‘It’s been a lifelong thing for me’: parents’ experiences of facilitating a healthy lifestyle for their children with severe obesity | BMC Public Health

The aim of this study was to better understand the experiences and challenges of parents/caregivers who were not or had chosen not to engage in a clinical tertiary obesity intervention program for children/adolescents with severe obesity, in facilitating a healthy lifestyle for their child/adolescent with severe obesity. Three major themes were identified—parents’ own lifelong obesity narrative, parents’ perceived inevitability of child/adolescent levels of obesity and parents’ perceived challenges in getting medical help for child/adolescent reduction in levels of obesity. Themes, sub-themes, and exemplar meaning units are displayed in Tables 2 and 3, and 4 and described in detail below.

Table 2 Themes, sub-themes and exemplar meaning units reflecting Parental own weight-related factors
Table 3 Themes, sub-themes and exemplar meaning units reflecting Parent perceived inevitability of child with obesity
Table 4 Themes, sub-themes and exemplar meaning units reflecting Parent perceived challenges in getting medical help for child weight loss

Parent lifelong obesity narrative

In describing challenges associated with helping their child/adolescent live a healthy lifestyle, many parents described their own history of lifelong issues or challenges with weight and shape. This history included obesity in childhood and bullying, parents’ levels of obesity being ‘out of control’, children/adolescents being aware of their parents’ struggle with their own weight, perceived cyclical failed attempts at weight loss, feelings of sadness and self-defeating evaluation, and acknowledging the importance of, but avoiding engagement in, health-related behaviours. The parents who reported previous attempts at weight loss all had levels of overweight or obesity at the time of interview.

The negative narrative of obesity was long-standing and entrenched for many parents. In describing challenges in supporting their child/adolescent’s healthy lifestyle, parents spoke of their own experiences of childhood and their parents’ negative weight-related behaviours, and how this impacted on their own health behaviour beliefs for their own children, such as Mel (P4):

I think it made us obsessed about food because there was just no flavour and no texture, and it was just quite miserable. Well, I think that we all—we’re emotional eaters and I can’t plan… so if something good happens then we celebrate with a treat. If something bad happens we commiserate with a treat and [sister name] and I, both of us have talked about this.

Parents commonly reported various negative weight-related experiences such as obesity in childhood and a history of weight-related teasing: “[My husband] was bullied for his weight when he was younger. But like us, his Mum took him to the doctor, and they just said, you’ll grow, it’s fine. It’s not so fine” (Robyn, P5).

Parents also described their feelings about their own current weight, their attitude towards making health related behaviour change, and often the effect this had on their child/adolescent. Parents reported their own weight as having ‘got out of hand’ or not knowing how to get started with weight loss. As Sharon (P2) noted, “And then when they put you on the scales and you’re like “Have I put on 10 more kilos since Christmas? Oh my God. It’s like it’s not happening then”. Parents spoke about knowing their children had awareness of their (the parent’s) own struggle with their level of obesity. For instance, Robyn (P5) described, “I go to the gym six times a week, and the boys know that”, highlighting her children’s awareness of their parents’ behaviour, and their knowledge that she is perpetually aware of her weight status. Parents often spoke about feelings of sadness and self-critical evaluation of their current weight status, such as Karen (P7); “I’m slowly getting more and more overweight and older and increasing my chances of diabetes and stuff. Knowing that I have been fit and healthier in the past and remembering those times”, with several parents actively labelling themselves as lazy such as Chrissy (P9), “We’re all lazy”. Some parents, like Alexis (P12), described knowing their weight was a problem but were not actively interested in doing anything to change this “Everything is just emotional. That’s it and sometimes it’s just too hard”. Many parents also described examples of knowing they should, but avoiding engaging in, health-related behaviours with their children and family, like Sharon (P2):

With [child name] trying to say “Mum, let’s go walk, let’s go walk”, and I feel like I’m letting her down, because she’s trying so hard to make changes, and going “I want to walk, I want to walk, but I’m like, yeah, “Next week darling, I really can’t focus right now, I’m sorry, leave me alone, I’m on the computer”.

Parents described their own history of multiple and repeated attempts at weight loss—attending the gym, restrictive fad diets or dieting, weight loss supplements or pills, weight loss programs, health professional advice, and two parents had undergone or were planning bariatric surgery. Many parents spoke of a perceived failure of weight loss as their reason for stopping any health-related behaviour change:

I went to the gym for a year I was toning, so that was the good thing about it, but I wasn’t losing anything, and I wanted to go and lose weight. So, I lost a kilo in six months, and I had three days a week a personal trainer, I was going to aerobics classes, I was trying so desperately. Sharon (P2).

This narrative of perceived failure of weight loss was described in a cyclical nature—that is, parents tried a health-related behaviour change, perceived failure, stopped the newly adopted behaviour, and returned to their previous unhealthy lifestyle. This cycle was often described as negatively influencing parents’ own current motivation, where parents described the capacity to change as being too late or too hard, like Alexis (P12):

I was walking like an hour a day for five days a week and didn’t lose anything. It just deflates me and now it’s just even worse now because I’m not doing anything, that’s my fault. I’ve got my own issues.

