Clinically obese children identified facilitators and barriers to initiating and maintaining the behaviours required for weight loss

DESIGNQualitative study.SETTINGLeeds, UK.PARTICIPANTS20 clinically obese children (8–14 y, 14 boys), who were attending aNational Health Service funded weight loss programme for .3months, were selected on the basis of availability.METHODSAll children participated in individual 20 minute interviews, whichaddressed initial awareness of weight problems, the process ofbehavioural change, previous attempts to lose weight, reasons forlosing weight, and facilitators and barriers to weight loss. As well, 17children participated in focus groups of 6–8 children that lasted about40 minutes and addressed issues raised during the interviews.Interviews and focus group discussions were tape recorded, semi-transcribed, and analysed using the 5 stage framework analysistechnique (familiarisation, theme identification, indexing, charting,and mapping and interpretation).MAIN FINDINGS5 themes were identified. (1) Reasons to change. Bullying was a majorreason for change. All children admitted that they had experiencedbullying, and some suggested that bullying had become ‘‘normal’’behaviour: ‘‘You hear people calling them fat but that’s just normalisn’t it?’’ Most boys described how retaliating for bullying led toexclusion from school activities. A second reason to change was adesire to ‘‘fit in,’’ to ‘‘blend in’’ with their peers and not be singledout. A desire to improve physical abilities (primarily related to socialissues in the school playground) was identified by 11 children as areason for change. Only 2 children mentioned future health as areason for change.(2) Cues for action. Most children identified bullying as the way inwhich they came to recognise their obesity, but only 4 said it was theimpetus for change. More commonly, the driving force for thedecision to lose weight was an external influential figure or rolemodel (often the mother).(3) Barriers to action. Children noted the sacrifices needed in orderto lose weight and their struggle to adhere to lifestyle restrictions:‘‘You have a chocolate bar and put on a pound, you have sixteenhundred apples and you take off half a pound.’’ Children who hadreceived advice from dietitians felt that they were a barrier toengaging the problem: ‘‘Dietitians never listen’’ and ‘‘They just tellyou what to eat, what to do.’’ Some children blamed their parents forfailing to recognise the problem until it was a much bigger problem.(4) Continued compliance. Children noted that the real challenge wasnot in deciding to lose weight, but in taking action and maintainingit. Continual support was central to their ongoing motivation and selfefficacy.(5) Barriers to compliance. Children acknowledged their low levels ofconfidence and self esteem, which affected their motivation and selfbelief. They identified barriers to behaviour change that were beyondtheir control: actions of peers, voices of authority figures, physicalinability, access to sports facilities, cost of ‘‘healthy’’ school meals,and area of residence. Another obstacle was the time frame forweight loss; ie, gradual weight loss takes place over an extendedperiod of time and requires delayed gratification, whereas childrenwanted the immediate gratification of fitting in.CONCLUSIONSChildren who were clinically obese described facilitators to weightloss in terms of reasons for change (ie, bullying, a desire to fit in, andenhancement of health and physical activities) and cues for action(ie, an external authority figure, usually their mothers). They alsoidentified barriers to action and continued compliance with weightloss, including the sacrifices needed in terms of lifestyle restrictions,parental delay in recognising the problem, the need for continualsupport to maintain their motivation, and the extended time frame(and delayed gratification) required for gradual weight loss

Topic: Obesity and Health Practices
Subfield: Pharmacy
Field: Health Professions
Domain: Health Sciences