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"The thing is, kids don't grow the same": Parent perspectives on preschoolers' weight and size in Soweto, South Africa.

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van Sluijs, Esther MF 
Draper, Catherine E 


The prevalence of overweight and obesity is high among preschool age (3-5 years) children in South Africa, and children in urban low-income settings are particularly at risk. A better understanding of how parents or caregivers of young children perceive children's weight and size, as well as contextual factors influencing perceptions, is needed to inform interventions. The aim of this study was to examine how parents of preschool children in Soweto, South Africa, view childhood obesity, and to situate these perspectives in the context of the home environment in which preschool age children in Soweto live. Semi-structured in-depth interviews were conducted with 16 parents in four neighbourhoods of Soweto. Interviews were audio-recorded, transcribed verbatim, and analysed using reflexive thematic analysis following a contextualist approach. Three themes were developed: growing differently, the 'right' way to be, and weight is not health. These themes capture parents' views on complex and reportedly inevitable causes of obesity, ideas about acceptable and preferred body sizes, and the low priority of weight per se compared to health. The findings suggest that childhood obesity prevention in South Africa needs to be done in a non-stigmatising way that recognises environmental and contextual factors, such as parents' limited sense of agency in relation to their children's health and weight, and concrete resource constraints. Environmental barriers to healthy behaviours need to be addressed in order to overcome the coexisting challenges of childhood undernutrition and obesity in urban low-income South African settings.



Adult, Body Mass Index, Caregivers, Child Health, Child, Preschool, Female, Health Behavior, Humans, Interviews as Topic, Male, Middle Aged, Parents, Pediatric Obesity, Poverty, Qualitative Research, South Africa, Young Adult

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PLoS One

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Public Library of Science (PLoS)


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Medical Research Council (MC_UU_12015/7)
Medical Research Council (MR/K023187/1)
Economic and Social Research Council (ES/N013891/1)
MRC (MC_UU_00006/5)
The work of S.K. and E.M.F.v.S. was supported by the Medical Research Council (MC_UU_12015/7, and a flexible supplement award for S.K.). The work was undertaken under the auspices of the Centre for Diet and Activity Research (CEDAR), a UKCRC Public Health Research Centre of Excellence (RES-590-28-0002). Funding from the British Heart Foundation, Department of Health, Economic and Social Research Council, Medical Research Council, and the Wellcome Trust, under the auspices of the UK Clinical Research Collaboration, is gratefully acknowledged. Funding from the Research Councils UK Newton Fund to the University of Cambridge (ES/N013891/1) and from the National Research Foundation to the University of the Witwatersrand (UID:98561) is also gratefully acknowledged. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.