A peer-research project to explore parents’ perceptions of reasons for weight loss in obese

children.

Fiona Gillison1, Geraldine Cooney1, Angie Davies2, Fiona Dickens3 & Penny Marno3

1 Department for Health, University of Bath

2 Independent public advisor

3 Swindon Borough Council

Draft report - in preparation

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AbstractThe aim of this study was to pilot a training package for peer-interviewers, through recruiting

and training members of the public to take part in a participatory research project to explore

parents’ views of the factors that help obese children to lose excess weight. A participatory

approach was chosen as parents of overweight children are typically difficult to engage in

research or health services, and thus we considered a peer-to-peer research approach may

be more acceptable and attractive. The training package was delivered over three half days,

aiming to increase knowledge regarding ethics and research processes, and provide

interview skills training and practice. Four parents (all female) were trained as peer-

interviewers, and three of the four went on to successfully complete interviews. The target

group for interview participants was parents of children classified as obese through the

National Child Measurement Programme (NCMP) in their reception school year (age 4-5

years) but a normal (healthy) weight by year 6 (age 10-11 years). Participants were recruited

through letters sent from the school nurse team of one local authority, advertisements on

internet parenting fora, and disseminated to adults attending commercial weight loss

classes. Only four parents could be recruited over a 5 month period; all were mothers. The

analysis was conducted collaboratively by the peer-researchers and university research

team in two stages. 1) The transcripts were coded to identify all points raised, and 2) All

collaborators met together to review the transcripts, first seeking thoughts and reflections

from the peer researchers as to the ‘main messages parents were making in the interviews’,

and the combining these with the clusters identified in stage 1. All clusters and messages

where then compared and contrasted to refine the data into distinct, overarching themes.

Three themes were identified; Whole Family Action, Support (sources and importance of),

and Protecting Childhood. The themes converged to suggest that parents did not relate the

changes to children’s lifestyles (physical activity and diet) that may have contributed to

obesity reduction to stem from the ‘trigger’ of the NCMP feedback letter, or from children’s

weight management services (experienced by two families). Instead, the stimulus for change

in the child’s lifestyle stemmed from a parents’ decision to lose weight, which then had

knock-on effects on family diet and activity levels (n=3), or was attributed the change to

changes in the child’s preferences (n=2). Some parents also believed that regardless of

changes to family dietary and activity habits, weight loss had been due to the child simply

‘growing out’ of an earlier body shape. This was reflected in parents’ comments that

overweight and obese children should not be singled out as ‘a problem’, but that if changes

to the child’s lifestyle were warranted, the whole family should change together. The

participatory research process resulted in a considerable shift in the interpretation and

emphasis of the findings relative to the initial university-researcher led coding exercise, and

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a more radical set of recommendations for service development. Thus, the study

demonstrated that this approach to participatory research was not only feasible, but led to

more insightful research outcomes.

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IntroductionChildhood obesity is a significant issue for public health, increasing children’s risks of current

and future ill health, poor wellbeing and social disadvantage. National monitoring data shows

that while most children who are obese at age five are also obese at age 11, a minority

(around 12%) show a significant decrease in excess weight, jumping from the classification

of obese at age 5, to a healthy weight by age 11. As few parents engage with health

professionals in managing childhood obesity, how these improvements are brought about is

largely unknown.

Parents’ reluctance to engage with health professionals around childhood weight issues

seriously restricts our ability to gain access to this population and conduct useful research in

this area. Our own (and others’) past research suggests that parents of overweight and

obese children find receiving feedback that their child is overweight upsetting; they feel

judged by health professionals, are concerned about stigmatising their child, and feel their

own priorities for their child’s health (e.g., psychological wellbeing) are not always

acknowledged by public health teams (Gillison et al., 2014). One way to gain better access

to the perspectives of this population could be through collaborative, or participative

research. The current research therefore had two aims: i) to pilot a brief training package for

parent interviewers to conduct research interviews within their own community on a sensitive

topic, and ii) to generate qualitative data to explore our research question; ‘What reasons do

parents ascribe for the reduction of excess weight in formerly obese children?’. The project

was supported by the local public health team who were interested in improving their

understanding and practices in relation to childhood obesity prevention.

