Social Implications of Overweight and Obesity in Children

Written By: Sam Savage

Published Date: July 29, 2008 Last Edited: July 29, 2008

By Edmunds, Laurel D

PURPOSE. To elucidate some of the social impacts that overweight and obesity in children has on families. Healthcare practitioners may be unaware of these impacts if not similarly affected. DESIGN. Qualitative semistructured, interview-based study.

METHODS. A purposive sample of parents (n = 58) with overweight and obese children (n = 48) from three areas in the United Kingdom was used. Analysis was thematic and iterative, underpinned by Grounded Theory.

RESULTS. There are many social situations that have an impact on the child directly (stigmatization), on parents (blame), and on the family in general (being ostracized).

PRACTICE IMPLICATIONS. Seeing the child and his/her family in a broader context with improved understanding of the complexity of raising an overweight child.

Search terms: Child, obesity, overweight, parents’ experiences, qualitative, social impact

First received September 3, 2007; Revision received January 23, 2008; Accepted for publication February 27, 2008.

Obesity in children, from infants to teens, shows few signs of abating, and its effects are increasing globally (Lobstein, Bauer, & Uauy, 2004). In the United Kingdom, primary care personnel, particularly the practice nurses, are the front line for tackling child weight management. School nurses in countries such as the United Kingdom and the United States also have a vital role to play. Most weight management interventions have concentrated on diet and physical activity because these are the main components of published interventions and make sense intuitively. The interventions in the literature, in turn, have been interpreted for national guidelines (e.g., United Kingdom, Australia, Canada, United States, and several other countries). However there are a number of studies that show healthcare practitioners recognize their role in the treatment and prevention of obesity in children but are not sure how to help, and they often feel that it is not a productive use of their time (Jelalian, Boergers, Alday, & Frank, 2003) despite these guidelines.

For children, the worst aspect of overweight and obesity are psychosocial (Dietz, 1998). Some interventions, both prevention and treatment, have included psychological strategies, but treatment interventions also need to consider the personal social circumstances of families, beyond their social demographic, and these are often not explicit. Although awareness of these issues is becoming more accepted, applying this awareness may improve any intervention (Jelalian Wember, Bungeroth, & Birmaher, 2007). Not addressing these “softer” aspects of management may hinder the efficacy of intervening with diet and physical activity.

Healthcare practitioners may not always appreciate the wider impact of having an overweight child in the family and so may not be as supportive as one might wish (Edmunds, 2005). The acceptance, or lack of it, of overweight is likely to vary to some degree culturally in the United Kingdom, and probably in other countries. However, for most, there are negative consequences of being overweight or having an overweight child in the family. This study elucidates some of these wider social impacts of overweight for children and their families. These broader consequences have not been investigated before and may help practitioners understand their plight better when interacting with families coping with overweight children.

Methods

In-depth interviews were chosen as the most appropriate method for exploring the very complex and extremely sensitive subject of childhood obesity. Interviews allowed for greater flexibility and interaction, and allowed novel topics to arise so that themes could be identified. The method of constant comparison was used to refine and revise themes. This approach was underpinned by Grounded Theory, which provided a framework to explore parents’ experiences and their social interactions with health professionals (Strauss & Corbin, 1998). Data were collected and analyzed concurrently, and the emergent themes are detailed below.

Recruitment and Sample

Three geographical areas of England were selected to increase the likelihood of participation as the social stigma associated with childhood obesity was a major barrier to finding a range of parental experiences with children of each gender, from different social backgrounds, and with access to different healthcare provisions. Parents of children (younger than 1-15 years) who had concerns about their children’s weight were included. Within a reasonably homogeneous sample, “data saturation” is achieved within 40 interviews (Pope, Ziebland, & Mays, 2000). Here, 58 parents of 48 children (20 in each of Central and South Western England, and 8 in Northern England) were included in the study.

Parents with any weight concerns about their child(ren) were invited to take part in the research. Parents were recruited via a number of methods, including via health professionals, posters in primary care settings, and advertising in local papers. Recruitment through weight loss groups was added subsequently to improve response rates. Parents were self-selecting, and those interested in taking part received either an information sheet or were invited to telephone the author for more information when responding to advertisements. Parents were recruited via the following sources: 21 from advertisements, 9 (out of 22 who were informed) from pediatric dietitians, 9 from slimming groups, 8 from a weight management clinic, and 1 from a poster in their primary care setting. Forty- four of the children’s parents were White, and the others were of Afro-Caribbean, Indian, and Iranian ethnicities.

