| Abstract | Childhood obesity (CO) is an epidemic issue in developed and developing countries (e.g. UK as developed and Iran as developing country) which needs to be addressed. Parents’/children’s awareness of weight status and health behaviours of the child are considered an initial step to prevent and mange CO. Thus, the aim of this thesis is to examine and explain parents’ and children’s awareness of the child’s weight status, Physical Activity (PA), Sedentary Behaviour (SB) and Fundamental Movement Skills (FMS) among normal weight and overweight children, in two different countries (i.e. Uk and Iran) with high rate of CO through a mixed method approach. Adopting a sequential explanatory design, this research is conducted in two consecutive phases, including three quantitative studies (using questionnaires) in phase one, following by qualitative study (using interview) in phase two to explain findings of quantitative studies. It should be noted that the studies in this thesis were conducted prior to the covid-19 pandemic.
The sample in the three quantitative studies (studies 1-3) consisted of 217 children (aged 8-10 years); 98 British and 119 Iranian as well as their parents. To assess actual weight status, Body Mass Index (BMI) percentile was measured and children were categorised as normal weight (N=71 British & 74 Iranian, if BMI <85th percentile) and overweight (N=27 British & 45 Iranian, if BMI ≥85th percentile). PA, SB (GeneActive accelerometers) and Fundamental Movement Skills (FMS) (Test of Gross Motor Development–2) of children were objectively measured. Verbal and visual tools were applied to assess weight status perception. Questionnaires were used for assessing PA, SB and FMS perception.
Results of quantitative studies found that many overweight children and their parents in both countries underestimated the child’s weight status verbally and visually, while British parents and children had lower accuracy than Iranian. In both weight groups Iranian parents, their children and British children overestimated the child’s PA level while British parents accurately perceived it. Iranian children’s overestimation of PA was more than British children. In addition, British parents and their children as well as Iranian normal weight children underestimated the child’s SB while Iranian overweight children were aware of their SB. Iranian parents overestimated SB of their children. Concerning FMS, in both countries parents of normal weight children were aware of the FMS levels of children whereas parents of overweight children and all children themselves were not aware of that. Comparing the two countries in study 3, British overweight children had higher levels of overestimation than Iranian overweight children.
The qualitative study (study 4) used semi-structured, face-to-face interviews with 40 parents (20 in each country) who had an 8-10 year old child and were fluent in their respective native languages (English and Farsi). Interviews were recorded, transcribed and analysed thematically.
Results of the qualitative study showed that in both countries parents felt responsible for CO and un/healthy behaviours of children, however Iranian parents, attributed the responsibility also to school and government as well. British parents placed less responsibility on these organisations. ‘Denial’ was suggested as a parental reaction to CO, and low activity levels and poor FMS of children which may impact parents’ awareness. There were a variety of reasons for denial but denial to avoid the social stigma attached to CO was raised mainly among Iranian parents while denial due to normalisation of obesity as well as to deflecting parental responsibility was raised more by British parents. While denial of high SB leading to underestimation was discussed by British parents, overestimation of SB was also discussed by Iranian parents as a strategy to encourage children to be more active, to avoid labelling their child as ‘hyperactive’ and also to persuade schools and government to promote PA of children. Nonchalant and positive attitudes towards CO and the notion that children will grow out of it was another parental reaction to CO discussed by parents in both countries. These factors were suggested by parents as potential reasons for parents’ misperception of their child’s weight. Time, cost, convenience, parents’ lack of knowledge (on all aspects of obesity, nutrition, PA, SB and FMS) child’s preference and weight as well as peer pressure were proposed by parents as barriers to behaviour change.
Overall, the results of the studies in this thesis showed that parents’ lack of awareness of CO, PA, SB and FMS of children is a critical issue for managing and treating CO and promoting healthy behaviours of children. In this regard, it was also found parents face various barriers that they need to be supported to overcome them suggesting that increasing awareness alone might not be sufficient. CO prevention and management is a shared responsibility that needs a multi-disciplinary multisector approach. In addition, the results of the studies in this thesis showed that to improve efficacy of intervention programs they need to be tailored to countries/cultures. |
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