisfaction among adolescents that are overweight and obese relative to healthy weight youth, and that most of the negative association operates through perceptions of self, peers, parents, and school. We find little or no gender difference in the association between body weight and perceptions of self, peers, parents, and school; however, we find perceptions of body weight are generally more strongly associated with low life satisfaction among girls compared to boys.

Overweight and obese adolescents: what turns them off physical activity?

A systematic review of qualitative studies was undertaken to understand the barriers to physical activity experienced by adolescents who were overweight or obese. From a search of electronic databases and 'grey' literature, published between 1950 and 2009, 15 studies met the inclusion criteria. Bronfenbrenner's model of human development provided an ecological lens for identifying and synthesising barriers to physical activity. Two reviewers appraised study quality. Miles and Huberman's cross-case analysis was integrated with thematic networking to synthesize the individual, interpersonal and environmental level barriers for boys and girls of different ethnicities and socioeconomic status, across school settings and generalised context. Thirty-five barriers were identified, 13 of which occurred in physical activity situations in the school setting, 18 were not linked to a specific setting, and the remainder were common across both contexts. The fact that these barriers emerged from studies that focused on topics such as victimisation and mental health is particularly poignant and reflects the potentially pervasive influence of adolescent's excessive weight not only in relation to physical activity situations but other aspects of their lives. Furthermore, socioeconomic status and ethnicity was poorly considered, with only one study linking these participant characteristics to quotations and discussing the potential implications. At present, there are few qualitative studies with sufficiently thick description or interpretive validity that provide insight into this vulnerable group of adolescents, and give them a voice to influence policy and practice.

Overweight Adolescents' Self-Perceived Weight and Weight Control Behaviour: HBSC Study in Finland 1994-2010

Introduction. Overweight and perception of being overweight, may lead adolescent to lose weight. The aim of the present study was to investigate overweight adolescents' self-perceived weight, body dissatisfaction, and weight control behaviour during 1994-2010 in Finland. Methods. The country-representative, cross-sectional data of 15-year olds were obtained from the Health Behaviour in School-aged Children (HBSC) study, conducted in 1994 (N = 1194; males: 48%), 1998 (N = 1545; 49%), 2002 (N = 1745; 50%), 2006 (N = 1670; 47%), and 2010 (N = 2082; 48%). Results. The majority of overweight boys (62-69%) and girls (89-100%) assessed themselves as too fat, and their body image was lower than in nonoverweight adolescents. The highest prevalence of current weight controlling was found in 2006 in males (18%) and in 2010 in females (39%). Conclusion. The phenomena were current and gender differences notable, but there was no statistically significant difference in overweight adolescents' self-perceived weight, body dissatisfaction, or weight control behaviour between survey years.

It's not just about the french fry: avoidance as an idiom of distress among overweight and obese adolescent boys

The purpose of this article is to explore idiom of distress and its application to overweight and obese adolescent boys. This case study suggests that avoidance, as an idiom of distress, offers self-protection from suffering among this population. Fieldwork included 55 face-to-face contact hours, 25 virtual contact hours (i.e., text messaging, e-mails, phone calls), and 16 person-centered interviews. The daily suffering experienced by this group of boys, and their collective enactment of avoidance as a self-protective strategy, offer an understanding of their lives beyond their obese bodies. Avoidance behaviors, however, can result in negative social consequences such as isolation. Recognizing avoidance as an idiom of distress permits parents, teachers, health professionals, and researchers to interact with overweight and obese adolescent boys in a profoundly different way. Attending to the personhood of these vulnerable boys was an important finding of this qualitative study.

Obesity in a life-course perspective: an exploration of lay explanations of weight gain

AIM

The present study investigated the way in which people who had experienced medically defined obesity understood and explained the causes of the weight gains they had experienced during their life course and related such explanations to gender and social background.

METHOD

The study was a qualitative in-depth interview study of 20 Danish middle-aged women and men with high and low levels of education who had experienced obesity.