Children came from a range of different socioeconomic backgrounds, and 29 were girls. Their shapes were compared with a standardized set of body shapes (Stunkard, Sorensen, & Schulsinger, 1983; see Figure 1) for children over the age of 4 years by the author in conjunction with parent(s). Growth records were used to classify younger children. The aim of using the shapes was to illustrate rather than to provide actual estimates of BMI. Shapes were selected because they did not require the presence of the child and were less intrusive. Recruitment was difficult, and this approach was less likely to result in objections. More importantly, some parents were concerned about raising awareness of overweight in their child(ren) where none existed, or revealing the extent of their concern as parents, particularly in the child’s own home, and so were more willing to participate in these circumstances.

The ages and sizes of the children can be seen in Table 1. Their parents’ socio-economic statuses can be see in Table 2. Categorization was based on the main earners’ incomes in accordance with the U.K. standard occupational classification (Office of Population Censuses and Surveys, 1990).

Interviews

The interview schedule was piloted and included topics such as the child’s weight history from pregnancy in conjunction with the body shapes (see Figure 1) and photographs, together with family weight history, self-help strategies, and societal interactions. In- depth, semi-structured interviews were conducted by the author and audio-tape recorded with the participants’ written consents; 96% were interviewed in their own homes. Thirty-eight interviews were conducted with mothers and 10 with both parents present. Interviews took between 45 and 150 min, with most lasting around 75 min, and they were conducted over a period of 15 months up to January 2002 and from March to November, 2005. Other topics have been published and presented elsewhere (e.g., Edmunds, 2005, 2006; Edmunds, Mulley, & Rudolf, 2007).

To illustrate the starting points for discussion, the following is from the interview schedule:

For any period when the parent describes the child as overweight the interviewer would ask: how the parents felt about it, whether they were aware of the child being bothered about their weight and whether anyone else (such as friends, family, general practitioner, practice nurse, teacher) had commented on the child’s weight. (Did your child say anything to you about it? Do you think they were aware that they were putting on weight? Did anyone else say anything to you about your child? Did this change have any effect on you? Did this change have any effect on your child?).

Many of the issues included here stemmed from these questions.

Analysis

Descriptive data were recorded documenting children’s ages and the current and past shapes of the children and other family members. All the interviews were transcribed verbatim, checked for accuracy by comparing the transcript with the tape, and reread several times. The main, or higher, initial categories were “reactions of others,””learning to cope with their size,””clothes,” and “the impact of teasing and bullying”; these were divided into further subcategories. Themes were discussed with a second qualitative researcher with evidence from the data. Finally, two focus groups were held, one in each of Central and Southern England, to test the veracity of findings with participants. It was not possible to repeat this in Northern England due to lack of funding. Analyses followed a well established social science methodology and findings represent the author’s interpretation of parents’ perceptions. Further details of the methods can be found in an earlier article (Edmunds, 2006). The sex, age, and shape of the children have been used as an identifier for their respective parents’ observations.

Results

The nature of the interviews resulted in very rich, wide-ranging data. The families were diverse in that 11 had only one child, 4 families reported that all the children in the family were overweight, and 33 had just one overweight child. Non-overweight children in some families were still quite young and so could gain excess weight with time. The findings here concern the index child, their families, and any siblings if appropriate.

Four higher categories emerged from the interviews: “reactions of others,””learning to cope with their size,””clothes,” and “the impact of teasing and bullying.” The first, “reactions of others,” was subdivided into family members, strangers, and general societal messages. One important category, healthcare professionals, has been omitted here because these findings have been published elsewhere (Edmunds, 2005). However, one of the respondents from the subsequent data collection in Northern England made a relevant comment: “I’d like them [healthcare practitioners] fo understand just how complicated it [bringing up an overweight child] is” (mother: girl 7 years, shape 6). Coping with the child’s size and clothing received little subdivision, whereas the last category included schools, holidays, and home locations. The main issues for parents have been illustrated; as one mother put it, “It’s all things that other people take for granted every day with their children” (mother: girl 3y, shape 7).