Parents described examples of acknowledging, but not acting on, their own and their child/adolescent’s level of obesity in instances requiring them to also engage in health behaviours, like Sharon (P2): “They’re [all the kids] always punishing me, because I didn’t do it. They’re always saying “You promised me and we haven’t gone walking”. Nearly all the parents with obesity described instances of unhealthy family eating behaviours, often explained through a lens of rationalising these unhealthy options, such as Karen (P7); “We used to have cooked meals like a few years ago. Especially when our fridge died, and I couldn’t afford to get another fridge, that is when we started with the frozen meals. Convenience and money”. Parents also described how their lifetime of obesity had a negative effect on their attempts at health-related behaviour change their child’s current levels of obesity, like Karen (P7),

He [child/adolescent] knows about the healthier options because he’s had them in the past, just my motivation and energy. Yes, and just the confidence because I haven’t really learnt the skills throughout my life to do it and stuff as well.

In summary, it appeared that in this theme parents described a negative and pervasive lifelong obesity narrative which had a detrimental effect on their child, children, and/or family, and that parents felt was unlikely to change.

Perceived inevitability of child with obesity

In discussing challenges experienced when supporting their child/adolescent to engage in a healthy lifestyle, parents felt a level of obesity was ‘inevitable’ for their child/adolescent, and that it presented an overwhelming long-term challenge no matter how hard parents tried to change it. At the time of interview, all but one child/adolescent had BMI-z scores (standardized score for gender and age) at or above the 99th percentile. All parents reported previous failed attempts at reducing their child’s level of obesity. Parents described wanting to help but that their motivation had been undermined by a sense of inevitability and hopelessness, feeling ineffectual due to past failures of reducing their child/adolescents level of obesity, ‘bad genes’, feelings of desperation due to past failures at reduction in obesity level, the gravity of their child’s severe obesity, feelings that their child/adolescents level of obesity was out of control, worry about their child’s long-term future, and child awareness of the gravity of the severity of obesity, frustration at the effort with no success, unwillingness to restrict child/adolescent diet, and defense of inactivity.

Although parents expressed a desire to help their child/adolescent, it seemed that parents’ motivation had been eroded or undermined by a sense of inevitability, hopelessness, and feelings of desperation for success in reducing their child\adolescents level of obesity, such as Carly (P3); “I’d do anything to learn more or help more”. Many parents attributed both their child’s severe obesity and often their own to “bad genes”, such as Chrissy (P9): “She’s built like her dad so she’s short and stumpy. She’s got a big belly. She’s got, yeah, unfortunately she’s got the bad genes”. Other parents described these ‘bad genes’ as limiting their capacity to change the child’s trajectory of severe obesity and describing it as being out of their control. Mel (P4), for example, noted: “I’m not sporty. [Dad’s] not sporty. We’re musos. It’s not even in his genes and he hasn’t been – unfortunately we couldn’t encourage him to do something that we don’t know how to do”.

All parents acknowledged the gravity of the severe level of obesity for their child and worried about their child’s long-term future, and described feeling sad for their child/adolescent due to their current severe obesity, such as Delia (P8): “I feel sad for her, because I think “Oh God, you’re only six, what are you going to be like when you’re 15, 20, if we don’t get on top of this?”. Many parents also perceived that their child was aware of the gravity of their severe obesity, such as Sharon (P2): “We want to help her, because she’s been seeing the paediatrician for two years, but nothing changed and at the last visit her weight went right up, and I saw her face change, and I thought ‘She’s not happy’.

Parents expressed strong feelings of frustration about their child’s level of obesity, which was expressed in several ways. Parents described the negative impact placed on themselves by the constant awareness and time focused on the severe obesity, such as Carly (P3): “I think it’s also very taxing on my husband and I”. This feeling of frustration also resulted in parent inaction which was counterproductive to goals of reducing their child/adolescent’s level of obesity. For instance, parents described an unwillingness to place dietary restrictions on their child as they wanted their child to just be ‘normal child’, such as Robyn (P5): “I just want him to be a normal kid. He’s going to get enough structure in his life, so I just think – I don’t want to have to say, oh, no mate”. Lastly, parents also described this frustration in a defensive manner promoting active rejection of any health-related change, even when faced with serious consequences for their family, such as Alexis (P12):

We’re all overweight,. And school is tough. My husband gets a bit edgy, not anti, but just…Yeah, like when Department of Children Services – they are going to take him off us [for child obesity level]- we were trying to do as best as we can, you know.

Challenges getting medical help for reducing child/adolescent level of obesity

All parents described seeking help in various forms from medical professionals to help their child/adolescents level of obesity. Parents described difficulties with child comorbid medical diagnoses which made it difficult to achieve any reduction in child levels of obesity, and problems in seeking support and guidance from medical professionals.

