‘Health and happiness are more important than weight’: Why telling parents that their child is overweight may be ineffective at encouraging behaviour change

Childhood obesity is becoming more common.  The latest available statistics show that about 1 in 5 of 4-5year old children (22%), and about 1 in 3 (33%) of 10-11year old children were overweight or obese in the UK .  This puts more and more children at risk of serious, chronic health conditions such as diabetes and heart disease which have traditionally only been observed in adults.  Overweight and very overweight children are also at risk of mental health problems such as depression; sometimes made worse because of weight-related teasing or bullying by their peers.  Preventing more children from becoming overweight, and helping those who already are overweight to prevent further weight gain, or to lose weight, is therefore important. 

However, a huge number of factors contribute to the rising obesity rates in adults and children.  The solution is certainly not simple, and our researchers are working at finding out more about the many different factors that contribute to the current ‘obesity epidemic’. 

Some people think that one factor that plays a part in childhood obesity is that some parents don’t know that their child is overweight and because they don’t know, they don’t do anything about it.  Therefore, it was thought that telling parents that their child is overweight could prompt some action to avoid further weight gain. However, studies so far have shown that telling parents about their child’s weight status has very little effect on behaviour change; although some parents are more likely to agree that their child is overweight after having been informed about it by researchers, many parents do not agree with the feedback or think that their child’s weight puts them at risk of health problems.  In other words, they seem to disregard the information for some reason.

Researchers from our department wanted to better understand why telling parents about their child’s weight status had so little effect; and in fact often resulted in negative reactions. 

They interviewed 52 parents, who received a letter from the National Child Measurement Programme (NCMP), which informed them that their child was overweight or very overweight.  The National Child Measurement Programme was established by the Department of Health in 2005 to monitor national trends in heights, weights and BMIs of children in Reception (aged 4-5 years) and Year 6 (10-11 years) in publicly funded primary schools in England.

The researchers asked questions about parents’ thoughts on the feedback, and whether they agreed with it.

It transpired that in all interviews, parents used a variety of markers, other than weight, to decide whether their child was a healthy weight or at risk of health problems caused by their weight.  The majority of parents felt that their child ate a healthy diet, was physically active, and was not teased or bullied, and therefore they were not concerned about their child’s weight.  Furthermore, many parents did not think their child ‘looked overweight’, often in comparison with the child’s peers. In this context parents also often referred to build (‘big bones’), or to ‘puppy fat’ which they expected their child to lose during puberty. Parents shared the view that ‘health and happiness is more important than weight.’

This means that simply telling some parents that their child is overweight might not be an effective means of raising awareness about potential health problems, because they might not think that weight is a very accurate measure of their child’s health.  Taking a child’s lifestyle into account (diet, physical activity, and emotional health) might be a good way to improve the dialogue with parents about a child’s health. 

Furthermore, because there seems to be an assumption that children will lose any extra weight during puberty, parents may think that overweight is an issue that will correct itself over time.  However, there is plenty of good research showing that overweight children are highly likely to turn into overweight adults; perhaps not least because of differences in appetite, as discussed in our previous blog.  Findings from this study showed us that more work needs to be done to communicate the link between child weight and adult weight better. 

Lastly, because parents compare their own children to others, and weight has overall gone up in the population, they may consider their child ‘normal weight’ when it is, in fact, overweight.  Although there is also the argument that all measures of weight status are somewhat arbitrary and not without their faults, they do give a good indication about where things are headed, particularly for those at the upper end of the range.

Although these findings are from only one study, and interviewed only a small number of parents and may therefore not hold true for a larger number of parents, they nonetheless bring up some points that might be worth thinking about in more detail. No doubt, weight is certainly not the only important marker for a child’s well-being, but given that many overweight children and adults suffer from related physical and mental difficulties, paying attention to a child’s weight is also not insignificant. Because ultimately, parents and health professionals want the same thing: keeping children happy and healthy.

Article Reference:  Syrad H, Falconer C, Cooke L et al. ‘Health and happiness is more important than weight‘: a qualitative investigation of the views of parents receiving written feedback on their child’s weight as part of the National Child Measurement Programme. J Hum Nutr Diet. 2014;n/a.  http://onlinelibrary.wiley.com/doi/10.1111/jhn.12217/abstract