Akhtar-Danesh, et al., examines the parents' perceptions on why children become obese, on how obesity impacts a child's health, and the challenges involved in preventing a child from becoming overweight and/or obese.
Parents' perceptions and attitudes on childhood obesity: AQ-methodology study
In the abstract the authors discuss how this research was planned and put together. The parents that were utilized in this study -- thirty-three parents who were at a healthcare clinic to have wellness check-ups for their babies -- were placed into groups with two classifications that reflected two different viewpoints. One was, "…confident in delivering healthy nutrition"; and the second viewpoint was "family physical activity focuses" (Akhtar-Danesh, 2011, p. 67). The point of the research was based on the need to find out what parents believe is right when it comes to the issue of good health for their children -- in particular, what weight is okay for their children to carry, in their own minds' eye viewpoint.
The authors, writing in the Journal of the American Academy of Nurse Practitioners, recognize at the outset that they are delving into a problem that is a "growing public health concern" in America. When the prevalence of obesity in young children -- especially very young, ages 2 to 5 years -- increases from 5% of the population in 1980 to 13.9% of the population in 2003, it is a serious concern not just for parents but for society. In that same time frame -- in children ages 6 years to 11 years of age -- the incidence of obesity increased from 6.5% to 18.8%; and for adolescents aged 12 to 19 years (in that same window of time), the percentage of adolescents that are considered obese rose from 5% to 17.4% (Akhtar-Danesh, 67). This data comes from the Centers for Disease Control National Center for Health Statistics, based on a survey published in 2004.
What are the risks for girls when they are obese at age 5? They are at risk, the authors say, for "uninhibited overeating, weight concerns, and body dissatisfaction later on…" in their lives, which can lead to emotional and psychological problems. There are many more examples given in the article of what can happen to young people who are already overweight to the point of obesity, though the salient point of the research is the perceptions of parents regarding their children and weight issues.
What are some of the reasons children's weight gets out of control to the point of obesity? Akhtar-Danesh explains that in terms of the obesity crisis worldwide, there are environmental factors, lifestyle preferences, and also the "cultural environment" plays an important role in this matter. Specifically, the issues relating to weight gain include: a) excessive sugar intake in soft drinks; b) too few fruits and vegetables consumed; c) "increased portion size"; d) increased sedentary time and reduced time for physical activity (Akhtar-Danesh, 67).
Speaking specifically about American children, the authors note that about 60% of children between 3 and 5 years of age spend part of the day in childcare facilities. This is up from 53% in 1991, and many of those children in childcare eat "…at least one meal and one snack" at their childcare center. The point here is that if the childcare teacher (or provider) encourages physical activity, the children obediently follow; however, if the childcare provider does not participate in healthful activities for the children, weight gain can become a problem (Akhtar-Danesh, 68).
When setting out to plan responsible strategies to keep children healthy and away from fatty, sugary and salty snacks, it is important to take family behaviors and environmental influences into consideration. If the family is given to having the television on all day, and bowls-full of chips and unhealthy snacks are always available, there is no doubt that the children of those kinds of families have the potential to become obese at a very young age. "Parents act as agents of food socialization for children," the authors explain (68).
Moreover, in childhood the person's cells are increasing in both size and number, and "over-nutrition during this period can set the stage for becoming overweight or obese for a lifetime" (Akhtar-Danesh, 68). In other words, what the human body's cells get during childhood, they will want later in life; the body will be screaming for more and more food, not the good kind but the kind that person favored in childhood (think McDonald's "Happy Meals").
Research Design - Methodology
The authors used a Q-Methodology, which employed both qualitative and quantitative strategies. This technique was not original but in fact has been used in various areas of health research projects, including "weight control in obese women… evaluation of job satisfaction, patients' viewpoints about health and rehabilitation, and clinical decision making" (Akhtar-Danesh, 69). The reason for using the Q-Methodology, the authors explain, is because it is effective at identifying "diverse viewpoints" and "commonly shared views" and is "particularly useful in research" that delves into "human perceptions and interpersonal relationships" (Akhtar-Danesh, 69).
The way Q-Methodology works is in two phases; first the researchers come up with sample statements that relate to the subject that is being explored; and secondly, the researchers review and evaluate the responses from participants and rank them in order of their "points-of-view, preferences, judgments, or feelings about the statements" that are contained in the first phase (sample statements that respondents are asked to react to).
What was asked of participants in that first phase of statements they had agreed to respond to? Twenty parents that were taking their children to a medical clinic in Canada agreed to participate, and a "trained research assistant described the study" to those twenty parents, who were initially asked "open-ended" questions that assessed their views and behaviors. For example, they were asked: a) about their understanding of good health, of healthy and unhealthy food; b) about their current eating habits; c) about their perceptions of how unhealthy nutrition could negatively effect their children over the long haul; d) about childhood obesity; e) about how often they speak with other parents of young children about nutrition; f) about exercise and sports and how much they believe is needed for a child -- and about how much exercise they are engaged in themselves; g) about their views of "ideal weight"; h) about the barriers to getting children to be physically active, in particular obese children (Akhtar-Danesh, 69).
Next the researchers took the answers from those 20 parents and "reached consensus on a set of 42 statements" that covered all the important views that the parents presented. Those 42 statements (that parents in the research would respond to) were numbered randomly and each was typed on a card. Now the researchers were ready to launch their project.
A sample of 100 parents from that Canadian clinic were called by telephone and invited to participate, and had it explained to them that they would be sent a questionnaire and asked to rank the order of the 42 statements along a continuum from "most disagree" at one end to "most agree" on the other (Akhtar-Danesh, 70). Of the 100 Q-samples sent out, the researchers received 33 back (32 mothers, 1 father). The mean age for the parents was 34.4 years, and the mean age for their children was 16 months. Seven of the parents were overweight (this is self-reported so there is no absolute assurance that the answers were totally candid); twenty-five said they were normal weight.
Nineteen of the parents claimed they were "delivering healthy nutrition to themselves and their family"; those 19 also said there were very few "excuses" for failing to serve healthy foods (Akhtar-Danesh, 70). These 19 asserted that they served fruit and vegetables "at least two or three times a day" and did not agree that "unhealthy foods were more convenient and cheaper" hence they did not rely on these cheaper unhealthy foods. Thirteen parents focused on the importance of physical activity and the role activity can play in avoiding childhood obesity and those 13 did not agree that walking 30 minutes daily was "too little activity for good health" (Akhtar-Danesh, 71).
This group of 13 parents said they "…try to avoid fast food and processed food when possible" (of course that is not saying they avoid those foods, they just "try" to avoid them); they also "strongly opposed" the notion that "It is unhealthy to include fats in my child's diet" (Akhtar-Danesh, 71). The thirteen also disagreed with the statement that "It's better not to talk with other parents about children's nutrition as you don't want to cause trouble over a clash of values" (a ridiculous statement to begin with, which the authors may have used as a trap to see which parents would agree with such an absurd idea) (Akhtar-Danesh, 71).
There were statements that amounted to a consensus; to wit, both groups strongly agreed that exercise and sports are "very important to a child's health status" and they agree with…