MethodDesign:Three two hour workshops were run during February and March 2016 to provide interview

training, and a final workshop was conducted following data collection to analyse the

interview transcripts. The training was designed and delivered by a qualitative researcher

(FG), a Public Involvement Consultant (GC), and a member of the public (herself a parent)

recruited from a public consultation panel (AD).

Workshop 1: Background to the research topic, aims and objectives, discussion of how to

conduct research into sensitive topics

Workshop 2: Understanding the research process, including ethics and quality, and an

introduction to conducting interviews.

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Workshop 3: Completion of interview skills training and confirmation of the protocol.

Following the workshops, the recruitment of study participants was managed by the lead

author, including explaining the study, consent process and screening volunteers for

interview. Written consent was obtained by parent interviewers prior to interview. Interviews

were digitally recorded, transcribed verbatim, and anonymised prior to analysis. Ethical

approval was provided by the University of Bath Research Ethics Committee.

Participants and recruitment: Parent interviewers: Potential interviewers were recruited through advertisements in local

press, on online fora (i.e., volunteering websites, parent fora, and sites advertising part-time

work) and from those involved in local authority health promotion services. We aimed to train

four parents to facilitate lively workshops, and sufficient numbers for potential withdrawal.

Interview participants: Parents of children who were identified as obese when weighed as

part of the NCMP in reception year (age 4-5), who were then identified as a healthy weight in

Year 6 (age 10-11) were eligible to take part. Initial recruitment was facilitated by the local

authority, through identifying eligible parents through their historical National Child

Measurement Programme (NCMP) data, and sending invitation letters to all parents (plus

one later reminder) (n = approximately ??). As this generated insufficient numbers,

recruitment was extended through the fora described above, plus advertisement to local

members of Slimming World. The target sample size was 10 parents.

Analysis: Evaluation of training programme: Ongoing feedback was collected from trainee researchers

after each workshop (what was clear, what needed further practice/explanation). In addition,

a brief knowledge test was conducted at the end of Workshop 3 to test (and emphasise)

important ethical and research-quality related issues (Appendix 1). Feedback on prepared-

ness and confidence was also gathered in telephone de-briefing sessions between the

Public Involvement Consultant and peer interviewers after each interview.

Data analysis: The interview transcripts were analysed through thematic analysis (Braun &

Clarke, 2006). The process was led by the lead university-based researcher (FG) who read,

re-read and coded key meaning units across transcripts. These were then grouped into

clusters, and discussed with the second researcher (GC), who had also familiarised herself

with all interviews (Table 1). Discussion focussed on refining the clusters to reduce overlap

and ambiguity, and ensure all codes/themes were represented at the next stage. This

process was undertaken ahead of involvement of parent researchers to reduce the data into

a manageable number of categories and topics for group discussion. Prior to the final

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workshop, all peer researchers were sent the transcripts of all of the interviews completed.

They were each allocated one transcript to read in detail, which was different from the

interview they had personally conducted to ensure that each workshop participant would be

familiar with at least two interviews. Participants could read all transcripts if they chose to.

Table 1: Clusters identified following coding of all transcripts by university-based researchers

Cluster Description

1. Recognition that

child is overweight

How the parent became aware that the child was

overweight

Memory (or not) of receiving an NCMP letter

Discussions ‘looking back’ at beliefs about the

child’s weight at an earlier time

2. Parents’ health

beliefs

Parents’ belief as to whether their child is/was

overweight

Parents’ beliefs about whether or not the child’s

weight status will change if nothing is done.

Beliefs about the dangers (or not) of being

overweight.

3. Parent’s role and

responsibility

Parents’ views on the legitimacy of measurement

/professional involvement in weight loss – should

we be weighing children in the first place, and

telling parents their children are overweight?

