Focus group results
Overall, eight saturated themes emerged from the data, with additional unsaturated themes noted for further study. All themes surrounded the central concept that parents are aware of overweight as a problem among children and believe that it is worthy of attention and intervention. See Table 3 for a list of themes and supporting quotes.
Table 3. Focus group themes and supporting quotes
Theme #1: Parents generally think that other people's overweight children are lazy and do not exercise. However, two contrasting ideas emerge when parents are asked about their children; either that their children do not exercise enough, watch too much TV, or play too many video games; or that their children are active, but still seem to gain weight.
Parents expressed a bias against other overweight children (that they are lazy or do not exercise) but did not have this bias about their own children. When talking about other children in their communities who are overweight, parents used descriptors such as “lazy,” “poor choices,” and “poor parenting.” However, in describing their own children parents did not use these words. In fact, parents often made excuses for their children, suggesting that they believed their children did exercise enough and were mystified by their continued weight gain. One mother exemplified this perfectly by stating “even while being active he still seems to hold that weight. He rides bikes, runs all over the place but he's still overweight.”
Theme #2: Parents are concerned about their child's weight, particularly as it relates to health and future health, and are interested in information about exercise and dietary changes to help their child lose weight. However, some are concerned that telling their children to lose weight will lower their self-esteem.
Many parents were aware of the fact that being overweight as a child directly affects one's health. For example, one father stated “I also worry about this because, you know, because both of his grandfathers were insulin-dependent diabetics and they both have had heart attacks and open heart surgery and, you know. And one of his grandfathers died of a stroke, so you put all those extra combinations in there and you know the overweight isn't good for his health because of the history…the family history of the medical problems.” Despite this concern, many parents seemed hesitant to discuss the issue of being overweight with their child, or hesitant to encourage weight loss, as they feared this would have negative ramifications, either in terms of self-esteem or promoting unhealthy eating through eating disorders. One parent stated “you don't tell them that they're overweight, that they need to do something, but you give them healthy choices, you know, you have to guide them.”
Theme #3: Though most parents believe that unhealthy habits contribute to childhood obesity and their child's weight problems, some parents believe that obesity has genetic links, that children will “grow into their height” or that even with healthy eating and exercise, some children will be overweight.
Many parents believed that their children were going to be overweight no matter how healthy their habits. Several parents stated this was due to “genetics.” “If it's because of a child's eating habits, or because they'd rather sit around and watch TV then yeah, but like in my family it's overweight in the genes for the most part. And my children aren't real overweight but they can be easily if they stop being active.” Other parents believed their children were going to experience a “growth spurt” and that after this time, their child would no longer be overweight. “My hope is that as he grows he'll grow out of a lot of it and I've seen that happen with a lot of children that did once they hit sort of the teen years and had a growth spurt became long and lean who weren't when they were young.” Their belief that some children will just be overweight, no matter their habits, was also expressed about parent's own weight status, in that they felt that they (the parents) would remain overweight no matter what types of intervention they attempted.
Theme #4: Parents have tried a variety of methods to help their children lose weight, but none have been successful and most are short-lived.
Parents were keenly aware that they needed to increase their child's exercise and decrease caloric intake to improve child weight status. They had attempted to do this through modifications in the home environment, such as starting a walking program, decreasing fast-food consumption, or having more fresh fruits and vegetables available. However, parents also readily reported that these attempts met with limited success and were short-lived. “We started a program, a walking program, her and I did that for awhile but then like I said we each get busy and we don't get it done.” Some families reported that the reason that these programs are not more successful is that the children do not see any results to motivate them to continue the program; “We've done exercising. We've done riding the bicycles, you know, every night, you know, and then he thinks it's not doing anything because, you know, he doesn't have enough patience, you know, I think to give it the long term…he's like most people, they want the overnight success story.”
Theme #5: Parents are concerned that other children make fun of their overweight children.
Most parents reported that their children had reported being made fun of because of their weight status. “A lot of name calling that comes with being overweight. I hear a lot of kids call…him fat.” This was particularly difficult for some parents who themselves were overweight as children, and caused parents to be more critical. “I'm probably a little more critical than I should be; I worry about being too critical, you know as far as I don't want to cause my child to have an eating disorder because of my comments, I don't want to be verbally abusive, but yet you try to protect them because you don't want them to go through what you went through all your life and experience the no dates, no dresses that fit, people making fun of you.”
Theme #6: There are many perceived barriers to their children losing weight including, most importantly, lack of resources in the community, poor school lunches, distance to weight loss programs, time to do healthy activities (e.g., exercise, prepare a healthy meal), the higher cost of healthy foods, the potential cost of weight loss programs, and a lack of motivation on the part of their children.
The lack of resources was exemplified by one family which had recently moved to a small rural town from a large urban area and reported “When we moved here…we were used to having a lot of low-fat and high-fiber alternatives and things and different brands and our selections here are much more limited and because not many local shoppers are looking for that our local grocery really can't afford to give shelf space to it” suggesting that item availability in grocery stores may be a concern. Another family expressed a concern regarding the expense associated with eating healthy; “I also find when I'm grocery shopping and I'm looking for healthy snacks they are so much more expensive than the other ones that it is very frustrating to go to the grocery store and think you're buying healthy stuff and then your grocery bill is so high.” Another concern was lack of parent time to make the necessary changes; “Parents don't have enough time to fix a balanced supper and it is easier to throw something together that's maybe not as nutritious and more fattening than a more balanced meal.” And, finally, other parents were concerned that their children would refuse to engage in the changes recommended by their parents; “She refuses to diet or do anything like that.”
Theme #7: Motivation is key to helping their children succeed, but is difficult to provide. Some possibilities for motivation include goal setting, money or other incentives, social support from other children, and making a program enjoyable.
All parents were concerned about motivating children to engage in and then maintain behavior change. They felt that any program that was going to be successful for children would have to be motivating; the children would have to want to come to the program on a regular basis and express this desire to their parents, rather than parents having to coerce children into attending. “I want my daughter to say, let's go, let's go: we're going to be late. I don't know…what would do that, but that's what I would like…where she just wants to come to it.” Parents also felt that the program should motivate behavior change through incentive programs; “Something else that would keep the kids more involved is…like a reward type of program. You know, if they were rewarded for every achievement that they made, then they, you know, got some kind of a reward or something to make him feel a sense of accomplishment.” Parents also felt a successful program would be goal oriented; “Where they could, you know, set goals and then they could meet those and it would make them feel better.”
Theme #8: Parents wanted a free or low-cost comprehensive program that gives the option of life-long participation, with a weight loss facility that is open long hours.
Parents consistently reported that no programs were available in their areas to help their children become healthier or lose weight. However, should such a program become available, they had several suggestions for details of the program including convenience, affordability, and longevity. “If you could go at your convenience, the place is always open, you let yourself in, went in, did your activities, and left when you were done.” “Where it's still affordable for everybody to go. And that would be another thing, is the cost of the program…it should be free, state funded.” “I guess the program that I'm thinking of that yes, it would have to be a lifetime. Maybe you wouldn't want to do it every week for the rest of your life, but I would think you'd still go back.”