Qualitative studies among obese children and adolescents: a systematic review of the literature

Assessment of the potential effects of l-carnitine and cinnamon supplementation on weight loss and body composition

OBJECTIVE

Aim: To assess efficacy of L-carnitine and cinnamon alone and in combination on body composition parameters in addition to compare between them.

PATIENTS AND METHODS

Materials and Methods: Sample of 28 obese and overweight adults in Babylon city, sample collection includes patients in places, or by internet, where interview take place according to specialize questionnaire height, weight, and body mass index were measured.

RESULTS

Results: A significant differences P<0.05 among gender distribution between male and female. A significant difference between (150-160 cm, 160-170 cm) as compared with (170-180 cm, 180-190 cm). A significant difference between 170-180 cm as compared with 180-190 cm but non-significant differences between 150-160 cm as compared with 160-170 cm. A significant difference between 26-35 as compared with 36-45, 46-55, but non-significant differences between 36-45 as compared with 46-55. A significant difference between body weight, body fat, water content, skeletal muscle, and body mass index after treatment, but non-significant differences between protein, and inorganic salt after treatment and at baseline. A significant difference between body weight, water content, skeletal muscle, and body mass index in group treated with cinnamon as compared with negative control group, but non-significant differences between body fat, protein, and inorganic salt as compared with negative control group.

CONCLUSION

Conclusions: The prevalence of overweight and obesity within accepted range of that reported in Iraq, important relationship was reported between several life style risk factor, as soon as diagnose increase in weight and education health program for behavior of life style were high recommended.

Perspectives of healthcare professionals on facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle

Objective

To explore the perspectives of healthcare professionals (HCPs) within an integrated care approach on the facilitators, barriers and needs in children with obesity and their parents in achieving a healthier lifestyle.

Methods

Semi-structured interviews were conducted with eighteen HCPs working within a Dutch integrated care approach. The interviews were analyzed by performing a thematic content analysis.

Results

Main facilitators identified by HCPs were support from parents and the social network. Main barriers were first and foremost family's lack of motivation, which was singled out as a precondition for starting the behavior change process. Other barriers were child's socio-emotional problems, parental personal problems, lack of parenting skills, parental lack of knowledge and skills regarding a healthier lifestyle, parental lack of problem awareness and HCP's negative attitude. To overcome these barriers, main needs that HCPs suggested were a tailored approach in healthcare and a supportive HCP.

Conclusion

The HCPs identified the breadth and complexity of underlying factors of childhood obesity, of which the family's motivation was pointed out as a critical factor to address.

Innovation

Understanding the patient's perspective is important for HCPs to provide the tailored care needed to address the complexity of childhood obesity.

The Impact of Sport Activity Shut down during the COVID-19 Pandemic on Children, Adolescents, and Young Adults: Was It Worthwhile?

We conducted a national retrospective survey of 1764 athletes aged ≤25 years to investigate the benefit–risk balance of sport closure during the COVID-19 pandemic peaks in Italy. Univariate and multivariable analyses were carried out to investigate the association between sport practice during the study period and (1) the risk of SARS-CoV-2 infection in athletes and their families and (2) body mass index (BMI) change, and adherence to World Health Organization (WHO) guidelines for physical activity. The percentage of subjects with a positive SARS-CoV-2 test was similar in those participating and not taking part into sport activities (11% vs. 12%, respectively, p = 0.31). Restricting the analysis to subjects who practiced sports within an organized sport society/center, the risk of SARS-CoV-2 positivity was reduced for athletes who had never stopped their training (odds ratio (OR); 95% confidence intervals (CI): 0.62; 0.41–0.93). On the other side, responders who had stopped sport activity showed a 1% increase in BMI. Adherence to WHO guidelines for physical activity was significantly higher for athletes who had continued sport activities. In conclusion, sport closure and limitations had an important negative impact on the overall health of young athletes, being also not effective in reducing the spread of COVID-19.

Weight-Based Victimization and Physical Activity Among Adolescents With Overweight or Obesity: A Scoping Review of Quantitative and Qualitative Evidence

Background

Increased physical activity engagement plays a vital role in preventing and treating overweight or obesity in children and adolescents. Research has found that adolescents who are overweight or obese tend to participate in less physical activity than adolescents of average weight. Weight-based victimization (victimization related to weight or body size) is highly prevalent in adolescence and seems to be a factor that might negatively impact engagement in physical activity. This scoping review's objective was to identify the nature and extent of research evidence on links between weight-based victimization and physical activity among community-based or primary health care samples of adolescents who are overweight or obese.

Methods

Following established scoping review methods, we searched electronic databases PubMed, Web of science, SportDiscuss, and Cinahl from 23 Nov 2020 to 02 Dec 2020. Published studies with community-based or primary health care samples of adolescents who were overweight or obese (aged 13–18 years, Iso-BMI ≥ 25, i.e., age and gender specific percentiles based on specified cut-off value for overweight and obesity) and that were peer-reviewed and published were included in the analysis. Data from the included studies were put into a table and analyzed descriptively and numerically in terms of the extent and nature of the studies.

Results

After full text review, 12 articles were included, equally distributed in the qualitative and quantitative paradigm. There was a homogeneity of the research designs applied. Articles revealed high frequency of weight-based victimization. Among quantitative studies the reported links between weight-based victimization and physical activity were somewhat mixed, with three studies reporting weight-based victimization to negatively impact physical activity, while three studies report no significant impact. Qualitative studies reported experiences of teasing and bullying by peers, humiliation, and feelings of insecurity about appearance as barriers to engagement in physical activity.

Conclusion

The empirical evidence on the links between weight-based victimization and physical activity among community-based or primary-health care samples of adolescents who are overweight or obese is sparse. The results revealed a high presence of weight-based victimization in physical activity which seems to act as barriers for activity engagement. There is a need for more research to advance the understanding of the links between weight-based victimization and physical activity among community-based or primary-health care samples of adolescents who are overweight or obese.

