What Are the Barriers at Home and School to Healthy Eating?: Overweight/Obese Child and Parent Perspectives

10.1097/jnr.0000000000000321

Hee Soon KIM；Jiyoung PARK；Yumi MA；Mihae IM

children ； feeding behavior ； focus groups ； pediatric obesity ； South Korea

The Journal of Nursing Research

27卷5期（2019 / 10 / 01）

1 - 9-010

英文

Background: Most studies that have investigated factors influencing eating habits among obese children have focused mainly on individual or interpersonal factors and applied quantitative research methods. Purpose: This study was undertaken to identify the barriers in home and school settings that hamper healthy eating in overweight and obese children in South Korea. Methods: Focus group interviews were conducted with 15 overweight/obese children and 15 parents. A standard manual with open-ended questions was developed. Content analysis was used to identify key findings. Results: Participants were aware of the importance of home and school environments in shaping children's eating habits. Five major barriers, respectively, at home and at school emerged from the data. At home, the food preferences of parents affected the eating habits of their children. Moreover, parents worried about providing differentiated diets for siblings and about the permissiveness of grandparents toward grandsons. Furthermore, working parents preferred easy-to-prepare instant foods and said that their children ate overly quickly. At school, children cited time pressures, poor cafeteria environments, and ineffective nutrition education as barriers, whereas parents worried about inconsistent management by teachers and the unsafe food environment around the school. Conclusions: These environment-related barriers may be resolved through changes in the behavior of children, parents, and teachers as well as through the continued efforts of schools, community stakeholders, and policymakers, all of whose cooperation is essential to fostering a healthy food environment for children.