Parents’ perceptions of their personal responsibility

for making sure their child has a healthy weight.

4. Protection from

knowledge

Not letting a child know as a means of protecting

them

Concerns over the risks to child’s wellbeing if

weight was talked about, or made an issue, within

the home.

Parents’ views on whether or not their child should

be made aware that they are overweight.

5. Protecting childhood Discussions about the rights of a child to have a

‘normal’ childhood, to do what other children do,

without being worried about their weight.

May link to cluster 3 - issues about concern for

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wellbeing if children are made aware that they are

overweight / made to feel different

6. Child’s role The degree to which parents expect the child to be

in control of their choices around weight (e.g., what

they eat and drink outside the home)

Parents’ views of the child’s competency to control

their eating and drinking.

Degree to which parents feel a child’s weight is the

child’s own responsibility.

The degree to which parents involve the child in

making lifestyle changes (e.g., gets them involved

in food preparation etc.)

7. Social support Recognition of the importance of social support

(within the family, or from groups)

Peer influences on the child and their weight-related

activities (positive or negative)

8. Stigma Views of fairness/discrimination against people who

are overweight in general.

Discussion of whether weight concern stems from

trying to force everyone to be a certain size for

aesthetics, rather than for health reasons.

9. Helpfulness of

professional support

Parents’ reports of services and whether or not they

have been helpful.

Parents’ reports of commercial organisations and

whether or not they have been helpful.

10. Barriers and

enablers

Suggested tips and tactics.

Changes that the family has made on purpose to try

and reduce the child’s weight

Changes that the family has made that have had an

impact on the child’s weight, even if that wasn’t the

purpose

Discussions of how having a child who is

overweight has impacted family life.

Barriers to making lasting changes.

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The process of collaborative analysis was facilitated through three stages; in Stage 1, peer-

researchers were asked to provide their reflections on the interviews (“what are the main

messages that you think the parents were making that we should feed back to service

providers?”). These reflections were discussed in order to focus and refine initial thoughts,

and all key issues identified were recorded onto post-it notes for further consideration. In

Step 2, the peer-researchers were provided with the list of clusters and definitions generated

by the coding process (Table 1; each also represented on a post-it note), which were

discussed to ensure understanding. In Step 3, both sets of post-it notes were collated and

used in a prioritisation task with the aim of creating agreed principal themes. To do this, a

nominal starting point was taken (i.e., one post-it note), against which each other post-it note

was then compared to ascertain (a) if it was substantively different or related to existing

ideas on the table (i.e., within the same theme), (b) if distinct, whether the new idea was

more or less important in answering the research question than the others on the table, and

(c) to ensure that each idea was optimally worded or framed to explain the points discussed.

This approach was used as a means of ensuring all of the clusters generated from inductive

coding and all themes generated by the peer-researchers were discussed together, and to

provide structure to the process of funnelling all possible insights into a manageable and

hierarchical set of themes.

Interview ScheduleThe interview schedule (Appendix 2) was drafted by the university research team based on

past work with parents, reference to published literature, and discussion with local public

health teams. The draft was refined with the peer-researchers during Workshop 3, after

piloting the schedule on each other.

ResultsPeer-interviewer trainingThrough brief debriefing interviews, the peer-researchers reported that the training course

had improved their skills and confidence in conducting interviews, and given them insights

into the purpose and conduct of research studies. They felt that they gained transferable

skills as well as deeper knowledge and understanding in a subject area of interest to them.

Participants commented on the usefulness of listening exercises and the opportunity to

practice interview skills. Role play was described as challenging but helpful. All had felt fully

prepared to conduct a ‘real’ interview following training, and had not taken up the offer of

additional group, or one-to-one support. A limitation of skill development was the low number

of participants attracted, which meant that the peer-researchers did not have the opportunity

to conduct more than one interview each, and thus improve their skills.

