Intra-familial stigmatization

Stigma-Generating Mechanisms in Families Enrolled in a Pediatric Weight Management Program: A Qualitative Study of Health Identities and Healthcare Authenticity

In recent years, there has been increased awareness of obesity as a condition that carries a high level of stigma, as well as growing recognition of its prevalence and harm. Despite the increasing body of research on this topic, there is a gap in the literature regarding mechanisms that generate or exacerbate perceptions of weight stigma, especially within families and pediatric healthcare settings. The present study aims to identify potential stigma-generating mechanisms by focusing on inter-relational dynamics within these contexts. We conducted in-depth, semi-structured interviews with 11 families and analyzed the data by applying sociological theories on health identities and authenticity. Our study found four themes that represent potential stigma-generating mechanisms by being explicitly related to familial health identities and healthcare authenticity: (1) negotiating and reconstruction familial self-understanding, (2) between guilt, shame and conflicts, (3) navigating weight perceptions, and (4) the necessity of positivity and relevance. Our study shows the complexities of weight stigma within family and pediatric healthcare settings, emphasizing the need for sensitive and tailored support, as well as the value of working authentically as crucial aspects in preventing and/or reducing stigma.

Mechanisms of Stigmatization in Family-Based Prevention and Treatment of Childhood Overweight and Obesity

It is well established that overweight and obesity are often accompanied by stigmatization. However, the influence of stigmatization on interventions for overweight and obesity remains unknown. Stigma may be particularly harmful to children. This study aimed to examine how stigmatization affects efforts to reduce childhood overweight and obesity through family interventions. This research was conducted in a socially disadvantaged area in Denmark. Twenty-seven families and forty professionals participated in in-depth interviews or workshops. The data were analyzed using CMO configurations from a realist evaluation and the theory of stigmatization developed by Link and Phelan. Thus, an abductive approach was employed in the analysis, with its foundation rooted in the empirical data. The study found that the mechanisms of stigmatization could 1. restrain professionals and parents from approaching the problem-thereby challenging family recruitment; 2. prevent parents from working with their children to avoid eating unhealthy food for fear of labeling the child as overweight or obese; and 3. cause children with obesity to experience a separation from other slimmer family members, leading at times to status loss, discrimination, and self-stigmatization. The study showed how the mechanisms of stigmatization may obstruct prevention and treatment of childhood obesity through family interventions. It is suggested that the concept of stigma should be incorporated into the program theories of interventions meant to reduce childhood overweight and obesity.

A Qualitative Evaluation of Social Aspects of Sugar-Rich Food and Drink Intake and Parental Strategies for Reductions

Danish children have a much larger intake of sugar-rich foods and drinks than recommended. This study aimed to (1) explore social aspects and practices of pre-school children's intake of sugar-rich foods and drinks and (2) evaluate barriers and parental strategies to reduce their children's intake of sugar-rich foods and drinks employed in connection with the 3.5-month family-centred intervention trial 'Are you too sweet?'. Intervention components included communication of the recommended maximum intake and reduction strategies, supported by resources encouraging and facilitating behavioural changes. A random sample of families (n = 24) from intervention schools participated in post-intervention semi-structured interviews. A thematic content analysis was conducted, revealing three main domains of social practices: (1) 'family treats', including the weekly Danish concept 'Friday sweets', (2) 'everyday treats', such as sweet snacks in lunch packs, between-meals snacks and soft drink habits and (3) 'socialized treats', including treats at special occasions. Parents employed several strategies, most often substitution and portion-size reduction, but also limiting home availability. Families most frequently made changes that were easily adoptable and close to existing routines at home. In conclusion, the intervention components provided families with knowledge and strategies that facilitated behavioural changes towards reducing the intake of sugar-rich foods and drinks.