Reactions of Others

The social stigma associated with excess weight was exhibited by everyone from family members to complete strangers. Fathers were more concerned and sensitized if they had been overweight as children, “I’ve suffered all my life” (father: girl 15 years, shape 7). Normal-weight fathers were less concerned and still gave their children treats, “He doesn’t tend to be here evenings and weekends when she’s constantly asking for food … [he] hasn’t had the experience of taking her to the doctor, trying to buy clothes” (mother: girl 8 years, shape 5). Others found having an overweight child difficult: “My husband was so embarrassed and made some comments about it [eating chocolate cake at a party], but L took no notice and just sat down and ate them [2 large pieces]” (mother: boy 15 years, shape 7).

Having an overweight child created potential for discord between parents, further complicating raising an overweight child: “I remember having big arguments with my husband about this [the amount of food the child should eat]” (mother: boy 1 year, shape 6/7). Three mothers felt they had to protect their children from their fathers’ lack of sympathy: “His dad had a tough upbringing in Africa. He thinks I’m being too fussy and I’m making him [son] look silly” (mother: boy 9 years, shape 6/7); He’s so angry… with the NHS [National Health Service] and with the school.. .it just makes thing worse” (mother: girl 12 years, shape 7); “He does moan at A about food …If we take him anywhere and A starts to play up he [father] goes to pieces you know, he just thinks he’s gotta shout at him, tell him, you can’t make him, the more you shout at A the more he’s gonna be like it” (mother: boy 13 years, shape 6/7).

Grandmothers also were not necessarily supportive, but in different ways. Some “nagged” their daughters: LE: “Who was it who told you you’ve got to do something about her weight?””Well me mum’s the one, she goes on about Z’s weight” (mother: girl 13 years, shape 7). Many, however, were responsible for increasing the overweight child’s intake, some with the best of intentions: “She [grandmother] says it’s nice to see kids eat, these kids these days, they don’t eat anything” (mother: boy 11 years, shape 5), or they wanted to feed them “proper” meals (meat, two vegetables, and puddings) or “sweets”: “As soon as we walk through the door, out comes the fairy box [full of sweets]” (mother: girl 9 years, shape 6). Others saw grandmothers’ influences as less helpful: “I always bring my mum into it, she causes the problem. I say to M, you are old enough now to say ‘No nanny, no thank you, I don’t want it'” (mother: girl 9 years, shape 6/7); “My mum-since my dad died, she just can’t be bothered. She … she’ll sit there and she’ll eat packets of crisps and sweets, and she’s always got bagfuls of sweets” (mother: boy 12 years, shape 6/7). Behavior patterns across generations were having an impact on these children.

Overweight children were perceived as “fair game,” and parents recalled comments from strangers that were more or less insulting: “Cor, she likes her chips” (mother: girl 9 years, shape 6); “Look at his legs!” (mother: boy 8 years, shape 7); “What is that child still doing in a pushchair?” (mother: boy 10 years, shape 5); “Has she got a giantism problem?” (mother: girl 13 years, shape 5/6); “Do they have the same father?” (mother: boy 11 years, shape 6). Mothers were often left dumb-founded and further concerned about the messages their children were receiving.

All those interviewed were aware of their children being ostracized because of their weights. Four parents of 7-11 year olds talked about children not being invited to parties. Some mothers were conscious of “people looking at you, judging you” (mother: son 1 year, shape 6/7), being made to feel “out of place” (mother: girl 3 years, shape 7), and “stared at” (mother: girl 14 years, shape 7). As one mother said “I know I shouldn’t worry about what other people think, but we do don’t we” (mother: boy 3 years, shape 7). The plethora of television programs over the last 3-4 years in the United Kingdom raising awareness may be having the unintended effect of “making it worse” (mother: girl 14 years, shape 7). One mother talked about the influence of raising awareness in schools, often in response to bullying incidents: “The headmistress talked about it in circle time. It’s making children more aware of who might be overweight, and they’re being targeted. It’s so unhelpful” (mother: girl 7 years, shape 6). Another mother (girl: 14 years, shape 6/7) summed the situation up “We’re made to feel like lepers.”

Learning to Cope with Their Size

Overweight children without underlying medical causes tended to be tall. Their bodies were more developed than their cognitive and emotional maturity, and children had to learn to cope with the consequences of living in a large body. Many parents described their children as “gentle giants” as they had encouraged them to be caring: “She’s so strong. We had to stop her swinging her friend around. She [friend] is half her [daughter’s] size” (father: girl 7 years, shape 6); “The teacher told us that he’s really good at looking after the younger children in the playground” (mother: boy 8 years, shape 6).