Links between obesity, weight stigma and learning in adolescence: a qualitative study

BACKGROUND

Educational attainment is a key social determinant of health. Health and education are linked by multiple pathways, many of which are not well understood. One such pathway is the association between being above a healthy weight and lower academic achievement. While various explanations have been put forward to explain this relationship, evidence for causal pathways is sparse and unclear. This study addresses that evidence gap.

METHODS

We interviewed 19 adults (late 20s; 14 female, 5 male) and one young person (14 years, male) from the UK in 2019/2020. Participants were recruited from the ALSPAC 1990s birth cohort, sampled to ensure diversity in socio-economic status and educational attainment, and a community-based weight management group for young people. Interviews focused on experiences of being above a healthy weight during secondary school and how this may have affected their learning and achievement. Interviews were face-to-face, digitally recorded, and transcribed verbatim. We analysed the data thematically.

RESULTS

We identified key pathways through which higher body weight may negatively impact educational performance and showed how these are linked within a novel theoretical model. Because larger body size is highly stigmatised, participants engaged in different strategies to minimise their exposure to negative attention. Participants sought to increase their social acceptance or become less socially visible (or a combination of both). A minority navigated this successfully; they often had many friends (or the 'right' friends), experienced little or no bullying at school and weight appeared to have little effect on their achievement at school. For most however, the behaviours resulting from these strategies (e.g. disruptive behaviour, truanting, not working hard) or the physical, social or mental impacts of their school experiences (e.g. hungry, tired, self-conscious, depressed) made it difficult to concentrate and/or participate in class, which in turn affected how teachers viewed them.

CONCLUSIONS

Action to combat weight stigma, both within schools and in wider society, is urgently required to help address these educational disparities that in turn can impact health in later life.

Adapting pediatric obesity care to better suit adolescent patients: Design of a treatment platform and results compared with standard care in the national patient quality register

BACKGROUND

Obesity constitutes a critical risk for adolescent health. This study aimed at identifying youth-friendly components of obesity treatment.

METHODS

In this feasibility study, an adolescent obesity treatment platform was implemented at two Pediatric outpatient clinics in Sweden. Body mass index (BMI), BMI z-score, and the category of obesity (International Obesity Task Force) were compared before and after the intervention and with data on standard care from the Swedish Childhood Obesity Treatment Register.

RESULTS

The study included 99 participants (49 females) aged 13-18 years from 1 September 2014, to 31 December 2016. A pediatric nurse met the participants on average 6.5 times in the average inclusion period of 15 months. Physical activity sessions attracted 63 participants. Acceptance Commitment Therapy and In Real Life groups attracted 24 participants. At inclusion, 62 participants had obesity and 37 severe obesity, and 71/99 (72%) remained in the same category. The mean BMI increased from 32.0 to 33.4 kg/m2 (p < 0.01), but 56/94 (60%) participants lowered their BMI or increased less than 1 kg/m2 and 73% stayed to the end of the study. Participants who were new to treatment and participants coming for more than eight visits to the nurse did not increase in BMI. BMI did not change for the 221 out of 641 register patients who had two recordings of BMI in the study period.

CONCLUSIONS

The platform was successful in increasing retention, and 60% of participants lowered or maintained their BMI. Still, seven out of ten adolescents with obesity or severe obesity remained in the same weight category.

Adolescent Girls With Overweight and Obesity Feel Physically Healthy and Highlight the Importance of Mental Health

Introduction

Obesity in adolescence is a significant ongoing public health problem that has not improved over the past decade.

Objective

This descriptive qualitative study explores the perspective of female adolescents who are overweight or obese regarding their views on health and weight within the clinic setting.

Methods

In-depth interviews were conducted with female adolescents (age 13–19 years old; BMI ≥85th percentile) from the mid-west region of the United States (N = 28). Inductive thematic analysis using Braun & Clarke’s methods was utilized.

Results

The findings from this study revealed that the adolescents’ view of health encompasses physical, mental, and psychosocial health dimensions, and despite being overweight and obese, the participants felt healthy. Participants discussed the need to eat healthier and increase their daily physical activity, but were unable to transform this into action. Within the clinical setting, the adolescents were sensitive to weight discussions.

Conclusion

Results from this study can increase providers’ understanding of the adolescent, increase awareness of adolescent sensitivity, and assist researchers in developing age-appropriate interventions for effective treatment and prevention of childhood obesity.

Strategies to reduce attrition in managing paediatric obesity: A systematic review

OBJECTIVE

To conduct a systematic review of the literature for strategies designed to reduce attrition in managing paediatric obesity.

METHODS

We searched Ovid Medline (1946 to May 6, 2020), Ovid Embase (1974 to May 6, 2020), EBSCO CINAHL (inception to May 6, 2020), Elsevier Scopus (inception to April 14, 2020), and ProQuest Dissertations & Theses (inception to April 14, 2020). Reports were eligible if they included any obesity management intervention, included 2 to 18 year olds with overweight or obesity (or if the mean age of participants fell within this age range), were in English, included experimental study designs, and had attrition reduction as a main outcome. Two team members screened studies, abstracted data, and appraised study quality.

RESULTS

Our search yielded 5,415 original reports; six met inclusion criteria. In three studies, orientation sessions (n = 2) and motivational interviewing (MI) (n = 1) were used as attrition-reduction strategies before treatment enrollment; in three others, text messaging (n = 2) and MI (n = 1) supplemented existing obesity management interventions. Attrition-reduction strategies led to decreased attrition in two studies, increased in one, and no difference in three. For the two strategies that reduced attrition, (a) pre-treatment orientation and (b) text messaging between children and intervention providers were beneficial. The quality of the six included studies varied (good [n = 4]; poor [n = 2]).

CONCLUSION

Some evidence suggests that attrition can be reduced. The heterogeneity of approaches applied and small number of studies included highlight the need for well-designed, experimental research to test the efficacy and effectiveness of strategies to reduce attrition in managing paediatric obesity.