RESULTS

Women mainly related weight gain to life-course transitions associated with the female biological lifecycle; to changes in social relations; or to personal problems connected with close social relationships and to side-effects of psycho-pharmaceuticals. Women with high levels of education tended more often to explain weight gain within a depth-psychological framework. Men related weight gain mainly to life-course transitions involving changing obligations connected with education, work, and family life; to periods of injury (sports or other) involving reduced levels of physical activity; and to personal problems connected with their work situation or financial troubles. Men with low levels of education tended to link weight gain directly to work environments, which were considered especially likely to lead to weight gain.

CONCLUSIONS

The study highlights marked differences in the way individuals explain their own weight gain. These differences relate to gender and, to some degree, social background. The findings may both inform and challenge public health promotion.

Adolescents' perceptions of obesity treatment--an interview study

PURPOSE

To describe adolescents' perceptions of obesity treatment in order to provide valuable information for design and development of treatment.

METHOD

A nominated sample of 18 obese adolescents (12 girls, 14-16 years, body mass index (BMI) 25-47.4 kg·m(-2)), recruited from a paediatric obesity clinic, participated in semi-structured interviews. These were analysed using a phenomenographic research approach. Purposeful sampling reflected variations in age, gender, degree of obesity, weight loss achievement, ethnicity, time of registration and socioeconomic status.

RESULTS

The adolescents expressed numerous physical, psychological and social disabilities as a consequence of their obesity. Qualitatively different ways of perceiving and responding to obesity treatment were identified and could be described in six categories of descriptions and a two-dimensional construct for interpreting these categories; (a) personal empowerment, (b) despair and disappointment, (c) safety and relief, (d) ambivalence and uncertainty, (e) acceptance and realisation and (f) shame and guilt. The distinguishing structures to be found between the categories were as follows: focus on the individual and focus on body weight.

CONCLUSIONS

Treatment strategies must consider the large impact obesity has on adolescents' lives. It is necessary to engage the obese adolescent personally in the treatment process and to focus on the adolescents' personal needs, goals and motive for weight reduction.

"That Could Be Me Squishing Chips on Someone's Car." How Friends Can Positively Influence Bullying Behaviors

Semi-structured one-on-one interviews with a purposive sample of 51 grade 7 students (12 years old) who reported bullying others explored what might encourage students to stop bullying others. The theoretical perspectives of symbolic interactionism, in particular the development of self and definition of the situation, were used to inform this study. Dissonance theory was used to understand how students felt about their bullying behaviors. The theme of peer group emerged as an influence when considering desisting bullying others. Feelings of dissonance reinforced by peers and the need to be accepted by peers facilitated positive changes if significant peers disapproved of bullying. Some students changed friendship groups to move away from negative situations, representing significant development of self. School-based programs can work to enhance the positive influence of prosocial students, to focus on the development of self, and to reduce the social status achieved by some through bullying others.

Self-perceived weight in adolescents: over-estimation or under-estimation?

Prevalence of obesity has increased worldwide in the past 20 years, but it is not known whether this has resulted in increased numbers of young adults feeling overweight. This study evaluated weight self-perception in a large, multi-ethnic sample of 14-15 years old (n=4167) in London, UK as part of a longitudinal, school-based study of health behaviours. Weight perceptions were recorded on a simple scale from 'too thin' to 'too fat'. Results indicated that under-estimation was more common than over-estimation, with more than a quarter of overweight or obese adolescents unaware of their excess weight. Under-estimation was greatest among boys and ethnic minorities. It may be timely to reassess weight control advice given to adolescents.

'I can actually exercise if I want to; it isn't as hard as I thought': a qualitative study of the experiences and views of obese adolescents participating in an exercise therapy intervention

A qualitative study nested within a randomized controlled trial explored obese adolescents' experiences of participation in an exercise therapy intervention. Semi-structured interviews were conducted with participants assigned to exercise therapy. Participants' reported feeling more energetic during and after exercise, than before. Many participants reported feeling happy/happier and expressed feeling better about themselves as individuals after the intervention. Most participants felt more confident in their ability to exercise regularly. Greater emphasis needs to be placed upon educating obese adolescents about the wide range of health benefits that exercise can provide, and that weight loss, while important, is only one such benefit.

