Send­ing par­ents let­ters to fight child­hood obe­sity doesn’t work

Western Daily Press - - Business - This ar­ti­cle first ap­peared on the web­site www.the­con­ver­sa­

AROUND this time ev­ery year, the height and weight of over 95 per cent of chil­dren in the first and fi­nal years of pri­mary school in Eng­land are mea­sured as part of the Na­tional Child Mea­sure­ment Pro­gramme ( NCMP). With child­hood obe­sity lev­els ris­ing, this data set is put to use to iden­tify and sup­port par­ents whose chil­dren are at risk.

In most lo­cal au­thor­i­ties, care­fully worded let­ters are sent home to par­ents whose chil­dren are over­weight, mak­ing them aware of this and of­fer­ing sup­port to bring about change. But only a hand­ful of par­ents take up of­fers of sup­port, and many have pub­licly ex­pressed the anger and distress they feel on re­ceiv­ing feed­back that their child is over­weight. In­deed, some health ex­perts have called for an over­haul of the so­called “fat let­ters”.

As a re­searcher who has been work­ing with pub­lic health teams and Pub­lic Health Eng­land to try and im­prove the feed­back process and im­pact on par­ents, I know it can be tempt­ing to dis­miss some par­ents’ neg­a­tive re­ac­tions as rare ex­cep­tions, or per­ceive them as a tem­po­rary distress that par­ents need to go through be­fore ac­cept­ing the truth about their child.

But af­ter 12 years, one thing has be­come clear: the way we are us­ing the NCMP data is alien­at­ing, rather

Obese peo­ple are stig­ma­tised by so­ci­ety – no won­der par­ents re­act de­fen­sively to let­ters in­form­ing them their child is over­weight, says Fiona Gil­li­son, reader in Health and Ex­er­cise Psy­chol­ogy at the Univer­sity of Bath

than en­gag­ing, the fam­i­lies we re­ally want to reach – so per­haps it’s pub­lic health pro­fes­sion­als, and not par­ents, who need to change.

Par­ents raise many very rea­son­able ob­jec­tions to feed­back that their child is over­weight. For ex­am­ple, some ar­gue that their child looks nor­mal (which may be true, now that one in three 10- to 11-year-olds are over­weight).

Oth­ers say that their child has started pu­berty, so should be judged by dif­fer­ent cri­te­ria.

Again, this may be true; re­cent anal­y­sis sug­gests that up to 32 per cent of early-ma­tur­ing ten- to 11-year-old girls con­sid­ered over­weight ac­cord­ing to their chrono­log­i­cal age would not be con­sid­ered over­weight if their level of ma­tu­rity were taken into ac­count.

Par­ents also re­port real fears that talk­ing to chil­dren about be­ing over­weight could harm their self-es­teem and well-be­ing, and ul­ti­mately lead to eat­ing dis­or­ders. While there’s no ev­i­dence that one leads to the other, dis­cus­sions with chil­dren about los­ing weight are as­so­ci­ated with poorer well-be­ing.

Par­ents also lack con­fi­dence that they are ca­pa­ble of mak­ing a dif­fer­ence, es­pe­cially if they have strug­gled with their own weight in the past. Where this is the case, par­ents don’t con­sider tak­ing ac­tion to be worth the po­ten­tial risks to their child’s well-be­ing.

These ob­jec­tions raise some gen­uine chal­lenges, but don’t fully ex­plain why some par­ents might con­sider these ar­gu­ments more com­pelling than fac­tual in­for­ma­tion about their child’s health. At the root of this prob­lem is the stigma at­tached to obe­sity and over­weight peo­ple.

Decades of re­search shows that the pub­lic and health pro­fes­sion­als alike have an un­con­scious bias against over­weight peo­ple, who are at­trib­uted with bad qual­i­ties such as glut­tony and lazi­ness. And it’s nor­mal for hu­mans to re­spond emo­tion­ally to judge­ments that may be stig­ma­tis­ing, and to try and dis­tance our­selves from stig­ma­tised groups by look­ing for rea­sons not to trust such judge­ments.

So how­ever sen­si­tively worded the let­ter is, when it com­mu­ni­cates that a child is over­weight, this news will al­ways trig­ger an im­pas­sioned and de­fen­sive re­ac­tion to the stigma im­plied.

From all the re­search I’ve read and con­ducted on this topic, it’s ap­par­ent that par­ents feel the health mes­sages around child­hood obe­sity speak to some­one else’s pri­or­i­ties, rather than their own. Par­ents are not un­in­ter­ested in their child’s long-term phys­i­cal health – far from it – but they do feel a more press­ing re­spon­si­bil­ity for their child’s well­be­ing here and now.

The more we fo­cus on the phys­i­cal health risks of child­hood obe­sity, while fail­ing to ac­knowl­edge where this may con­flict with par­ents’ own de­ci­sions, the more par­ents may feel we are chal­leng­ing their right to de­cide what is best for their child’s health.

Par­ents have rightly chal­lenged some of the as­sump­tions that weight feed­back let­ters are based on. They have ar­gued that pro­vid­ing feed­back can ac­tu­ally risk harm to chil­dren, for ex­am­ple by trig­ger­ing par­entchild con­ver­sa­tions about weight that wouldn’t oth­er­wise hap­pen.

Re­searchers in other fields have pointed out that hav­ing an aware­ness of a child’s weight may not be a re­quire­ment for changes in diet or ac­tiv­ity lev­els to take place.

Given that NCMP feed­back let­ters show no ob­jec­tive ef­fect on the up­take of child weight man­age­ment ser­vices or re­duc­tion in obe­sity lev­els, per­haps pub­lic health pro­fes­sion­als owe it to par­ents to con­sider al­ter­na­tives, rather than press ahead with more of the same.

NCMP data tells us where child­hood obe­sity is more preva­lent at the com­mu­nity level – not just for in­di­vid­u­als. So the data could also be used to tar­get en­vi­ron­men­tal or com­mu­nity-based re­sponses, such as sup­port­ing af­ter school phys­i­cal ac­tiv­i­ties in schools where obe­sity is most preva­lent.

It could also be used to in­vest in com­mu­nity de­vel­op­ment ini­tia­tives in ar­eas of high obe­sity, for ex­am­ple by of­fer­ing grants to com­mu­nity groups, set­ting up fam­ily healthy cook­ing and ac­tiv­ity events and co­or­di­nat­ing lo­cal me­dia cam­paigns.

If pub­lic health pro­fes­sion­als stop trig­ger­ing par­ents’ de­fen­sive re­ac­tions by in­form­ing them that their child is over­weight, they could be more re­cep­tive to ini­tia­tives which foster health­ier be­hav­iours. And surely that’s bet­ter for ev­ery­one.

Par­ents have rightly chal­lenged some of the as­sump­tions that weight feed­back let­ters are based on

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