The Impact of Social Isolation during the COVID-19 Pandemic on Physical and Mental Health: The Lived Experience of Adolescents with Obesity and Their Caregivers

Adolescence is a complex developmental phase, made more complex by obesity and the social isolation imposed by the COVID-19 pandemic. The literature related to the impact of social isolation on obesity self-management in adolescents is scant and inconsistent. This paper describes the phenomenon from the perspectives of a sample of adolescents with obesity enrolled in an inpatients' multidisciplinary rehabilitation program for weight-loss and their caregivers, and its impact on different life domains. Individual semi-structured ad hoc interviews were conducted with 10 adolescent-caregiver dyads, and narratives were qualitatively investigated using an interpretative phenomenology approach to data. Twenty participants took part in the study. The major themes that emerged from this study fall into five basic categories: (1) COVID-19 as an opportunity to reconsider what makes a good life; (2) Persistence in life; (3) Empowering relationship; (4) Daily routine in quarantine; (5) Lives on hold. Understandings drawn from this study may assist health care professionals in providing holistic support, and guidance to adolescents with weight-related issues and their caregivers who experience social isolation during the COVID-19 pandemic.

Female adolescents with overweight and obesity share their perspectives on the clinical setting and weight management

The clinical setting remains a strategic environment for early assessment, identification and treatment of adolescents with obesity. Yet, healthcare providers' (HCPs) efforts have been unsuccessful in improving physical activity, nutritional intake or body mass index in adolescents with obesity. Obesity is a chronic condition that influences how patients interact with HCPs and experience ambulatory healthcare appointments. However, it is unknown how female adolescents with obesity perceive the clinical setting, especially regarding weight management. The purpose of this study was to explore the perceptions of female adolescents with obesity regarding health and weight management in the clinical setting. Using a qualitative design, 28 English-speaking female adolescents, 13 to 19 years of age, with a body mass index ≥85th percentile for height and weight participated in individual interviews. Results demonstrate that adolescents with obesity desire to be recognized as unique individuals and to be involved in their own health conversations. The participants reported that their health care was inadequate when they received impersonal and vague advice from HCPs on weight loss. Weight-related communication was best received in a kind and empathetic manner, with a focus on improving one's health (instead of losing weight). Adolescents in this study articulated the components of healthy eating and physical exercise, yet were unable to synthesize this knowledge into specific dietary practices and daily physical activities. The insights derived from female adolescents with obesity provide guidance on how HCPs can improve their relationship and engage the adolescent in weight-based discussions. Concrete, actionable recommendations are provided for providers who work with female adolescents who are overweight or obese.

Research in adolescent healthcare: The value of qualitative methods

BACKGROUND

The vast majority of publications about adolescent healthcare use a quantitative methodology that often involves long and expensive research protocols with results that do not always provide answers adequate to the complexity of the questions being asked. The qualitative method is sometimes a more effective alternative for exploring some of these. This method can be defined from its objective, which is to generate theoretical hypotheses, its mandatory consideration of the researcher's subjectivity, and the importance it ascribes to the context of the participants' experience. Among the many techniques of qualitative research, the use of phenomenological methods, in particular, interpretative phenomenological analysis (IPA), is highly developed in medical research.

OBJECTIVES

To define the qualitative method and describe the principal stages of a phenomenological qualitative study.

RESULTS

The three stages of a qualitative study are data collection (population and sampling, data collection methods), data analysis, and writing up the results. Purposive sampling makes it possible to include participants who can describe in detail, and as experts, their experience during semi-structured interviews. The analysis takes place in two stages, the first very descriptive, the second more interpretative. The results are written-up in a narrative form, including both direct quotations from the interviews and the researchers' interpretation.

DISCUSSION

The issues of health promotion and healthcare associated with the management of chronic symptoms or diseases in adolescents involve an extremely rich and complex context. Qualitative methods make it possible to approach these questions and to understand them better by generating hypotheses from a rigorous scientific procedure appropriate to the context and objectives. In addition to being used on their own, they can be used on an exploratory basis early in a quantitative study to help define it better, for explanatory purposes, to help understand complex quantitative results, or combined with a quantitative study. The qualitative and quantitative results will then be integrated.

Talking About Childhood Obesity: A Survey of What Parents Want

OBJECTIVE

Determine parent preferences when discussing their child's weight with regard to weight-based terms, terms that are the most motivating, preferred setting, and whether or not awareness of their child's weight status impact these preferences.

METHODS

Parents of children ages 3 to 17 years (N = 349) presenting for health supervision visits completed a survey to assess the degree of offensiveness and motivation for change of commonly used weight-based terminology, as well as the preferred setting for discussion of weight. Parents were asked to assess their child's weight status using recommended terminology ("obese," "overweight," "healthy weight," "underweight"), and their responses were compared to the children's objective body mass index (BMI) percentile.

RESULTS

The children had a median age of 10.3 years; 47.3% were female, 15.8% had overweight (85th-94th percentile BMI), and 11.5% had obesity (≥95th percentile BMI). Of children with overweight/obesity, 84.2% of parents underestimated their child's weight status. The least offensive terms were "at-risk weight," "BMI is high," "BMI is above 95%," and "unhealthy weight." The more offensive terms (P < .001) were "overweight" and "obese." The parent's perception of their child's weight did not affect offensiveness ratings. "Obese" was the strongest motivator for change (P < .001), and "unhealthy weight" was next. Well visits were preferred for discussing weight (P < .001). Most parents preferred to have the child remain in the room (P < .001), especially if the child was older (P < .001).

CONCLUSIONS

Providers should use preferred terms when discussing excess weight regardless of a parent's perception of their child's status and should also consider the motivational value of the term. "Unhealthy weight" was both preferred and motivating, but "obese" was the most motivating.