Obesity among Scottish 15 year olds 1987-2006: prevalence and associations with socio-economic status, well-being and worries about weight

BACKGROUND

Increases in the prevalence of child and adolescent obesity have accelerated since the mid 1980s. Socio-economic status (SES)-adiposity relationships appear less clear in adolescence than childhood, and evidence on whether increasing obesity is itself patterned according to SES is inconsistent. Increasing prevalence may have increased the tolerance, and reduced recognition of, or concern about, obesity. The aim of this study is to report the prevalence of obesity and its association with SES, well-being and worries about weight among 15-year olds in 1987, 1999 and 2006.

METHODS

Height and weight data obtained from 15-year olds in 1987 (N = 503), 1999 (N = 2,145) and 2006 (N = 3,019), allowed categorisation of obesity (UK90 criteria). SES was represented by parental occupational class and area deprivation; psychological wellbeing by the 12-item General Health Questionnaire (GHQ-12) and self-esteem; weight worries by 'a lot' of worry about weight.

RESULTS

Obesity prevalence was 6.7%, 10.6% and 15.9% (males), and 5.4%, 11.5% and 14.9% (females) in 1987, 1999 and 2006. Among obese males, BMIs increased over time. There was little evidence of differentials in obesity in respect of either SES measure, and none for increased disparities over time. There was no association between obesity and GHQ-12 'caseness' or (except females in 2006) self-esteem. Weight worries were more prevalent among the obese and increased over time overall, but the obesity-weight worry relationship did not change. At each date, large proportions of the obese did not worry 'a lot' about weight, while among the non-obese, up to 18.8% males and 40.1% females (in 2006) did worry.

CONCLUSION

Between 1987 and 2006, prevalence of obesity among Scottish 15 year olds increased around 2.5 times. However, this increasing prevalence did not impact on the obesity-weight-worry relationship. While many obese adolescents appear unconcerned about their weight, a significant minority of the non-obese worry needlessly.

The experiences of young people with obesity in secondary school: some implications for the healthy school agenda

In 1995, the World Health Organisation launched a Global School Health Initiative to reduce health risks among young people. In the UK, the National Healthy School Programme (HSP) developed as part of a wider government commitment to promoting social inclusion. One of the key issues to be tackled by the programme is childhood obesity, for obesity is widely argued to be a public health problem for which a solution needs to be found. However, the assumption that obesity is necessarily problematic and that a higher body weight leads to health problems and social exclusion, is not without challenge. Critics of anti-obesity campaigns question the significance of weight per se and highlight the potential implications of discrediting not only fatness, but also the people who are seen as fat. This paper therefore explores the experiences of young people with obesity within the secondary school environment in relation to areas of concern prioritised by the HSP. The paper draws upon data from a qualitative research study involving 18 children and young people, between the ages of 10 and 17. Data were generated in focus group discussions and individual interview with participants of a community-based obesity intervention programme in South Yorkshire, UK. Data collection took place in 2005, and thematic analysis of the data was undertaken. Findings suggest that the issues prioritised in the HSP, particularly physical exercise and healthy eating, present challenges to young people with obesity and can reinforce their vulnerability to bullying in schools and contribute to their social exclusion. It concludes that social exclusion is a process experienced by, and pertinent to, children and young people, which has meaning for their experiences of, and during, childhood and youth. The whole-school approach of the HSP may fail to adequately address the experiences of marginalised and vulnerable groups of young people within schools, challenging and undermining the social inclusion agenda in which the programme is grounded and contributing to the construction of undesirable, fat, young bodies.

Social implications of overweight and obesity in children

PURPOSE

To elucidate some of the social impacts that overweight and obesity in children has on families. Healthcare practitioners may be unaware of these impacts if not similarly affected.

DESIGN

Qualitative semistructured, interview-based study.

METHODS

A purposive sample of parents (n = 58) with overweight and obese children (n = 48) from three areas in the United Kingdom was used. Analysis was thematic and iterative, underpinned by Grounded Theory.

RESULTS

There are many social situations that have an impact on the child directly (stigmatization), on parents (blame), and on the family in general (being ostracized).