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Interview outcomesThe recruitment process was very challenging, and after six months of concerted recruitment

attempts, supported by local authority colleagues running the NCMP and those running the

child weight management service, only four interviews were completed (of six initial

volunteers; two failed to respond to further contact). All participants were women, lived with a

male partner, and had children of ages ranging from primary school age to adult (all had at

least one child aged 9-11, the target in relation to receiving a recent NCMP feedback letter).

Three women had attempted to lose weight themselves using a commercial weight loss

service over the period during which their child had lost their excess weight, and two had

used local authority children’s weight management services. Two interviews were conducted

in participants’ homes, and two in local cafés; interviews lasted from x to x minutes.

The feedback from the peer-researchers (Stage 1) introduced a shift in emphasis of the

data, and three agreed key messages to take forward;

i) parents’ experiences of relatively poor support from health professionals (in content, or

duration) versus access to valued ongoing support from a commercial weight loss

programme,

ii) the trigger for change in diet or physical activity coming from a parent’s own wish to

make a change or lose weight themselves, and not triggered by ‘news’ that a child is

overweight,

iii) parents’ beliefs of health risks and likely consequences of childhood overweight being

grounded in familial (genetic, hereditary) risk rather than risks specific to the child; this

was reflected in parents’ endorsement of a whole family approach to lifestyle change,

not singling children out for weight-reductive diets or activities.

The Stage 3 discussions of all 13 themes resulted in agreement that there was considerable

overlap between concepts that different members of the team had identified, and that these

could be adequately represented in three overarching themes; Whole family action, Support

(sources and importance of), and Protecting childhood.

Theme 1: Whole Family ActionTheme 1 (Table 2) was considered to be of the greatest priority – representing a ‘necessary’

condition for any change to happen. This theme indicated that for the parents in our sample,

the first step in changing children’s environments was a parents’ interest in, and willingness

to change their own diet or activity levels. Two parents did engage with children’s weight

management services as a result of their child being identified as overweight, both of which

involved taking part as a family, but neither parent believed this had had a long term impact

on the child’s health behaviours or weight; they believed that the loss of excess weight was

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more associated to separate, parent-instigated decisions taken at a different point in time. As

such, although having an overweight child may have strengthened parents’ resolve on behalf

of the family, learning that a child was overweight (through an NCMP letter or otherwise) was

not seen as sufficient to trigger changes on its own.

Three of four parents talked about how their child’s diet in particular had changed as a result

of the parent attending a commercial weight loss programme, as the parent then started to

cook from scratch, providing much healthier meals for all the family. Further, two parents

also started taking their overweight child to meetings with them, which seemed to be enjoyed

by the child (in terms of social support, seem Theme 2) and as a starting point for educating

the child on how to make healthier choices for themselves when outside the home.

The Whole Family Action theme was characterised by parents’ assertions that children

should not be singled out for special diets or physical activity programmes, but that the

whole family should become healthier together. While this did not seem wholly consistent

with the decision to take children along to attend Slimming World (as such children would

necessarily be aware that they are overweight, and attending sessions that children who

have a healthy weight do not), it appeared that this was considered a normal family activity

as they were attending with their parent.

Reflecting the primacy of parental willingness to change their own lifestyle, Themes 2 and 3

followed on from the point where a parent had made the decision to change: In Theme 2

(Table 3) parents identified professional and social support as a facilitator to change, and

lack of professional and social support as a barrier to change. Theme 3 (Table 4) reflected

parents’ goal of protecting their child from potential threats to their self-esteem or wellbeing

from being labelled as overweight, and from the burden of weight control.

Theme 2: Support Parents were generally critical of the support given to them by health professionals, and

many were unsure where they could go to get support, or what was available. While the two

families who had attended the local weight management scheme (MEND) appreciated the

opportunities this provided for their children to spend time with others who were also

overweight, there was a feeling that the support was too short-term, and not focussed on

what was important to parents. In particular, parents criticised the scheme from its over-

emphasis on food labelling. In contrast, the time-unlimited support from commercial

programmes was praised, particularly referencing positive regard from group leaders and

other people trying to lose weight “everyone in the group absolutely loves her, yeah”. Thus,

the sort of support that seemed to be preferred and more sustainable, was in the commercial

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sector where taking children along allowed parents to still take action as a family (i.e., as

emphasised in Theme 1).