Cultural Influences on Childhood Obesity in Ethnic Minorities: A Qualitative Systematic Review

Introduction: Childhood obesity remains an unrelenting public health problem disproportionately affecting ethnic minorities. Although research has examined ethnicity as a factor of childhood obesity, few studies have examined cultural influences. The purpose of this systematic review was to examine the qualitative evidence of cultural influences on childhood obesity in ethnic minority groups. Methodology: Selective sampling of studies since 2008 yielded 251 articles. Twelve articles that addressed cultural influences on childhood obesity were identified for review. The Culture Care Theory Sunrise Enabler factors were used as an a priori framework for theme coding. Results: Nine themes emerged: child feeding, family, gender roles, food, healthy child appearance, physical activity, sedentary activity, food cost, and obesogenic environment. Discussion: Cultural care practices such as traditional foods and family meals are protective factors in childhood obesity and should be encouraged by nurses caring for and working with ethnic minority populations.

Physicians' Perspectives About Burnout: a Systematic Review and Metasynthesis

BACKGROUND

Doctors' burnout is a major public health issue with important harmful effects on both the healthcare system and physicians' mental health. Qualitative studies are relevant in this context, focusing as they do on the views of the physicians of how they live and understand burnout in their own professional field.

OBJECTIVE

To explore physicians' perspectives on burnout by applying a metasynthesis approach, including a systematic literature review and analysis of the qualitative studies.

DATA SOURCES

Medline, PsycINFO, EMBASE, and SSCI from the earliest available date to June 2018 REVIEW METHODS: This metasynthesis follows thematic synthesis procedures. Four databases were systematically searched for qualitative studies reporting doctors' perspectives on burnout. Article quality was assessed with the Critical Appraisal Skills Program. Thematic analysis was used to identify key themes and synthesize them.

RESULTS

Thirty-three articles were included, covering data from more than 1589 medical doctors (68 residents and 1521 physicians). Two themes emerged from the analysis: (1) stress factors promoting burnout-ranked as organizational, then contextual and relational, and finally individual-factors and (2) protective factors, which were above all individual but also relational and organizational.

CONCLUSIONS

The individual and organizational levels are abundantly described in the literature, as risk factors and interventions. Our results show that doctors identify numerous organizational factors as originators of potential burnout, but envision protecting themselves individually. Relational factors, in a mediate position, should be addressed as an original axis of protection and intervention for battling doctors' burnout.

Who is responsible for keeping children healthy? A qualitative exploration of the views of children aged 8-10 years old

OBJECTIVE

The issue of who is responsible for children's physical health is complex, with implications for targeting and developing strategies for health promotion and interventions to improve health. While there is evidence to suggest that children are able to construct notions of responsibility in relation to other areas of their lives, very little research has explored children's views of responsibility for their own health. The aim of this study was to explore children's views about who they feel is responsible for keeping them healthy.

DESIGN

Focus groups were used to gather qualitative data using a semistructured topic guide. Interpretative phenomenological analysis was used in an iterative, double hermeneutic approach to analyse the data.

SETTING

Focus groups took place in two UK primary schools in deprived inner city areas.

PARTICIPANTS

20 children aged 8-10 years took part in one of two focus groups (10 children in each group).

RESULTS

Three overarching themes were identified: (1) individual and collective responsibility, (2) marketing and conflict with taking responsibility, and (3) what people and organisations can do to help children to take responsibility. Children feel that they, parents, families, school staff, medical professionals, food producers, retail outlets, supermarkets, advertisers and the government are all responsible for their health and should thus demonstrate responsibility through their behaviours around children's health.

CONCLUSIONS AND IMPLICATIONS

Children's views were consistent with constructs of responsibility as both a moral obligation and a set of behaviours, and with wider sociopolitical philosophies of individual and collective responsibility. These findings further support a focus on integrated, system-wide approaches to children's health.

Viewpoints of adolescents with overweight and obesity attending lifestyle obesity treatment interventions: a qualitative systematic review

BACKGROUND

Current UK guidance recommends that adolescents with obesity attend a family-based multi-component obesity intervention. However, these programmes suffer from low recruitment and high rates of attrition. Understanding the views of adolescents is necessary for developing future interventions. The aim of this systematic review was to synthesize and explore the views of adolescents who have attended an obesity intervention.

METHODS

Published literature was identified by searching six databases. Studies of adolescents (12-17 years) who attended an obesity intervention were examined. Only studies that collected and analysed data qualitatively were included. Full texts were analysed using thematic synthesis.

RESULTS

Twenty-eight studies were included. Thirty-five analytical themes were developed that were broadly divided into seven domains. Key themes included ensuring adolescents receive a 'tailored intervention' that involves 'active engagement'. Support from professionals, family and peers were valued highly. Adolescents expressed 'prior fears of attending interventions' and wanted 'longer term support'. 'Enjoyment of sport and physical activity' was evident, and adolescents were strongly motivated by improving body image and social desirability.

DISCUSSION

Considering the views of adolescents attending obesity interventions may help to inform policy makers in the development of future interventions. This may lead to an improvement in recruitment and attrition rates.

School-Based Weight Management Program Curbs Summer Weight Gain Among Low-Income Hispanic Middle School Students

BACKGROUND

Research shows that elementary students gain weight over the summer. It is unknown if these findings apply to Hispanic adolescents. We evaluated school and summer standardized body mass index (zBMI) changes in Hispanic middle school students.

METHODS

Hispanic middle school students were randomly assigned to a weight management program (N = 230) or control condition (N = 195). Paired sample t-tests compared zBMI change scores during the school year versus summer when not enrolled in a weight management program (eg, control group). We used 2 × 2 repeated measures analysis of variances to determine program group differences in zBMI scores across school versus summer periods separately for normal and overweight/obese students.

RESULTS

In the control group, students' zBMI change scores decreased during the school year, but increased during summer for both normal weight and overweight/obese students. Program effects on zBMI indicated school year decreases and summer increases for both normal and overweight/obese students. However, zBMI scores did not differ by program status for normal weight students. Overweight/obese students in the program compared to the control group increased zBMI to a lesser extent over the summer.

CONCLUSION

For all students, zBMI increased during the summer. A school-based weight management program protected overweight/obese students against potentially greater summer weight gain.

[The relational issues surrounding food in obese teenagers and their family]

Several qualitative studies have been carried out into the relational issues in families where a teenager is suffering from obesity. Power struggles, issues related to love, relational distance and family organisation must be taken into account in the care of these teenagers. Work on the intrafamily relational aspects can help to improve the effectiveness of standard treatments.

