More community education and more physical education in schools are needed to manage the childhood overweight problem in Indonesia and other emerging economies.
Better community education regarding healthy lifestyles and encouraging carers to monitor their children’s growth will help in the fight to maintain a healthy weight, according to a new study on the perceptions of mothers and grandmothers toward childhood overweight in Indonesia.
The qualitative research indicates that simpler and more effective ways to disseminate healthy lifestyle messages are needed, as well as a greater quantity and quality of physical activity in schools. The findings were published recently in the International Journal of Behavioral Nutrition and Physical Activity.
The authors note that the study is the first in Indonesia to investigate the knowledge, attitudes, and beliefs surrounding childhood overweight of mothers/grandmothers from different socioeconomic groups.
The findings will help draw attention to the broader issue of rising overweight/obesity in emerging economies such as Indonesia and have several policy implications, say Cut Novianti Rachmi, MD, from the University of Sydney Clinical School, Australia, and colleagues.
One of the main messages is “for front-line health practitioners (doctors/midwives/nurses) to be more active in educating the community,” they say. This in turn will help to augment the health-related knowledge of the primary carers in countries such as these, which are experiencing explosions in childhood overweight and obesity, they note.
No Differences in Attitudes Between Difference Socioeconomic Groups
Study participants were drawn from three randomly selected cities in the Bandung area, of West Java, Indonesia, the fourth most populous nation in the world, where residents are of mixed ethnicities and from low to high socioeconomic groups, in order to facilitate exploration of a wide range of carers’ views and to observe whether socioeconomic factors contributed to these views.
Twelve focus-group discussions were conducted, equally split between carers (mothers and grandmothers) of children under 5 years, and carers of children aged 7 to 12 years. In total, 94 carers who were responsible for child feeding and eating participated.
Topics emerging from the discussion were categorized into factors contributing to overweight and awareness and feelings toward overweight children. Within these categories were several subcategories.
“There were several marked differences between the three socioeconomic groups involved,” write the authors, adding that although differences were expected to arise from carers of children under 5 years old vs older children within the same socioeconomic group, such differences were not observed.
All carers had similar opinions about the characteristics of overweight children including recognition of the fact that such children ate larger portion sizes and ate more frequently compared with children of healthy weight. Carers also recognized that dietary factors, activity/sedentary behaviors, and heredity all played a part in the development of overweight.
The authors highlighted that most carers agreed that the 2 hours of school-based physical education per week was too little.
Interestingly, carers of children in low- and intermediate-socioeconomic groups were less worried about physical education because they reported that their children spend most of their after-school hours playing outside, adding to their total physical-activity hours. Children in high socioeconomic groups, in contrast, participated in more extracurricular activities.
Also, in low-socioeconomic groups, women from villages with an active midwife were more actively involved in the focus-group discussion, possibly “highlighting the significant role [in education] played by front-line staff in the health system, eg, midwives and general practitioners,” note the authors.
Carers Know Weight but Not Height of Their Children
The study showed that most carers knew the current weight of their children, but less than 60% of these carers knew their children’s height.
Reflecting the need for improved health education, the authors write, “Knowing…a child’s weight and height status may be important first steps in recognizing whether children are underweight, of a healthy weight, or overweight.”
The focus groups also identified some cultural drivers behind concepts of overweight, with some carers agreeing that “chubbier is healthier,” which, the authors point out, is a cultural trait found in other countries too, for example, in Turkey “plump kids are healthy,” while in the United States “baby fat” is considered cute and healthy, and in the United Kingdom “a big baby is a healthy baby.”
Dr Rachmi and colleagues make a number of general recommendations as well as some Indonesia-specific ones.
“Consideration should be given to routine anthropometric measurements, currently undertaken in private elementary schools, being implemented in every school, thus providing feedback to parents about their children’s weight and height status,” they note.
And the Indonesian Department of Education may need to increase the times for children’s physical activities during school hours, for instance during recess or before and after school physical activities.
Finally, “future research should aim to explore the food choices made by carers and the involvement of other people in the household (father, grandparents) in making diet-related decisions,” they conclude.
Dr Rachmi and colleagues declare that they have no relevant financial relationships.
Int J Behav Nutr Phys Act. Published online July 27, 2017. Article
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