Parents identified the influence of peers as challenging to children trying to lose excess

weight; parents felt that peer groups were generally not active while spending time together

“that is their youth club - standing outside the chip shop”, and that when children got

together with their peers there was a tendency to eat junk food. Half of parents reported that

their child had been bullied because of their weight, or that bullying influenced their child’s

weight, and felt that schools could do more to address this. For example, one parent called

for schools to deliver education to pupils to reduce weight-related name calling.

Theme 3: Protecting Childhood Much of parents’ motivation not to single their child out for weight management, but to take a

whole family approach was through a wish to protect their child. Most of the children

discussed in the interviews had known they were overweight, either as the parent had told

them or they had been teased at school about their weight, but parents all reported that they

had down-played this at home. Furthermore, changes parents made to the family’s lifestyle

were not presented as something specifically for weight loss, but as a more generic need to

get fitter, or eat better. One parent went further, and talked about keeping the changes she

made (largely to the diet she provided to her children) as secret, or as ‘tricking’ them to eat

more healthily without their knowledge.

“I… add little cheats, I put…. er, we get a coke bottles, and then I put diet coke in

them, and they don’t know that they’re having it. Because if they know they’re doing

it, then they will go in the other direction.”

“Basically, I lie to my children, it’s awful (laughs).”

There was also a wish to protect children from the stigma or poor self-esteem that could

result from children feeling ‘singled out’ because of their weight. All parents expressed

strong views that all children should be entitled to a worry-free childhood without having to

be too concerned with what they eat, and enjoying the same treats as other, normal weight

children.

A related aspect of this theme, was parents holding a belief that their child would ‘grow out’

of their excess to take after a parent or family trait (quote about being like his dad – or other).

Three parents indicated that despite recognising that their child was overweight during early

childhood (confirmed or not by the NCMP letter), they had not necessarily believed that the

excess weight would persist and therefore did not feel the necessity to act on it. Two of

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these parents went on to state that looking back, they could see that if nothing had changed

their child would probably have not lost weight and perhaps even gained weight, and one

another parent firmly believed their child had grown out of their excess weight ‘naturally’, but

listed a number of significant changes to the child’s diet and physical activity nonetheless

that may have contributed to this.

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Table 2: Theme 1 – Whole Family Action

Cluster Illustrative quotes

Parent doing something for

themselves / Wanting to do

things differently

And also I went to Slimming World and started doing healthy living and stuff, as he’s not very fussy, so he

was just eating what we were eating. (P1)

We got dogs! So we were going on dog walks. But apart from that…So we did… He didn’t come on every

walk with me, but he was doing sort of one 40 minute walk a day? Which he wasn’t doing before. (P1)

Well I said I wanted to do Slimming World, this was a Christmas time, so when I decided after Christmas and

she said she’d come and do it with me and give it a go. (P4)

Weight / health risk is

genetic

Cause he’s very much like his dad in a lot of ways, you know, looks and everything, I just thought, ‘he will

lose it [weight]…’ in my mind. (P1)

It worries me a bit that she… ‘cause I’m diabetic, that she could develop diabetes. (P4)

Recognising (or not) that the

child is overweight

Yeah, he was a little bit chubby in the face..… but he always had been. (P1)

It was just me personally [that judged her overweight], doing my personal take on it. (P3)

You can see she’s overweight, erm, her clothes, she’s having to wear bigger clothes… (P4)

Family doing it together You know, it’s that, that idea from the very beginning, you make sure that they’re all included, you all eat

together. (P2)

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No because actually it [helping my child lose excess weight] works for me as well. Because she’s not a fussy

eater. It makes my life easier. And where I’m losing weight as well. She sees it, as not a competition, but she

likes to know how I’m doing, and I’m the same with her. We spur each other on. (P3)

I did say it would be good for her too. And we’d do it together, so.. … Yeah, I don’t think she would do it on

her own. (P4)

Table 3: Theme 2 - Support

Cluster Illustrative quotes

Available professional

support not always helpful

I think there’s also a place for people that have got issues to be able to talk to someone. And I wish there

had been more of a drop-in centre. Like counselling, but at school? (P2)

All they did [at MEND] was they gave them the tools to measure the foods, they knew what to eat. And I

don’t – and I told them about the exercise, but I don’t think they really had the positive mental attitudes.

