‘Choice’: what we mean by it, and what that means for preventing childhood obesity

AbstractObjective(i) To map how US adults value ‘choice’ in the context of obesity policy and (ii) to discuss implications for obesity prevention in children.DesignSemi-structured interviews (n 105) were conducted between 2006 and 2009 about causes of and solutions to childhood obesity. Quotes captured in field notes from community meetings (n 6) on childhood obesity prevention were also analysed. Each use of the word ‘choice’ and its variants was identified in these texts. Content and discourse were analysed to identify the implied values and meaning in each use.SettingNorth-eastern USA.SubjectsOne hundred and five adults, some involved in childhood obesity prevention initiatives.ResultsThree distinct frames of ‘choice’ emerged: (i) having choices (choice as freedom), (ii) making choices (choice as responsibility) and (iii) influencing choices (contextual constraints and impacts on choice). Many speakers used more than one frame over the course of an interview. Most people using the third frame seemed to share the values behind the first two frames, but focused on conditions required to enable people to be accountable for their choices and to make truly free choices. A small subset thought outside the frame of individual choice, valuing, as one person put it, a ‘social contract’.ConclusionsPublic debate in the USA about responsibility for and solutions to rising obesity rates often hinges on notions of ‘choice’. These frames, and the values underlying them, are not mutually exclusive. Respecting the values behind each ‘choice’ frame when crafting obesity prevention policy and employing all three in public communications about such policy may facilitate greater consensus on prevention measures.

Download Full-text

Modifying the food environment for childhood obesity prevention: challenges and opportunities

Proceedings of The Nutrition Society ◽

10.1017/s0029665113003819 ◽

2014 ◽

Vol 73 (2) ◽

pp. 226-236 ◽

Cited By ~ 31

Author(s):

Tarra L. Penney ◽

Eva Almiron-Roig ◽

Cindy Shearer ◽

Jessie-Lee McIsaac ◽

Sara F. L. Kirk

Keyword(s):

Childhood Obesity ◽

Obesity Prevention ◽

Food Environment ◽

Population Level ◽

Food Environments ◽

Clear Understanding ◽

Individual Choice ◽

Validity And Reliability ◽

Childhood Obesity Prevention ◽

The Individual

The prevention of childhood obesity is a global priority. However, a range of complex social and environmental influences is implicated in the development of obesity and chronic disease that goes beyond the notion of individual choice. A population-level approach recognises the importance of access to and availability of healthy foods outside the home. These external food environments, in restaurants, supermarkets, and in school, or recreation and sports settings, are often characterised by energy dense, nutrient-poor food items that do not reflect the current nutritional guidelines for health. In addition, our understanding of these broader influences on nutritional intake is still limited. Particularly, lacking is a clear understanding of what constitutes the food environment, as well as robust measures of components of the food environment across different contexts. Therefore, this review summarises the literature on food environments of relevance to childhood obesity prevention, with a focus on places where children live, learn and play. Specifically, the paper highlights the approaches and challenges related to defining and measuring the food environment, discusses the aspects of the food environment unique to children and reports on environmental characteristics that are being modified within community, school and recreational settings. Results of the review show the need for a continued focus on understanding the intersection between individual behaviour and external factors; improved instrument development, especially regarding validity and reliability; clearer reported methodology including protocols for instrument use and data management; and considering novel study design approaches that are targeted at measuring the relationship between the individual and their food environment.

Download Full-text

Stakeholder analysis of childhood obesity prevention policies in Iran

Archives of Public Health ◽

10.1186/s13690-021-00557-9 ◽

2021 ◽

Vol 79 (1) ◽

Author(s):

Shahnaz Taghizadeh ◽

Rahim Khodayari Zarnag ◽

Mahdieh Abbasalizad Farhangi

Keyword(s):

Childhood Obesity ◽

Obesity Prevention ◽

Policy Making ◽

Stakeholder Analysis ◽

International Health ◽

World Health ◽

Student Organization ◽

Structured Interviews ◽

Childhood Obesity Prevention ◽

Policy Making Process

Abstract Background Childhood obesity is one of the most serious health challenges and risk factors for various diseases. International health organizations, such as the World Health Organization (WHO), recommend more stakeholder engagement to discuss this health problem. Therefore, this study aims to identify and analyze the stakeholders of childhood obesity prevention (COP) policy making process in Iran. Methods In this study, semi-structured interviews were conducted with 24 Iranian stakeholders in the field of COP from February 2019 to May 2020. PolicyMaker V.4 and MAXQDA V.10 software were used for the analysis of stakeholders. Results Out of 24 interviewed stakeholders, 17 were active and seven were inactive. The most powerful and supportive stakeholders were the Ministry of Health and Medical Education (MoHME) and the national and regional Offices of Community Nutrition Improvement. Although stakeholders like the Ministry of Sports and Youth, the municipalities, the Secretariat of the Health and Food Safety, the Islamic Republic of Iran Broadcasting (IRIB), and Student Organization were among powerful bodies, they showed the least support for COP policies. The remaining stakeholders showed medium or low support and power in the policy making process. Conclusions Disconnect between stakeholders, less attention to prevention strategies, and high advertising of unhealthy foods were among the main challenges facing the COP policies in Iran and worldwide. Insufficient financial resources, little attention to the young people under 18, non-aligned policies of the Student Organization and the IRIB, and insufficient support of COP policies were among the key challenges to be handled.

Download Full-text

Stakeholders perspectives of barriers and facilitators of childhood obesity prevention policies in Iran: A Delphi method study

BMC Public Health ◽

10.1186/s12889-021-12282-7 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shahnaz Taghizadeh ◽

Mahdieh Abbasalizad Farhangi ◽

Rahim Khodayari-Zarnaq

Keyword(s):

Childhood Obesity ◽

Children And Adolescents ◽

Obesity Prevention ◽

Delphi Method ◽

Barriers And Facilitators ◽

Delphi Panel ◽

Structural Level ◽

Prevention Policy ◽

Childhood Obesity Prevention ◽

Prevention Policies

Abstract Background The prevalence of obesity among children and adolescents is one of the most important health challenges of the present century. Many factors affect the prevention policies related to this health problem and make their implementation difficult. This study examined perceived barriers and facilitators of childhood obesity prevention policies by stakeholders. Methods A qualitative descriptive research design based on Delphi method was conducted. In addition, semi-structured one-to-one interviews were conducted with childhood obesity prevention policy stakeholders (n=39) and initial identification of barriers and facilitators in this area. Interviews were digitally recorded, transcribed verbatim, and finally analyzed, followed by using thematic analysis. Subsequently, two-round Delphi panel was done by sending e-mails to stakeholders (21 stakeholders participated in the first round and 15 stakeholders in the second round) for the final selection of barriers and facilitators of obesity prevention policies among children and adolescents in Iran. Results The identified barriers and facilitators were divided into three levels: individual, executive, and structural. Barriers and facilitators of the structural level showed a high score and priority regarding obesity prevention policies among children and adolescents. Conclusion The existence of significant barriers at all three levels and especially at the structural level were among the concerns of stakeholders.

Download Full-text