Adolescents' perspectives on everyday life with obesity: a qualitative study

Purpose: This study aimed to gain an in-depth understanding of the perspectives and life experiences of adolescents living with obesity. Methods: Five adolescents living with obesity were involved in repeated interviews, and qualitative content analysis was performed. Results: Three themes emerged: obesity as a multi-faceted and difficult to solve condition; obesity as a shameful and vulnerable subject; and bullying and fragile social relationships. Adolescents living with obesity described everyday life challenges as difficult to interpret and solve. Adolescents living with obesity perceived causes for obesity differently, and those who emphasised familial determinants seemed to face greater challenges. Lack of support from parents, trusted friends and health-care providers and bullying, shame, guilt and self-blame represented threats that decreased motivation for help seeking and successful life-style changes. The adolescents were ambivalent regarding disclosing their concerns and seeking help. The adolescents feared that health care providers would demand too much from them, and peers were perceived as a possible source of support. Conclusion: Care providers need to be skilled in assessing each individual’s resources and interpretations of their condition, to be able to communicate in a respectful, patient-centred manner and to assist adolescents to explore their ambivalence and set their own realistic goals. More research is needed.

Health literacy in a complex digital media landscape: Pediatric obesity patients’ experiences with online weight, food, and health information

This study aimed to explore experiences with online information regarding food, weight management, and health in a group of adolescents in treatment for obesity. Individual semi-structured interviews with 20 adolescents were conducted. Participants used a screen-recorded laptop to demonstrate their search procedures and online information sources. The transcribed interviews were categorized using qualitative content analysis. The adolescents described both encouraging and discouraging experiences. On one hand, they said that online forums could provide nutritious meal ideas and inspiration as well as social support for behavior change. On the other hand, they mentioned that there was a confusing amount of misleading commercial content online and also experiences of peer-facilitated food marketing in online networks. An overarching theme was generated: social media might be a resource for health inspiration, health information, and social support, but requires awareness and competencies. Implications for clinical practice are discussed in light of these findings.

Lifestyle weight management programmes for children: A systematic review using Qualitative Comparative Analysis to identify critical pathways to effectiveness

This study aimed to identify critical features of successful lifestyle weight management interventions for overweight children (0-11years). Eleven qualitative UK-based studies examining children's, parents' and providers' perspectives and experiences of programmes were synthesised to identify components felt to be critical. Studies for this views synthesis were identified from existing reviews and an update of one review's search, which was run in December 2015. The identified components were then explored in a synthesis of intervention evaluations (five 'most effective' and 15 'least effective') conducted in western Europe, North America, Australia or New Zealand. The intervention evaluations were identified from existing reviews and an update of one review's search, which was run in March 2016. This evaluation synthesis was carried out using Qualitative Comparative Analysis. Three important mechanisms were present in all the most effective interventions but absent in all the least effective: 1/ showing families how to change: a) providing child physical activity sessions, b) delivering practical behaviour change strategy sessions, c) providing calorie intake advice; 2/ ensuring all the family are on board: a) delivering discussion/education sessions for both children and parents, b) delivering child-friendly sessions, c) aiming to change behaviours across the whole family; 3/ enabling social support for both parents and children by delivering both child group sessions and parent group sessions. To conclude, programmes should ensure the whole family is on board the programme, that parents and children can receive social support and are not just told what to change, but shown how.

Maternal concerns and perceptions of elementary school-age children's weight status

PURPOSE

The purpose of this study was to identify characteristics associated with maternal concerns for her child becoming overweight, and how these concerns are related to her perceptions of her child's weight.

DESIGN

A school-based sample of 55 children and their mothers from Houston, Texas, participated in a cross-sectional survey. Mothers reported on their concerns and perceptions regarding their child's weight. Child and mother height and weight were directly assessed to calculate body mass index (BMI). Covariate-adjusted logistic regression models were conducted.

RESULTS

Over one-third of mothers misperceived their child's weight status [9% (n = 5) overestimated; 27% (n = 15) underestimated]. Mothers of sons were less accurate compared with mothers of daughters. For every one unit increase in maternal BMI, mothers had 13% higher odds of being concerned of their child becoming overweight. Concerned mothers had 82% lower odds of underestimating their child's weight.

PRACTICE IMPLICATIONS

In order for school-based childhood obesity prevention and intervention programs to be successful, parents must accurately perceive their elementary school-age child's weight status. School nurses can be vital to these efforts through proper training and resources. Nurses can use the "School Nurse Childhood Obesity Toolkit" and motivational interviewing techniques to address parental concerns and perceptions prior to teaching behavior modification strategies to children/families.

Patient experiences of outcomes of bariatric surgery: a systematic review and qualitative synthesis

Although bariatric surgery is the most effective treatment for severe and complex obesity, less is known about its psychosocial impact. This systematic review synthesizes qualitative studies investigating the patient perspective of living with the outcomes of surgery. A total of 2,604 records were screened, and 33 studies were included. Data extraction and thematic synthesis yielded three overarching themes: control, normality and ambivalence. These were evident across eight organizing sub-themes describing areas of life impacted by surgery: weight, activities of daily living, physical health, psychological health, social relations, sexual life, body image and eating behaviour and relationship with food. Throughout all these areas, patients were striving for control and normality. Many of the changes experienced were positive and led to feeling more in control and 'normal'. Negative changes were also experienced, as well as changes that were neither positive nor negative but were nonetheless challenging and required adaptation. Thus, participants continued to strive for control and normality in some aspects of their lives for a considerable time, contributing to a sense of ambivalence in accounts of life after surgery. These findings demonstrate the importance of long-term support, particularly psychological and dietary, to help people negotiate these challenges and maintain positive changes achieved after bariatric surgery.