PRACTICE IMPLICATIONS

Seeing the child and his/her family in a broader context with improved understanding of the complexity of raising an overweight child.

Gender, ethnicity, culture and social class influences on childhood obesity among Australian schoolchildren: implications for treatment, prevention and community education

The aim of the study was to explore the associations between obesity, weight perceptions and gender, ethnicity, culture and social class in a large national study of Australian school children. Primary and high schools (N = 47) were recruited from every state and territory of Australia and included 7889 children from government, private and Catholic schools (82% response rate) in August-November, 2006. The socioeconomic status (SES) of schools was based on a government survey of total family income. A questionnaire completed by students, measured demographic details of gender, age, weight perceptions and ethnic/cultural background. Height and weight were measured by trained research assistants. Outcome measures included body mass index (BMI), prevalence of obesity, overweight, weight perceptions. Prevalence of obesity was 6.4% of males and 5.6% of females in primary school students (P = 0.34). More high school males were obese than females (7.7% vs. 5.7%, P = 0.001). Obesity was more prevalent among students from Pacific Islander backgrounds. Adolescents who were most likely to be obese were boys and girls of low SES or Pacific Islander or Middle Eastern/Arabic background. The least likely to be obese were Anglo/Caucasian or Asian students and in particular, the girls. Obese female adolescents from Aboriginal, Middle Eastern/Arabic and Pacific Islander backgrounds were less likely than their Caucasian or Asian peers to perceive themselves as 'too fat'.Those working in clinical, community or educational settings with young people and in particular, obese young people, should be aware that obesity is likely to be more prevalent, more culturally acceptable and perhaps more desirable among children and teens from low SES communities and/or Middle Eastern and Pacific Islander backgrounds. Health and social work professionals should be careful not to exaggerate the risks of overweight or obesity or inadvertently create weight concerns among young people. The different body image perceptions identified in this study should be taken into account when planning clinical, community or preventive initiatives among children or adolescents from varying ethnic groups.

Exploring the limitations of an adult-led agenda for understanding the health behaviours of young people

Public health and health promotion agendas are usually determined by adults, even when the 'target' population is children and young people. Adult-centred frameworks for health maintenance and the promotion of well-being risk ignoring young people's conceptualizations and experiences of health and health-relevant behaviours. However, the current policy emphasis in the UK and elsewhere apparently seeks to position young people at the centre of their own health-related decisions. Building on the United Nations Convention on the Rights of the Child, this paper examines and critiques policies relating to young people in UK, European and worldwide contexts. This paper then introduces data from two qualitative studies conducted in the UK. These studies illustrate that young people's definitions of health often run counter to prevailing public health and health promotion discourses. Young people do, however, often exhibit strategies for managing their health, even though they are frequently restricted by the perceptions that adults have about their lives and behaviour. This paper argues that the new policy discourse is not yet being systematically turned into action to give all young people a voice. This is important to begin to understand young people's perspectives about what matters to them and what really influences their health behaviours.

Making sense of eating, weight and risk in the early teenage years: Views and concerns of parents in poorer socio-economic circumstances

This paper reports findings from a qualitative study which examined the perceptions and understandings underpinning the dietary practices in families with 'normal' weight and 'overweight' young teenagers living in poorer socio-economic circumstances. Thirty four parents/main food providers of boys and girls aged 13-14 years from socio-economically disadvantaged areas in Eastern Scotland were interviewed. Within the home there was a strong acknowledgement of these early teenagers' own food preferences; parents also saw them as having increasing responsibility for their own food choices outwith the home but these were often described as 'not healthy' choices. However, parents saw dietary issues as of fairly low priority in the hierarchy of health-relevant and other risks facing their teenagers. Equally, these interviewees felt that issues around body shape and size at this age were less potentially problematic than the risks to teenagers' mental or physical health of their becoming obsessed with weight loss. Parents often made sense of their teenager's body size and shape in terms of the variety of body types in families and inherited traits. Interviewees seemed to lack a discourse to understand weight and overweight in this age group, falling back on understandings derived from the adult lifestage.