Introduction: The Voices of Lived Experience

Laura Stewart

Introduction

The aim of this book is to support healthy weight practitioners such as dietitians, nutritionists, psychologists, social workers, physicians, health coaches and other professionals who currently, or indeed wish to, work in the field of childhood obesity and weight management. It will interest students of these professions as well as practicing clinicians. It explores current evidence and best practice while delving into the practical delivery of clinical management and touches on prevention by briefly looking at the whole systems agenda and the early years.

In this introductory chapter, the points of view of children and young people, their parents and carers are given through a synthesis of published qualitative research of interviews with children and young people living with obesity and their parents. It is intended that giving such insight into the lived experience of children and young people and their families, at the beginning of a text book on childhood obesity and weight management, will be thought provoking for the reader. This introductory chapter is intended to aid weight management practitioners in considering their own personal approaches when reading the subsequent chapters, which cover the science, evidence and best practice of this discipline. This has been put into an introductory chapter to emphasise the importance to practitioners of hearing the voice of lived experienced. All direct quotes from children, young people and parents in this section are taken from and referenced to the original published work.

It was an important concept at the outset of writing this book that the voice of the children and young people living with obesity and their parents was heard and was at the forefront of the reader's mind. Although not the only source, a number of the works quoted below are from published qualitative works by this author and colleagues. Another important resource for this section was the recent work undertaken in 2022 by The Association for Young People's Health (AYPH) for NHS England [1].

To give another perspective, this book also brings to the fore the views of experienced professionals working in the field of childhood weight management. A number of one-to-one semi-structured conversations were carried out with clinical and research experts in this field by this author between 2021 and 2023. These included experienced dietitians, service managers, public health practitioners, physical activity experts and psychologists. Rich, unique insights with quotes and discussions of important themes that emerged during these conversations are given below in the second section.

The Voice of Children, Young People Living with Obesity and Their Parents

When Do Parents Look for Support?

For many parents, recognising the need to seek help for their child's weight management is a difficult process. Work by Gillespie et al. found that for some parents even discussing the topic of weight was overwhelming: 'the problem is too big', 'I can't bear to raise it, and I don't want to make things worse' [2].

Discussing what their reasons for seeking support for their child's weight were, this group of parents described possible 'triggers' for seeking help including

• recognising that their child was being bullied
• being aware that their child was wearing outsized clothes for their age
• having concerns about their child's current or future health [2].

Not being able to recognise that their child's weight was outside the healthy weight zone was something that parents spoke about.

'I didn't realise he was so overweight, I didn't realise he was that, because he doesn't look it because he's broad, so he carries it well, but I was quite shocked to find out his actual weight' [3]. This can lead to difficult conversations happening with health professionals who are raising the topic for the first time. While Murtagh et al. reported that young people can be aware of the need for support with their weight and are actually waiting for their parents to take action, 'I knew about it but my parents didn't believe me' [4].

Studies reported that consideration of the matter of a child's weight can be overwhelming for parents, 'the problem is too big' and 'I can't bear to raise it, and I don't want to make things worse' [2]. Rigby noted that the young people could also feel overwhelming, 'time to comprehend so you don't get overwhelmed' [1].

Attitudes and Qualities of the Health Professional

Families report that the attitudes of health professionals, especially their ability to build and develop rapport, are important to them [5]. Parents in studies have talked about the necessary qualities of the professional as 'being friendly, supportive, helpful, good listeners, non-judgemental and non-patronising' [1, 2]. As well as how vital it is that they are seen within a non-stigmatising service [2].

The 2022 work from AYPH discussed the negative feeling that can emerge when professionals do not have the right communication and people skills, 'One hospital appointment made my child feel set for self-destruction' [1]. Stewart et al. found that professionals not trained in the use of behavioural change techniques found it harder to form a rapport and make the families feel supported [5].

'I don't really think it was a success 'cause I don't think we both actually liked the dietitian, em. I think that wasn't just me, he didn't like her' and 'I expected more than just talk'

[5].

Using Behavioural Change Tools

When it came to aspects of behavioural change tools being used in programmes, it was reported by parents that tools were positive and enabling an improvement in self-esteem and ownership for the child and young person. 'None of us like to be told to do things and so it was like forming a partnership and it worked' and 'if she wanted a treat of chocolate throughout the day, she had to decide, she has to tell me' [5].

Using the tool of self-monitoring through keeping a lifestyle diary was seen as helpful in raising awareness of current behaviours, 'I was happy for C to watch TV but I wasn't aware of how much time she was actually watching but when we recorded it I was really surprised. I just wasn't aware of things that is why recording was so good' [5].

Stigma and Self-esteem

Many studies talked about participants reporting stigmatisation, low self-esteem and bullying of young people living with obesity [1, 6].

'he gets bullied, and everything, low self-esteem, he's got no friends, he doesn't go out' [2].

'if my daughter felt better about herself, she wouldn't be so angry all the time, she's got quite a lot of emotional issues due to being a bit heavy' [2].

'People call me names because they think it's funny but it's not' [4].

For young people, they felt that health services should give equal consideration to their mental health and well-being as to their physical health [1, 7]. Indeed, an important theme emerging from Yerges et al. was titled 'health is like a physical, mental and social balance'. Their work suggested that weight management programmes need to have a holistic-person-centred approach, taking equally into account these three interlinked aspects of a young person and their family's live [7].

'Because I mean like anything that affects a person's like day-to-day life I think could fall under health care, whether it is physical or mentally' [7].

A number of studies reported that parents were aware, and anxious, about the emotional effect of their child's weight. They talked about wishing for their child to be happy and how important it is to them, as parents, for their child's self-esteem to be positively impacted by the programme [1, 2].

'she used to be embarrassed at school cause there were things she couldn't do in PE that she can do now' [5].

'He used to wear jogging bottoms for comfort, but we managed to get him dress (in) trousers for school. He was saying it's really good isn't it, it has been really good for him' [3].

Programme Outcomes

This leads to consider what it is that children, young people and their parents regard as a desired outcome of treatment. For those children, young people and the parents interviewed, they reported that concentrating on a weight outcome of treatment was not always a positive concept. There was a reported ambivalence from young people towards being weighed and comments that...