Agriculture, Food Systems, and Nutrition: Meeting the Challenge

Malnutrition is a global challenge with huge social and economic costs; nearly every country faces a public health challenge, whether from undernutrition, overweight/obesity, and/or micronutrient deficiencies. Malnutrition is a multisectoral, multi-level problem that results from the complex interplay between household and individual decision-making, agri-food, health, and environmental systems that determine access to services and resources, and related policy processes. This paper reviews the theory and recent qualitative evidence (particularly from 2010 to 2016) in the public health and nutrition literature, on the role that agriculture plays in improving nutrition, how food systems are changing rapidly due to globalization, trade liberalization, and urbanization, and the implications this has for nutrition globally. The paper ends by summarizing recommendations that emerge from this research related to (i) knowledge, evidence, and communications, (ii) politics, governance, and policy, and (iii) capacity, leadership, and financing.

Metasynthesis of the Views about Treatment of Anorexia Nervosa in Adolescents: Perspectives of Adolescents, Parents, and Professionals

BACKGROUND

Anorexia nervosa in adolescents can be a difficult-to-treat disease. Because qualitative research is a well-established method for deepening our understanding of subjective experiences, such as eating disorders and their treatment, we sought to perform a systematic review of qualitative studies to synthesize the views of adolescents with this disease, their parents, and their healthcare providers about its treatment.

METHODS

We performed a thematic synthesis to develop the central themes that summarize all of the topics raised in the articles included in our review. The quality of the articles was assessed by the Critical Appraisal Skills Program.

RESULTS

We included 32 articles from seven different countries. Two central themes were inductively developed from the analysis: (1) the treatment targets (i.e., symptoms and patients in context), and (2) a therapeutic tool-a relationship, specifically the core concept of the therapeutic relationship.

CONCLUSION

Our results underline the difficulty in establishing a therapeutic alliance, the barriers to it, especially the risk that professionals, adolescents, and parents will not converse about treatment; although such a dialogue appears to be an essential component in the construction of a therapeutic alliance.

Metasynthesis: An Original Method to Synthesize Qualitative Literature in Psychiatry

BACKGROUND

Metasynthesis-the systematic review and integration of findings from qualitative studies-is an emerging technique in medical research that can use many different methods. Nevertheless, the method must be appropriate to the specific scientific field in which it is used. The objective is to describe the steps of a metasynthesis method adapted from Thematic Synthesis and phenomenology to fit the particularities of psychiatric research.

METHOD

We detail each step of the method used in a metasynthesis published in 2015 on adolescent and young adults suicidal behaviors. We provide clarifications in several methodological points using the latest literature on metasyntheses. The method is described in six steps: define the research question and the inclusion criteria, select the studies, assess their quality, extract and present the formal data, analyze the data, and express the synthesis.

CONCLUSION

Metasyntheses offer an appropriate balance between an objective framework, a rigorously scientific approach to data analysis and the necessary contribution of the researcher's subjectivity in the construction of the final work. They propose a third level of comprehension and interpretation that brings original insights, improve the global understanding in psychiatry, and propose immediate therapeutic implications. They should be included in the psychiatric common research toolkit to become better recognized by clinicians and mental health professionals.

The lived experience of anorexia nervosa in adolescence, comparison of the points of view of adolescents, parents, and professionals: A metasynthesis

BACKGROUND

Anorexia nervosa in adolescence has been increasingly documented in numerous quantitative and qualitative studies. Qualitative research, which focuses on subjective experience, is a well-established method to deepen our understanding and provide new insights about specific diseases.

OBJECTIVE

We conducted a metasynthesis of qualitative studies to explore how anorexia nervosa is experienced by adolescents, their families, and the health professionals who provide care for them and to compare their perspectives.

REVIEW METHODS

Five databases (Medline, PsycINFO, CINHAL, EMBASE, SSCI; 1990-2015) were systematically searched for qualitative studies reporting participants' views about anorexia nervosa. Article quality was assessed with the Critical Appraisal Skills Program (CASP). We used thematic synthesis to examine and summarize the topics found in the articles selected and develop their central themes.

RESULTS

We included 30 articles from seven different countries. Two domains of experience were inductively developed from the analysis: (1) constructs and beliefs about etiological theories of anorexia nervosa, and (2) the experience of the disease from the points of view of adolescents, parents, and healthcare providers.

CONCLUSIONS

We found important disparities between the three stakeholders. The adolescents underlined the psychological and emotional aspects of their experience, while the visible state of these patients' bodies impeded the work of the professionals. These difficulties shed new light on the stakes of treatment of anorexia nervosa in adolescence, which must integrate both its psychological and physical components.

A qualitative exploration of the work of embodiment in adolescent girls with obesity

Social representations generally associate obesity, especially in adolescent girls, with sedentariness, lack of self-control and laziness. These girls thus have substantial problems of self-esteem. Dietary, lifestyle and behavioural approaches alone cannot address this issue, for they do not apprehend all of the complexity of obesity. This qualitative study is based on a dual observation: that the work performed by adolescents is unrecognized and that the body is not considered as a subject of analysis. It raises the question of the corporality of these teens through an original perspective: that of the perspective of their organization of actions on, to and by the body, in specific situations. The objective is to have access to the corporal experience of young girls with obesity, so that we can understand and support them better. The data come from semi-directive interviews with 10 adolescent girls with obesity. The content was analysed in terms of concepts of professional didactics (a branch of educational psychology) and enaction. Five situations were identified from these interviews: the first, shopping with friends, concerns actions by the subjects towards their bodies; the other four are enacted actions: conduct towards a normal-weight person, conduct in public transportation, performing physical activity, and eating. The results show the work of these young women with obesity, the means they mobilize to live in their bodies and their considerable efforts of embodiment. Recognition of this work should help to enhance their self-esteem. Treatment and support may take this dimension of work into account and help them to become aware of the efforts they make every day.