(P2)

So we went for that for I think it was like a six-week thing. ….. But erm, it was only a six-week thing. It was

only that one. We only did that one. And then obviously we realised she’s putting more and more weight

on, so we just decided after Christmas we was gonna’ try Slimming World! (P4)

Well it [MEND] was just telling us what we should be feeding her and it’s just the healthy eating, yeah. (P4)

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Not knowing where to

access support

I don’t know. I suppose you say there are places that kids can go, but [I don’t know where] do you know

what I mean? (P3)

Maybe I’d like a support thing for children. Yeah, John’s age. You know, there isn’t a lot about like that….

‘Cause it does… it can wreck you down can’t it? (P4)

Importance of positive social

support

We really embraced it [MEND]. It was good to see that the children were helping each other, and I think

wat it was is that they didn’t feel that they were on their own. (I: Yeah.) It tended to be that you were the

big kid, and you were different, so you had to sit over there. But they were all in a group together. (P2)

With slim world, they’re not interested in what her weight is, and they are interested in her BMI. And her

BMI is coming down. Which is what they want it to do. Not what the scales say….and that is really really

good, keeps her motivated. …. And always praising her. Do you know what I mean? And that’s good

because she’s not worried about her weight. (P3)

Less support available as

the child gets older

At the moment in primary school there’s no stigma attached to going to see a counsellor, erm, but I think in

secondary (imitating son’s voice) ‘oh no, my mates might see me! (P2)

Peer influences Trying to get them to do that [active ways of spending time], but… you’ve got to get a critical mass, you’ve

got to be a certain number in that group that want to do it, then it will happen and the rest just follow. (P2)

I think the difficulties she has is, she goes out with her friends, they go to a thing called ‘Shake Away’…

Yeah, it’s milkshakes made with all, any different chocolate bar you want, and have that made into a

milkshake. So obviously that’s high in sugar, but, I suppose it’s hard for her when she goes out with her

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friends because they all, they all do it and she doesn’t want to be left out. (P4)

Table 4: Theme 3 - Protecting Childhood

Description Illustrative quotes

Aims to protect child from:-

Poor self-esteem

Bullying

Stigma

It is starting to come in to the boys’ arena as well, Tom is fourteen, and he’s starting to say now, he’s

looking at himself, and ‘how can I improve myself’ and everything. But I’m trying to say; “Do it in a healthy

way” (P2)

Do not single the children out, make them part of the group… And don’t make derogatory comments about

size, or little jokes, or digs… Because [other] children will follow. (P2)

That’s a problem of overweight. It’s too much. It’s banged into them too much. You cause major problems.

(P3)

Protection from knowledge

that they are overweight

I don’t make them paranoid, no, I didn’t say anything [about them being overweight]. (P1)

And that’s why I would never ever let her get weighed because I don’t want her coming home being hung

up on it, and going the opposite way and not eating. Or throwing up and then you’ve got a bigger situation

on your hands…I don’t want her to be hung up, [feeling] “I’m on a diet”. Because I’ve been hung up on my

weight for so many years, and it does get soul destroying. Anyone with a weight problem feels the same. I

just want her to make good choices. (P3)

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She knows [she’s overweight], those horrible, horrible children will say to her ‘you’re fat!’ and she got

bullied terrible. And was that the first thing that she, the way that she got to know that she might be

overweight. (P4)

Not singling children out And that’s one thing that I would pick up on, if anyone ever said anything to a child like that, and making

them separate from the group …. and, and labelling them, that’s the worst thing. (P2)