Children's experiences of meals after obesity treatment: a qualitative follow-up four years after a randomized controlled trial

Background

The practice of eating together, commensality, is rarely explored in the context of childhood obesity treatment. This is noteworthy given long-standing debates about the physical, psychosocial, and societal benefits of meals, especially family meals. Moreover, as children with obesity experience weight bias and stigma both within and outside the home, it is important to examine meals as a locus of social exchange around food and the body. Our study is based on the premises that eating together (i) matters and (ii) occurs in different environments with diverse social organization, where food-related interactions create varying arrangements of individuals, groups, their statuses, and their actions.

Method

The study explores children’s experiences of meals in different social contexts. Thirty-two children (age 8–10 years) living in Sweden were interviewed, 4 years after they entered an obesity intervention trial. Thematic analysis was applied to the data.

Results

We thematized three meal types, with each meal type having two subthemes: (i) “The family meal”, with “Shared routines, rituals, and rules” and “Individual solutions and choices”; (ii) “The school meal”, with “Rules and norms of the school” and “Strategies of the child”; and (iii) “The friend meal”, with “Handling food that was disliked” and “Enjoyment of food”. These three different meal types carried different experiences of and knowledge about how they were socially organized.

Conclusions

While the children spoke about the family and school meals as meaningful, the friend meal stood out as particularly positive. Contrary to our expectations, the children did not express experiences of weight bias or obesity stigma around meals, nor did they speak negatively about parental control of their food intake. Our findings, especially regarding the friend meal, have implications for further research into commensality and social influences on eating among children with obesity, from early childhood into adolescence.

‘I Think It Will Be Like This Forever’: How Family Narratives Affect Participation in a Childhood Weight Management Intervention

The family represents the cause of as well as the solution to childhood overweight in many family-based childhood weight management interventions. Involving the family also entails involving the individual family members’ experiences with, attitudes towards, and understandings of obesity. This study explores how families with life-long experiences of overweight manage and experience a family-based childhood weight management intervention in Northern Zealand in Denmark. The analysis is focused on family narratives and their temporal character. The families’ narratives about overweight and past weight management interventions are crucial to how they understand and manage the present intervention. Additionally, the families expect the focus on weight management to continue to be a constant part of their everyday life. The paper concludes that the understanding of weight management in interventions should take its point of departure in the life-world, which the individual family creates through members’ narratives about overweight.

Understanding children and young people's experiences pursuing weight loss maintenance using the Socio-ecological Model: A qualitative systematic literature review

Developing a broader understanding of children and young people's experiences of long-term attempts of weight management may provide insight into both enablers and barriers to successful weight loss maintenance. This review aims to explore children and young people's perceptions of long-term attempts of weight management. Six databases were searched for qualitative studies describing young participants (<25 years, previously or currently above a healthy weight) experiences of weight management for >6 months following intentional weight loss. A thematic synthesis was undertaken. Themes were interpreted using the Socio-ecological Model. Factors supporting attempts to maintain weight loss included having clear motivation for change; developing personal skills to manage the challenges of change; family support/dynamics that encourage healthy lifestyles; and health-promoting cultures in schools/workplaces, communities, and the broader living environment. Conversely, ambivalence, difficulty coping with changes, peer pressure, challenging family dynamics, limited professional support, and unhealthy living environments were barriers to maintaining behavior change. These facilitators and barriers at each level of the Socio-ecological Model informed a model of weight loss maintenance for children and young people. Supporting children, young people, and families to develop the skills to manage the individual, social, and environmental challenges that shape attempts of long-term weight management will help to support their ability to manage their weight long term.

Exploring the Causes of Obesity Among Adults in the Kurdish Regions of Iran: A Qualitative Study

BACKGROUND

Obesity is one of the most important public health problems in the world, which is occurred by various factors. The purpose of this study is to explore the causes of obesity in the Kurdish regions of Iran with a qualitative approach.

METHODS

A qualitative content analysis study was conducted in the Kurdish regions of Iran from June 2019 to November 2019. The data were collected by holding focus group discussions and semi-structured interviews with 111 obese and thin men and women, and experts from different fields, who were selected through purposive sampling. Additionally, the data were analyzed by the conventional content analysis approach following the steps proposed by Graneheim and Lundman. The researchers used ATLAS.ti (Version 2019) software for data analysis and management. Lincoln and Guba's criteria were used to assess the quality of the research.