However, this was not always the case. The only grandmother who took part in the interviews said of her granddaughter “I’m worried that when she runs to me, she’s going to knock me over,” and of greater concern, “We need to get her tantrums under control” (grandmother: girl 3 years, shape 7). One mother recalled her son’s story, “They wanted to have him statemented for disruptive behavior in the infants [school for 5-7 years]. He was injuring the other children and crashing into the furniture. He was just being boisterous, but he did look about 8…. and then he was diagnosed with dyspraxia when he was 7” (mother: boy 9 years, shape 6/7). Two of the older children (both large adult size) were encountering the authorities: “He was with a group of friends [and an adult at 1:00 a.m.]. . . . She [policewoman] charged in and got him by his lapels and dragged him to the front of the shop” (mother: boy 15 years, shape 7); “S has been through an anger management course at school, and on Tuesday of this week she was actually arrested . . . there’s a possibility of her being prosecuted” (mother: girl 13 years, shape 5).

Clothes

Buying clothing that fit, was age appropriate, and “looked nice” was problematic for all the parents interviewed and worsened with age and size, especially for girls. For one mother this started in very early: “I couldn’t get a nappy to fit her. She’d outgrown all the ones in the supermarket” (mother: girl 3 years, shape 7). Most of the children in this study were wearing clothes that were sized 2- 3 years above their chronological ages, and some parents were making their children’s clothes: “I’ve had to start making her clothes . . . You can’t even buy clothes off the peg, . . . I can’t have anything with a zip or a button because it just won’t stay up on her, at all” (mother: girl 3 years, shape 7). Mothers (or grandmothers) who could not sew had to resort to other solutions: “I had to buy him dwarf’s trousers” (mother: boy 8 years, shape 7). This was particularly difficult with school uniforms where schools had specified suppliers: “She’s already in the largest size trousers that the school [up to 18 years] suppliers make, and she’s only 12” (mother: girl 12 years, shape 7).

Wanting their children to “look their best” was a topic that most mothers discussed. As children became older, some chose clothes to disguise their sizes: “I know she wears baggy T-shirts to try to hide it” (mother: girl 10 years, shape 6). As children got older and larger, the ubiquitous “baggy sweats” were mainly due to lack of choice: “Obviously it’s hard, ain’t it, when they’re bigger to get really nice clothes” (mother: girl 14 years, shape 7). Younger children wanted to be more fashionable: “She wants to wear fashionable clothes but she won’t look very nice in them so I have to try and talk her out of it” (mother: girl 9 years, shape 6). Looking and being treated as older and so being expected to behave accordingly was commented on frequently in a variety of contexts. However, this was particularly an issue for mothers of preadolescent girls whose clothing could result in their looking adolescent and having to cope with unwanted attentions. The Impact of Teasing and Bullying

Teasing and bullying was particularly notable in the school setting and started at the youngest ages if the children were overweight enough: “I don’t like talking about it in front of her . . . because when she went into reception, she did have a bad time to start off with [suffering name calling, resulting in a lack of confidence when she was 4 years old]. But she says to me “am I fat Mummy?” and she’s only 5 now” (mother: girl 5 years, shape 7). Another, a 5-year-old boy, pleaded with his mother to take him to the doctor because he was being so badly bullied at school: “He used to come home from school crying . . . ‘please take me to the doctor Mummy, I’m too fat'” (mother: boy 5years, currently shape 5). Name- calling started between shapes 4 and 5, usually with taunts: “You wear your mum’s knickers” (mother: girl 7 years, shape 5) and increased in frequency and nastiness with fatness; one boy was exposed on the lavatory at school by a gang of boys (mother: boy 8 years, shape 7).

Parents also thought physical education lessons exacerbated the situation. “The teasing started when he started having to change for PE” (mother: boy 8 years, shape 7). These effects could be long lasting: “Why don’t you want to do PE, its fun? and she said ‘Somebody called me fat’. . . and I think since then it’s stuck in her head” (mother: girl 6 years, shape 6/7). Most parents talked about problems on PE days with “battles” with younger children and older children skipping school, which in one instance was leading to a far worse situation: “At first she only missed school on PE days, now she hardly leaves her room. . . . She’ll only go to the corner shop on her own” (mother: girl 12 years, shape 7). When parents attempted to discuss these situations with teachers, they were often dismissed or made to feel blameworthy, particularly with older children: “You can see they just think it’s your fault and that you’re making a fuss” (mother: boy 12 years, shape 6/7).

