A qualitative investigation into the levers and barriers to weight loss in children: opinions of obese children

Background

The alarming increase in the worldwide prevalence of childhood obesity is now recognised as a major public health concern. Failure to isolate and understand the external and internal factors contributing to successful weight loss may well be contributing to the ineffectiveness of current treatment interventions.

Aim

To identify the physical and psychological levers and barriers to weight loss experienced by obese children using qualitative techniques.

Methods

20 participants were randomly selected from a population of clinically obese children (7–15 years old) attending a weight‐loss clinic for >3 months. The children expressed their opinions in a series of interviews and focus group sessions. Data were recorded, semitranscribed and analysed using the thematic framework analysis technique and behavioural‐change models.

Results

Children described the humiliation of social torment and exclusion as the main reasons for wanting to lose weight, although initiation of behavioural change required the active intervention of a role model. The continuation of action was deemed improbable without continual emotional support offered at an individual level. Behavioural sacrifice, delayed parental recognition and previous negative experiences of weight loss were recognised as barriers to action. Participants identified shortcomings in their own physical abilities, the extended time period required to lose weight and external restrictions beyond their control as barriers to maintaining behavioural change.

Discussion

This study identifies the important levers and barriers experienced by obese children in their attempt to lose weight. Dealing with these levers and barriers while acknowledging the complex interplay of social and emotional factors unique to the individual may well promote successful weight control.Recent expansion of population‐based epidemiological evidence shows dramatic increases in both overweight and obese populations across the developed world.¹ Research suggests that the levels of childhood obesity in the UK have more than doubled within the last decade,² and increasing numbers of children are maintaining their obesity status into adulthood.³ With the National Health Service already fronting an annual sum exceeding £2.5 billion² as a direct result of the obesity epidemic, the implications for future health expenditure are obvious. Obesity should be our public health priority, as it is proving to be one of the largest threats to longevity achieved over the last century.A review of the evidence base⁴ allows weight‐reduction studies centred around overweight and obese children to be categorised into five types: family‐based physical activity and health promotion interventions; family‐based programmes using parents as the major agents of change; family‐based behaviour‐modification programmes; behaviour‐modification programmes with no parental input; and exercise treatment programmes. The results have been mixed, with tentative conclusions and little indication as to the most effective way to progress forward.So why is it that our population of obese children find it so difficult to lose weight when those lifestyle factors that contribute to the condition are so widely recognised? Perhaps one explanation lies with the social psychology of risk taking. Human nature dictates that people will not always respond in a rational and predictable manner when given information about future health risks.⁵ Simply educating a population rarely has a marked effect on behavioural change,⁶ particularly with regard to children, in whom evidence has shown that supplying the required knowledge does not necessarily lead to action.⁷ To engage the obese child, we must first gain an insight into the ideas and opinions of that child so that we can work together towards a weight‐reduction scheme that is relevant to the child as an individual. This study aimed to examine the levers and barriers to weight loss from a child''s perspective using qualitative techniques previously proved successful in exploring human perception and opinion.^8,9 A qualitative approach to this study was deemed most appropriate as it provides “a holistic perspective which preserves the complexity of human behaviour”.¹⁰