She’s still 11, she’s got to have the treats for 11 year olds, so I don’t sit there and say she can’t have

chocolate and you can’t have ice cream, and you can’t have that. (P3)

Finding sensitive ways to

talk about it

Keep it positive! Don’t tell them ‘you’re fat’, don’t put any of those labels in (I: No…). ‘You’re cuddly’ – I said

to Irena you know, ‘you’re just cuddly’ and, you know, let’s get fit so that we can… do activities, not ‘cause

you can fit into a dress size’…(P2)

Concern about

screens/computers

I just nag him about his… fitness levels. (I: Okay.) Erm, because he is, like I say, always on his computer

and stuff, and I keep telling him that he needs to go out more (P1)

That is the worst thing that’s happened to this generation, is computer games. (P2)

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DiscussionThis participatory research project demonstrated that it was possible to train novice

interviewers within three, two-hour workshop sessions, to a point where they felt competent

to conduct interviews, and were able to deliver in-depth interviews with their peers. While

recruitment of interview participants was a significant limitation for the present study, four

interviews were conducted and together provide insight into some of the beliefs that parents

have about why children lose excess weight during their primary school years. Unanimously,

and even though some parents did accept offers of support from public health services,

parents did not consider that receiving this support, or the letter confirming that their child

was very overweight was a trigger to their child’s excess weight loss. Whether or not this

was the case, or just a perception cannot be assessed by the present research design.

However, the three themes appeared to converge towards an impression that parents found

it both difficult, and inappropriate to focus on influencing a single child’s weight or health

behaviours. Instead, their observations led them to believe that children’s weights were

influenced by ‘incidental’ changes to family lifestyles (e.g., changing food provided when

parents joined commercial weight loss programmes for themselves, getting a dog) or a child

simply ‘growing out’ of their weight, or becoming more active through their own choice.

Critique of the MethodThere was considerable difference between the analysis conducted by the university

research team (one of whom was a parent, one not) and the peer-interviewers. Although the

two perspectives were relatively easily brought together (i.e., there was much overlap), the

views of the peer-researchers in interpreting what others had said was given priority. The

function of the initial coding was to ensure that the raw data was considered systematically,

before conclusions were then drawn. This process worked well; getting the peer

researchers to provide descriptions in their own words, and debate whether two similar

constructs were similar or not, greater clarity and understanding was generated. There was

also a service provider/commissioner present, which helped to focus the discussions on

‘what is it that the parents we interviewed would want this person’s team to know’? The

specific prioritisation tool used was not essential to the process; its main function was to

provide a clear, flexible focus for group discussion. Using post-it notes that could very clearly

be written, rewritten and discarded was helpful in this respect in encouraging peer

researchers not to feel that any ideas generated by the university-based research team were

fixed and needed to be retained.

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Strengths and LimitationsA major limitation of the present study was the small sample size achieved. As discussed, a

range of different approaches were used, from personal letters to those known to be eligible,

personal approaches as child weight management sessions, and relaxing the criteria to

allow self-assessed cases of children losing excess weight and advertising online and with

the assistance of a commercial weight loss programme. It was considered that recruitment

would be possible, as we were looking for parents to report on something positive – whose

children may have been overweight once, but had now reduced this excess weight so had a

positive story to recount. However, this was some naïve assumptions; from the interviews

we did conduct we realised that parents did not necessarily feel they had a ‘good news’ story

to tell, as they did not have the same beliefs around the importance of a child’s weight in

determining their health, so weight loss was not seen as a sign of success. Additionally,

some parents had forgotten that they had received an initial letter informing them that their

child was obese at a young age, or feel that their child had done anything other than ‘grow

out’ of early ‘puppy fat’, so the study did not register as something relevant to them. As a

result of the limited sample pool, this study does not provide a broad overview of parents’

experiences, but a snapshot of experiences of a small number of parents (mothers) in one

local area. Expanding the participant pool to include fathers, and a greater range and diverse

spread of parents would improve the breadth and dependability of the findings.

To be finalised.

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