When parents tried to increase their children’s physical activity by taking them to school clubs, three mothers reported the following: “He [football coach] thought he would make his team less competitive” (mother: boy 12 years, shape 6/7); “She [dance teacher] made it clear she didn’t really want a big girl in her class” (mother: girl 10 years, shape 6/7); “I know they wouldn’t let her join in the country dancing display ‘cos she’s overweight” (mother: girl 9 years, shape 6).

The presence of an overweight child in the family had wider impacts. For example, in families that were financially able, holiday destinations were chosen where obesity was as prevalent as in the United Kingdom (Greece) “so she doesn’t have to worry about other people looking at her” (mother: girl 10 years, shape 6/7), or more so (United States). One mother also mentioned buying clothes for her daughter in the United States whilst on holiday as she could not buy suitable ones in the United Kingdom: “They cater for big children” (mother: girl 11 years, shape 7). One family invested in a caravan so that they could take their son away more often. Parents saw holidays as a way of alleviating the bullying and name calling their children were subject to at home from local peers. Their aim was to take their children “away” as much as possible to “give them a break.”

Removing their children from bullying also led some parents to not only change schooling for their overweight children, but in two families all the children had been sent to different schools that were usually smaller with tighter behavioral control: “[New school] is very small; there’s about 60 kids there, and there’s much less peer pressure” (mother: boy 11 years, shape 5). In one case this meant going from the state system to the private sector. At even greater cost, three families had relocated to improve the quality of life of all family members, but for the overweight child in particular: “Cs weight has made a difference to us moving” (mother: girl 11 years, shape 7), and “We bought the house in a cul-de-sac because we thought it would encourage him to play out more” (mother: boy 8 years, shape 7). Two other parents mentioned wanting to move, but the cost was prohibitive: “What can you do? You can’t move house can you? We couldn’t afford it even though we’d like to” (mother: boy 8 years, shape 7).

Discussion

These findings represent the views of parents who volunteered to take part in research that remains very socially sensitive. Therefore, the findings may or may not be generalizable, but they illustrate some of the issues that parents have to manage when bringing up an overweight child. The standard occupational classification was used to assess socio-economics status (SES) (Office of Population Censuses and Surveys, 1990), and the sample was dominated by respondents from higher groups. A recent survey in Scotland showed that the inverse relationship between SES and childhood obesity when measured by BMI is being maintained (Cecil et al., 2005); however, the issues discussed by parents revealed consistency of experiences regardless of SES grouping. The main difference for those with more disposable income was that they were in a position to effect larger scale changes such as relocating, or school moves, or more conducive holiday destinations.

Families with an overweight child or children still encountered the usual tribulations of everyday life but with the added burden of these social impacts. Mothers found it particularly difficult negotiating around an unsympathetic partner or their own mothers undermining their efforts to encourage healthy eating strategies. A small number of studies investigated child weight and family functioning in the 1980s, but little has been published recently. However, it has been suggested that taking these aspects of child weight management into account may improve the tailoring of interventions to the needs of the children and their families (Braet, 2005).

Clothing, which may seem relatively frivolous in comparison with the health consequences of obesity in childhood, was a major concern for most, if not all, parents. This was particularly true when they had daughters and as their children got older. “Nice” clothes have been shown to be a significant issue for overweight teen girls (Wills, Backett-Milburn, Gregory, & Lawton, 2006). Apart from the practical need to cover and protect, clothing is an important contributor to appearance and, hence, social currency. The choice for many overweight children may be between “dark and baggy” or more fashionable, but less flattering. Neither is likely to help with making and maintaining friendships. This may be contributing to a lessening of social acceptance and influencing the social marginalization that overweight teens experience (Strauss & Pollack, 2003). Therefore, parents struggled to find suitable clothing or had to take time to make clothing, as well as deal with the increasing consequences of their children’s social isolation.

Children were encouraged to become more careful with others when learning to cope with living in a body that was bigger than their chronological age. These types of behaviors were commendable but not necessarily typical of their age groups, and, again, these behaviors may have been setting them apart from their peers. The extra size and strength enables some children to become bullies, whereas in this sample, children were more likely to be bullied. This was to be expected given that parents volunteered to take part and provide information about their children. There is a growing body of evidence that overweight children are at significant risk of both being bullied and becoming bullies compared with normal-weight children (Griffiths, Wolke, Page, Horwood, & ALSPAC Study Team, 2006; Janssen et al., 2004). These tendencies may have an impact on the emotional, social, and psychological development of overweight and obese children and adolescents, as either end of the bullying continuum are likely to be less psychologically robust. Here two of the teens were not bullying but were expressing their anger forcefully and had already encountered the authorities, with the girl attending an anger management course. Previously, obesity has been shown to be predictive of delinquency in adolescent boys (Pine, Wasserman, Coplan, & Staghezza-Jaramillo, 1996). Perhaps the changes in society and the obesogenic environment have resulted in girls becoming more likely to behave in a similar manner.