Perceptions and Practices of Physical Activity Among Colombian Overweight/Obese Schoolchildren

The purpose of this study was to explore the contexts that shape obese children's engagement in physical activity (PA) focusing on children's perceptions. The qualitative design consisted of non-participant observations, and unstructured and semi-structured focus group and individual interviews. Data were analyzed by use of conventional content analysis. Participants were overweight/obese children from a public school in Colombia. The findings show that the main context where PA took place was during physical education (PE) classes at school and in the children's neighborhoods. The participants perceived the PE classes to be too competitive and demotivating. PA taking place outside school was associated with fun, but occurred only on an infrequent basis and was challenged by living in insecure neighborhoods. Adapting a health promotion approach that emphasizes participation and social environments might motivate obese children to become physically active at school as well as during leisure time.

Engaging children in the development of obesity interventions: Exploring outcomes that matter most among obesity positive outliers

OBJECTIVE

To explore outcomes and measures of success that matter most to 'positive outlier' children who improved their body mass index (BMI) despite living in obesogenic neighborhoods.

METHODS

We collected residential address and longitudinal height/weight data from electronic health records of 22,657 children ages 6-12 years in Massachusetts. We defined obesity "hotspots" as zip codes where >15% of children had a BMI ≥95th percentile. Using linear mixed effects models, we generated a BMI z-score slope for each child with a history of obesity. We recruited 10-12 year-olds with negative slopes living in hotspots for focus groups. We analyzed group transcripts and discussed emerging themes in iterative meetings using an immersion/crystallization approach.

RESULTS

We reached thematic saturation after 4 focus groups with 21 children. Children identified bullying and negative peer comparisons related to physical appearance, clothing size, and athletic ability as motivating them to achieve a healthier weight, and they measured success as improvement in these domains. Positive relationships with friends and family facilitated both behavior change initiation and maintenance.

CONCLUSIONS

The perspectives of positive outlier children can provide insight into children's motivations leading to successful obesity management.

PRACTICE IMPLICATIONS

Child/family engagement should guide the development of patient-centered obesity interventions.

Perspectives of obese children and their parents on lifestyle behavior change: a qualitative study

Background

In order to improve and optimize future behavioral family lifestyle intervention programs, more information on the perceptions of obese children and their parents of these programs is needed. As such, the aim of this qualitative study is 1) to explore the expectations of obese children and their parents in relation to lifestyle interventions; 2) to identify barriers to making lifestyle changes that parents and children face within their social context (within the family, at school and amongst friends and peers) as well as the things that facilitate these changes and 3) to identify the needs of obese children and their parents in the context of a lifestyle intervention.

Methods

A qualitative study using semi-structured interviews was conducted. Interviewees were participants in a lifestyle intervention program in the Netherlands.

Results

Eighteen children (mean age 10 years) and 24 parents were interviewed. The respondents expected to lose weight by being physically active or by eating healthily. Parents struggled with adopting and adhering to new rules and the absence of support of family members. Children struggled with inconsistent parenting and a lack of support from their parents. Bullying experienced at school impeded the children in their ability to make the necessary changes. Support from peers, on the other hand, stimulated their progress. Parents identified the need for the general practitioner to discuss overweight in a non-offensive way and to show an interest in the process of weight loss.

Conclusions

Participants in a lifestyle behavior intervention program benefit from parental support and help from their (extended) family, peers and friends. They would also profit from the sustained involvement of their general practitioner in assisting in the maintenance of lifestyle behavior changes.

Electronic supplementary material

The online version of this article (doi:10.1186/s12966-015-0263-8) contains supplementary material, which is available to authorized users.

'I just don't want to get bullied anymore, then I can lead a normal life'; Insights into life as an obese adolescent and their views on obesity treatment

BACKGROUND

Adolescent obesity is a complex condition involving social, emotional, behavioural and cultural issues.

DESIGN

One-to-one interviews and small focus groups with overweight and obese young people were conducted. Qualitative research is an appropriate method to explore the complexity of this issue.

SETTING AND PARTICIPANTS

Overweight and obese adolescent's attending a community weight management intervention in South Yorkshire.

MAIN VARIABLES STUDIED

Interviews aimed to explore the experiences of obese adolescents and their perspectives towards obesity treatment.

RESULTS

Adolescent's provided detailed accounts of their perspectives on weight gain, alluding to disordered patterns of eating and overeating, reported as being triggered by social and emotional factors, and in particular, bullying. Avoidance of bullying and a desire to integrate socially with peers were key drivers to seek treatment. Young people reported what they should do to lose weight, yet responsibility for successful weight loss and lifestyle change was repeatedly attributed to the treatment received, as opposed to viewing this as a combination of self-motivation coupled with support provided by friends and family.

CONCLUSION

Weight loss programmes need to consider the complex experience of obese young people in their design, focusing on how to implement long-term lifestyle changes.

Metasynthesis of youth suicidal behaviours: perspectives of youth, parents, and health care professionals

BACKGROUND

Youth suicide is a major public health issue throughout the world. Numerous theoretical models have been proposed to improve our understanding of suicidal behaviours, but medical science has struggled to integrate all the complex aspects of this question. The aim of this review is to synthesise the views of suicidal adolescents and young adults, their parents, and their healthcare professionals on the topics of suicidal behaviour and management of those who have attempted suicide, in order to propose new pathways of care, closer to the issues and expectations of each group.

METHODS AND FINDINGS

This systematic review of qualitative studies--Medline, PsycInfo, Embase, CINAHL, and SSCI from 1990 to 2014--concerning suicide attempts by young people used thematic synthesis to develop categories inductively from the themes identified in the studies. The synthesis included 44 studies from 16 countries: 31 interviewed the youth, 7 their parents, and 6 the healthcare professionals. The results are organised around three superordinate themes: the individual experience, that is, the individual burden and suffering related to suicide attempts in all three groups; the relational experience, which describes the importance of relationships with others at all stages of the process of suicidal behaviour; and the social and cultural experience, or how the group and society accept or reject young people in distress and their families and how that affects the suicidal process and its management.

CONCLUSION

The violence of the message of a suicidal act and the fears associated with death lead to incomprehension and interfere with the capacity for empathy of both family members and professionals. The issue in treatment is to be able to witness this violence so that the patient feels understood and heard, and thus to limit recurrences.