RESULTS

The results of the data analysis were classified into 5 categories and 16 sub-categories. The main categories included the modern lifestyle, sociocultural norms, indigenous culture of nutrition, lack of institutionalization of exercise, and low health literacy.

CONCLUSION

Changing people's beliefs and values ​​about obesity and thinness, changing the dietary habits of individuals, expanding and institutionalizing exercise and physical activity, and enhancing health literacy can prevent and control obesity.

Contextual Complexities in Implementing a Family-Based Childhood Obesity Intervention: The Perspectives of Enrolled Children and Their Parents

Family interventions to treat childhood obesity are widely used, but knowledge about how family dynamics are affected by these interventions is lacking. The present study aims to understand how a family intervention impacts the context of family dynamics, and how different contexts affect the families’ implementation of the intervention. Based on qualitative interviews, we studied families with a child between 9–12 years enrolled in a family intervention to treat childhood obesity at a pediatric outpatient clinic. We conducted 15 family interviews including 36 family members. We found that the family intervention created a new context for the enrolled children. They had to navigate in different contexts and non-supportive environments and push for change if they needed more supportive environments in their attempt to adhere to healthy habits. We show the complexities experienced by parents and grandparents when trying to comply with siblings’ and/or grandchildren’s different needs. The enrolled children were often indirectly blamed if others had to refrain from unhealthy preferences to create supportive environments. These findings are significant in understanding the important role of contexts in family-obesity interventions. This knowledge is relevant to health professionals, researchers, and policymakers.

Intra-familial health polarisation: how diverse health concerns become barriers to health behaviour change in families with preschool children and emerging obesity

In a disadvantaged rural area in Denmark, severe challenges have been identified concerning overweight and obesity in families with preschool-age children. The present paper examines how families with young children and emerging obesity issues perceive 'healthy living' and barriers to practising it. Using data from qualitative workshops with families and professionals working with them, we reveal health perceptions and related family dynamics. Drawing on P. Bourdieu's theory of habitus and 'tastes of necessity', K.L. Frohlich et al.'s notion of 'collective lifestyles' and E. Lindbladh and C. H. Lyttken's theory of preconditions for health behaviour change and reactions to risk-related information, we analyse how risk perceptions and related health practices within the families are influenced by the local contexts in the disadvantaged area under study. Despite shared perceptions of 'healthy living', we found that diverse health-risk perceptions created family dynamics in which parents performed opposed health behaviours, which became a huge barrier to becoming a healthier family. Based on our theoretical approach, we propose that risk perceptions and reactions are highly context dependent, as illustrated in both micro-contexts (family dynamics) and the macro-context (the disadvantaged area).

Families' Adherence to a Family-Based Childhood Obesity Intervention: A Qualitative Study on Perceptions of Communicative Authenticity

Childhood obesity is associated with severe physical and psychological health problems. Interventions are often directed at the whole family, but the literature provides no clear indication of the characteristics of an effective family-based intervention. The objective of the present paper is to study whether and how an analytical framework focusing on communicative authenticity can be used to observe and elaborate upon aspects of adherence in relation to health behavior change in a concrete family-based intervention. We do this by focusing on the families' experiences with a Shared-care health education intervention and thus explore the association between families' self-reported experience and their adherence to the intervention. The dataset consists of 21 in-depth semi-structured family interviews. The study shows that the Shared-care model has potential, but that this potential is rarely fulfilled in the intervention form under study. The sharing of care adds potential for several kinds of communicative authenticity because families are met by both the medical knowledge authority at the hospital and the local nurses in their municipality. It is, however, a significant finding that the families rarely benefit from this potential authenticity. Using theories of authenticity in this context adds theoretical and analytical potential and manages to incorporate elements of participation in tasks and practices of value, a sense of who we are and what we know, negotiation of meaning, emphatic caring, consistency between values and actions, and horizons of significance. The article brings new perspectives on how family-based interventions could be tailored to communicatively suit individual families.