1. Arcan, C.,Hannan, P. J.,Himes, J. H.,Fulkerson, J. A.,Rock, B. H.,Smyth, M.,Story, M.(2013).Intervention effects on kindergarten and first-grade teachers' classroom food practices and food-related beliefs in American Indian reservation schools.Journal of the Academy of Nutrition and Dietetics,113(8),1076-1083.
2. Banna, J. C.,Buchthal, O. V.,Delormier, T.,Creed-Kanashiro, H. M.,Penny, M. E.(2016).Influences on eating: A qualitative study of adolescents in a periurban area in Lima, Peru.BMC Public Health,16,40.
3. Barton, M.(2012).Childhood obesity: A life-long health risk.Acta Pharmacologica Sinica,33(2),189-193.
4. Bauer, K. W.,Hearst, M. O.,Escoto, K.,Berge, J. M.,NeumarkSztainer, D.(2012).Parental employment and work–family stress: Associations with family food environments.Social Science & Medicine,75(3),496-504.
5. Brüske, I.,Flexeder, C.,Heinrich, J.(2014).Body mass index and the incidence of asthma in children.Current Opinion in Allergy and Clinical Immunology,14(2),155-160.
6. Centers for Disease Control and Prevention. (2016). Healthy eating for a healthy weight. Retrieved from https://www.cdc.gov/healthyweight/healthy_eating/
7. Dattilo, A. M.,Birch, L.,Krebs, N. F.,Lake, A.,Taveras, E. M.,Saavedra, J.M.(2012).Need for early interventionsin the prevention of pediatric overweight: A review and upcoming directions.Journal of Obesity,2012,123023.
8. Feeg, V. D.,Candelaria, L. M.,Krenitsky-Korn, S.,Vessey, J. A.(2014).The relationship of obesity and weight gain to childhood teasing.Journal of Pediatric Nursing,29(6),511-520.
9. Fulkerson, J. A.,Kubik, M. Y.,Rydell, S.,Boutelle, K. N.,Garwick, A.,Story, M.,Dudovitz, B.(2011).Focus groups with working parents of school-aged children: What's needed to improve family meals?.Journal of Nutrition Education and Behavior,43(3),189-193.
10. Haerens, L.,De Bourdeaudhuij, I.,Barba, G.,Eiben, G.,Fernandez, J.,Hebestreit, A.,De Henauw, S.(2009).Developing the IDEFICS community-based intervention program to enhance eating behaviors in 2- to 8-year-old children: Findings from focus groups with children and parents.Health Education Research,24(3),381-393.
11. Hennessy, E.,Hughes, S. O.,Goldberg, J. P.,Hyatt, R. R.,Economos, C. D.(2012).Permissive parental feeding behavior is associated with an increase in intake of low-nutrient-dense foods among American children living in rural communities.Journal of the Academy of Nutrition and Dietetics,112(1),142-148.
12. Kim, H. S.,Park, J.,Ma, Y.,Ham, O. K.(2013).Factors influencing health-related quality of life of overweight and obese children in South Korea.The Journal of School Nursing,29(5),361-369.
13. Kim, J. G.,Jung, M. J.,Kim, J. S.(2016).Awareness and behavior of elementary school children on children's favorite foods.Journal of Food Hygiene and Safety,31(3),176-185.
14. Korea Centers for Disease Control and Prevention, The Korean Pediatric Society. (2007). 2007 Korean national growth charts. Retrieved from http://cdc.go.kr/CDC/mobile/info/CdcKrInfo0201.jsp?menuIds=HOME001-MNU1154-MNU0004-MNU1889&fid=28&q_type=&q_value=&cid=1235&pageNum=1 (Original work published in Korean)
15. Korean Ministry of Health and Welfare(2018).The seventh Korea national health and nutrition examination survey (KNHANES VII).Seoul, Korea:Author.
16. Korin, M. R. (Ed.)(2016).Health promotion for children and adolescents.New York, NY:Springer.
17. Krueger, R. A.,Casey, M. A.(2014).Focus groups: A practical guide for applied research.Thousand Oaks, CA:Sage.
18. Leines, D.,Gold, A.,Van Offelen, S.(2014).Go wild with fruits & veggies! Curriculum encourages children to eat more fruits and vegetables.Journal of Nutrition Education and Behavior,46(1),82-84.
19. Lincoln, Y. S.,Guba, E. G.(1985).Naturalistic inquiry.California, CA:Sage Publications.
20. McLeroy, K. R.,Bibeau, D.,Steckler, A.,Glanz, K.(1988).An ecological perspective on health promotion programs.Health Education & Behavior,15(4),351-377.
21. Oh, N. G.,Gwon, S. J.,Kim, K. W.,Sohn, C. M.,Park, H. R.,Seo, J. S.(2016).Status and need assessment on nutrition & dietary life education among nutrition teachers in elementary, middle and high school.Korean Journal of Community Nutrition,21(2),152-164.
22. Park, S.,Kang, J.-H.,Lawrence, R.,Gittelsohn, J.(2014).Environmental influences on youth eating habits: Insights from parents and teachers in South Korea.Ecology of Food and Nutrition,53(4),347-362.
23. Savage, J. S.,Fisher, J. O.,Birch, L. L.(2007).Parental influence on eating behavior: Conception to adolescence.The Journal of Law, Medicine, & Ethics,35(1),22-34.
24. Scaglioni, S.,Arriza, C.,Vecchi, F.,Tedeschi, S.(2011).Determinants of children's eating behavior.The American Journal of Clinical Nutrition,94(6, Suppl.),2006S-2011S.
25. Smith, S. M.,Sumar, B.,Dixon, K. A.(2014).Musculoskeletal pain in overweight and obese children.International Journal of Obesity,38(1),11-15.
26. Vio, F.,Fretes, G.,Montenegro, E.,González, C. G.,Salinas, J.(2015).Prevention of children obesity: A nutrition education intervention model on dietary habits in basic schools in Childe.Food and Nutrition Sciences,6(13),1220-1228.
27. Wilder Research. (2014). Nutrition and students' academic performance. Retrieved from https://www.wilder.org/sites/default/files/imports/Cargill_lit_review_1-14.pdf
28. World Health Organization(2017).Report of the commission on ending childhood obesity.
29. Yang, I.,Park, M.,Kim, H.,Jeong, Y.,Jo, M.,Kim, J.,Park, J.(2015).National school meal satisfaction survey.Seoul, Korea:Yeonsei University.
30. Yoo, S.,Yoon, N.,Ha, E.(2016).Perceptions and experience about obesity preventing and management: A social ecological perspective.Seoul, Korea:Research Institute for Healthcare Policy.