Child comorbid medical diagnoses make it hard to reduce level of obesity

Nearly all parents discussed a chronic medical condition for their child/adolescent as an additional layer of complexity alongside their child’s severe obesity. Children/adolescents health conditions/diagnoses included, respiratory conditions (asthma, allergic rhinitis, sleep apnoea, ear nose and throat issues), neurological abnormalities (absent posterior bright spot), muscle and joint conditions (low muscle tone, join pain), mental health diagnosis (autism, attention-deficit/hyperactivity disorder, anxiety, depression), and metabolic conditions (fatty liver disease, high blood pressure). Many parents directly attributed their child’s severe obesity to their child’s comorbid medical diagnoses, and often minimised the role of unhealthy foods and behaviours, such as Sharon (P2):

I think it’s her asthma medications in the past, I think it’s a lot to do with her health that’s been unhealthy, her asthma, her allergic rhinitis, it’s constant, her hay fever that’s constant, probably her sleep apnoea. So, I don’t think it’s totally just been her diet, I think it’s, because she was active and fit, and she does her school stuff, sport and things. And she’s not one to say “No, I don’t want to go walking”.

Parents described wanting to support their child/adolescent in living a healthy lifestyle but being unsure how best to engage in health-related behaviour change that would be appropriate for their child’s medical diagnoses, such as Doug (P1):

Because with his asthma and everything – I was not an asthmatic kid so I didn’t have a problem. [Mum name] was not an asthmatic kid. Both of us, when we were young we were active and with this we’re trying to work out what we can and what we can’t do and what he can eat and try to help him.

Parents reflected on the negative effects of comorbid conditions on their children’s severe obesity and feelings of hopelessness about future reductions of this level, even when engaging in making health related behaviour change, such as Carly (P3):

He’s got an absent posterior bright spot which is the bit that controls your hypothalamus. So it’s not his fault. The messages aren’t quite – they’re misfiring to tell him that he’s either full or had enough. It slows his metabolism down so even though we do such a restricted diet and we do a lot of exercise, it’s just he’s always going to be carrying a little bit extra.

Difficulties with medical professionals in seeking support for reductions in child level of obesity

Parents all described seeking health-related behaviour advice from differing medical doctors (often termed “General Practitioners”, or “GPs”, in Commonwealth countries such as Australia) and specialists to address their child/adolescent’s severe obesity, and advice specific for their child/adolescent’s comorbid medical diagnoses. Parents described repeated efforts to get help, but experienced minimisation of their children’s health problems by professionals, professionals blocking access to specialist services, feelings of frustration with negative and unhelpful attitudes of medical professionals, perceptions that specialist advice did not help, feeling judged by specialists who assumed parents were unwilling to follow their advice, and loss of confidence in specialist advice.

All families described repeatedly seeking help from primary care medical professionals (GPs) when seeking support specific to their child/adolescent’s severe obesity, such as Robyn (P5) “[Child names] been through quite a bit already, with regards to weight, so…Well, he’s been to – so, lots of GP visits, because we’re concerned about it”. Parents often described their worries were minimised by these professionals, like Delia (P8):

Over the years I’ve brought it up so many times with different GPs about her weight, and they all just kind of fob it off, like “Oh, she’s not that bad”. I’m like “Well, it’s not normal for a child to be this size”.

Parents also described being actively blocked by GPs in seeking additional help from other specialist services: “That’s why I’m thinking “What’s wrong with this kid?”. That’s why I said I wanted to go and see an endocrinologist, but this GP has just said no, just do the blood tests”. Delia (P8).

Many families were or had engaged with medical specialists, such as psychologists, paediatricians or dieticians, to address their child/adolescent’s severe obesity. Parents often described feeling frustrated with the negative and unhelpful attitudes of these professionals, like Carly (P3),

He [child] was probably 18 months old or maybe it was a bit earlier when I got the diagnosis. I thought there was something wrong – he [Paediatrician] said to me, “There’s no name for it. It is what it is. It’s just a birth defect and there’s nothing you can really do, maybe a bit of physio.” So, he [the Paediatrician] was a bit of a douche.

Parents described that medical specialists were unable to provide guidance that resulted in any change in health behaviours or reduction in the level of obesity in their child, as suggestions had been tried but had failed, such as Jane (P13):

They gave me a food diary, how much portion I should give to [Child name] and just the cycle. But I wasn’t able to get back to the dietician this year. It’s not helpful because what he eats is still the same. So there’s no variety or whatever and it’s just morning tea, lunch or whatever. It’s still the same. There’s nothing…There’s no change at all.

Some parents described feeling that specialists assumed parents were unwilling to follow their advice, leading to frustration. Such judgment was often expressed as leading to a loss of confidence in advice from medical professionals, such as Mel (P4): “When you see a nutritionist or a dietician they don’t seem to actually understand about autism, that it’s not just being a brat, it’s an actual – it’s not going to go away”.