Literature review: perceptions and management of body size among normal weight and moderately overweight people

Improved understanding of how normal weight and moderately overweight people manage their body weight and shape could be used to inform initiatives to prevent and treat obesity. This literature review offers a thorough appraisal of existing research into perceptions and management of own body size among normal weight and moderately overweight people. The studies reported in the 47 publications reviewed here address various themes based on different conceptualizations. The studies point out that normal weight and moderately overweight people are much concerned about their body size, but huge discrepancies are found between their own perceptions and study categorizations. The studies also indicate that normal weight and moderately overweight people are actively engaged in managing their body size through numerous managing strategies, and dieting is widespread. Together the studies do not form a unified and coherent research field, and there is a bias towards North American study populations. Methodological problems were identified in some publications, raising questions about generalizability of the findings. Moreover, only few studies give deeper insight into the specific perceptions and actions. Repeated studies are needed in broader and more differentiated geographical, social and cultural contexts, and longitudinal studies and more in-depth explorations are especially needed.

Re-entering obesity prevention: a qualitative-empirical inquiry into the subjective aetiology of extreme obese adolescents

BACKGROUND

While numerous studies highlight the relevance of socio-cultural factors influencing incidence and prevalence of obesity, only a few address how obese people perceive causes and prevention of or intervention for obesity. This study contributes to a more thorough understanding of subjective aetiologies and framing themes for a mainly understudied but promising field. Thus it may serve for the development of effective public health strategies to combat obesity.

METHODS

Autobiographically based in-depth interviews were conducted with 20 patients (adolescents and young adults) institutionalised in the obesity rehabilitation centre INSULA in Bischofswiesen (Germany). The data were analysed with Atlas.ti with regard to two main perspectives: (1) How the interviewees perceive 'their' obesity from a subjective point of view and (2) which conclusions they draw from their own 'story' concerning prevention/intervention strategies.

RESULTS

The interviewees did not indicate a clear starting point for their overweight. Nevertheless, certain life-events (e.g. divorce or illness of parents) were identified as catalysing weight gain. As a consequence of coping with distress, body weight rises rapidly and not continuously. Obesity was generally framed as a problem primarily located within the family and not in the wider environment. Corresponding to this, the family was identified as the main and most important addressee of preventive measures. The interviewees highlighted the importance of personal responsibility as a prerequisite for self-determined action against obesity, but denied any link between responsibility and guilt.

CONCLUSIONS

This study contributes substantially to a broader perspective on the prevention of obesity. First, more attention has to be paid to the interactions of medical aspects and the social dimension of obesity. Second, prevention efforts should be more aware of the relevance of subjective aetiology when it comes to the definition of reasonable and effective governance strategies in tackling obesity. Third, current assumptions concerning the importance of personal responsibility for obesity prevention might underestimate the relevance of self-determined action of the obese.

Parents' obesity-related behavior and confidence to support behavioral change in their obese child: data from the STAR study

OBJECTIVE

Successful childhood obesity interventions frequently focus on behavioral modification and involve parents or family members. Parental confidence in supporting behavior change may be an element of successful family-based prevention efforts. We aimed to determine whether parents' own obesity-related behaviors were related to their confidence in supporting their child's achievement of obesity-related behavioral goals.

METHODS

Cross-sectional analyses of data collected at baseline of a randomized control trial testing a treatment intervention for obese children (n = 787) in primary care settings (n = 14). Five obesity-related behaviors (physical activity, screen time, sugar-sweetened beverage, sleep duration, fast food) were self-reported by parents for themselves and their child. Behaviors were dichotomized on the basis of achievement of behavioral goals. Five confidence questions asked how confident the parent was in helping their child achieve each goal. Logistic regression modeling high confidence was conducted with goal achievement and demographics as independent variables.

RESULTS

Parents achieving physical activity or sleep duration goals were significantly more likely to be highly confident in supporting their child's achievement of those goals (physical activity, odds ratio 1.76; 95% confidence interval 1.19-2.60; sleep, odds ratio 1.74; 95% confidence interval 1.09-2.79) independent of sociodemographic variables and child's current behavior. Parental achievements of TV watching and fast food goals were also associated with confidence, but significance was attenuated after child's behavior was included in models.

CONCLUSIONS

Parents' own obesity-related behaviors are factors that may affect their confidence to support their child's behavior change. Providers seeking to prevent childhood obesity should address parent/family behaviors as part of their obesity prevention strategies.

'It's on your conscience all the time': a systematic review of qualitative studies examining views on obesity among young people aged 12-18 years in the UK

OBJECTIVE

To explore the perspectives of young people in the UK on obesity, body size, shape and weight.

DESIGN

Systematic review of qualitative studies using thematic synthesis.

DATA SOURCES

Sensitive searches of 18 electronic databases from 1997 to February 2010 supplemented by grey literature searches.

STUDY SELECTION

Studies produced since 1997 using qualitative methods to collect perspectives of people aged 12-18 years in the UK, reporting methods for data collection or analysis. Studies of people with eating disorders and those rated low in reliability and usefulness were excluded.

RESULTS

Searches identified 30 studies involving over 1400 young people from a range of contexts. Young people of all sizes placed considerable emphasis on personal responsibility, and on the social, rather than health implications of being overweight. Young people with experience of obesity described severe, unrelenting, size-related abuse and isolation. Regardless of their own size, young people were judgemental of individuals who were overweight, but those with experience of obesity described an environment that contained multiple barriers to weight loss. Only one study asked young people directly what might support them to have a healthy body size. Study findings were configured under three main themes, labelled with quotes from included studies: general perceptions of size and society's responses ('It's on your conscience all the time'); the experiences of young people who were overweight ('If I had the choice I wouldn't be this size') and these larger young people's experiences of trying to loose weight and suggestions for action ('Make sure, even when it's hard, you've got people there').

CONCLUSIONS

The perspectives of young people in the UK, when synthesised across the spectrum of body sizes, paint a picture of a stigmatising and abusive social world. Research and policy need to engage young people actively so as to address the social implications of obesity.