The negative societal messages that children receive not only start before the age of 5 years (Musher-Eizenman, Holub, Miller, Goldstein, & Edwards-Leeper, 2004), but they continue to worsen (Latner & Stunkard, 2003). Parents, here, reported experiences in keeping with this. Many were faced with professionals who shared these negative attitudes toward their children and toward them for allowing their children’s weight to develop. Both teachers and healthcare professionals showed a range of attitudes. Teachers were not always helpful, leaving children to fend for themselves in the school environment (Fox & Edmunds, 2000). Parents perceived responses from healthcare practitioners to range from positive, but not necessarily helpful, to negative and sometimes dismissive, making mothers feel blameworthy and guilty-typically in front of the children (Edmunds, 2005). Those professionals involved with careers focused on diet or physical activity may be even more unsympathetic as some have been identified as being at greater risk for body image and eating problems, which may have influenced their career path initially (Yager & O’Dea, 2005).

Persistent obesity is associated with lower educational attainment, poorer employment and relationships, and psychological morbidities, particularly in women. However, these do not have an effect if children are only overweight/obese in childhood (Viner & Cole, 2005), and so intervening appropriately to manage weight during growth remains desirable. In summary, the experience of being an overweight child, or having an overweight child in the family is very complex and very individual. The social consequences of being overweight or obese as a child affected the whole family, particularly mothers who were trying to balance the child’s dietary and physical activity needs with those of the family’s without further stigmatization. There are associated financial and social costs that may not be appreciated by healthcare practitioners and teachers. Some families functioned better than others, and this influenced how well the children coped with their larger sizes. Mothers may have devoted time to looking for help, which was minimal, and the social stigma resulted in a lack of willingness to discuss childhood weight, with one mother describing it as an “open secret.” A better understanding of the family/social context may inform practice and interventions for overweight and obese children.

Acknowledgments. Approval was granted by the Applied Qualitative Research Ethics Committee in Oxford (AQREC No. A00.020), the South West Local Research Ethics Committee (Study No. 2000/4/5Ss), and the Harrogate Local Research Ethics Committee (Study No. 05/Q1107/54).

The study was funded by South East Region NHS Executive Research and Development Fund Grant No. SEO 151 and the University of Warwick Medical School.

Thanks to all the parents who took part and to the health professionals whose help was invaluable; to Rosemary Conley Slimming Clubs and Slimming World for their support in Central and South West England; and to Professor Mary Rudolf and Bernadette Mulley at the University of Leeds for their help with recruiting interviewees in Northern England.

The social stigma associated with excess weight was exhibited by everyone from family members to complete strangers.

Clothing, which may seem relatively frivolous in comparison with the health consequences of obesity in childhood, was a major concern for most, if not all, parents.

How Do I Apply This Information to Nursing Practice?

The most appropriate way to incorporate the above into practice is to understand that childhood weight management is about far more than diet and physical activity. Parents raised several issues that may benefit from practical support, such as being directed to counselors (financial or psychological), advice on schooling, suitable clothing outlets, activities where overweight children are not stigmatized, and psychological resilience or self-confidence programs. Additionally, practitioners may appreciate the broader picture and complexity of raising an overweight child. There may be other family issues (e.g., divorce, grief, integrated family) not presented here that also would have an impact on managing the child’s weight. Many parents are likely to have tried self-help approaches before seeking help from a health professional, and it can take a lot of courage to ask for such help. Parents are not solely to blame. The recent Foresight Report (Kopelman, Jebb, & Butland, 2007) highlighted environmental and societal changes that increasingly promote weight gain. However, parents carry most of the responsibility and are best placed to remedy the situation; but for most, support will be required to help them help themselves.

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Laurel D. Edmunds, PhD

Laurel D. Edmunds, PhD, is an Obesity Research Psychologist, Head of Research, iOpener Ltd, Oxford, England, United Kingdom.

Author contact: [email protected], with a copy to the Editor: [email protected]

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