Obesity of preschool children in HK: A mixed method of study

Background and Aims: Obesity is the world’s fastest growing epidemic, especially in areas of rapid social and economic transition of South East Asia. The prevalence of childhood obesity in Hong Kong and China has been rapidly increased for a decade. Literature on obesity, with hundreds of confirmed and putative "causes” and hypothesized (though rarely proven) preventive strategies. Contemporary scholars have called for obesity research to stop focusing on single issues (at the level of the genome, the individual, or society as a whole) and embrace multi-level theories that allow the interplay between micro-and macro to be explored and followed over time. Since little information of Hong Kong childhood obesity has been available, the study aims at investigating the social and cultural factors of childhood obesity in Hong Kong. Methods: A mixed method including quantitative and qualitative studies has been employed for this study. Ten in-depth cases studies of six obese and four normal weight toddlers and young children were recruited from four kindergartens with different socio-economic characteristics through out the City. Ethnographic observation at home, in kindergartens, in restaurants/ café’ s; semi-structured interviews with child, parents, grandparents, live-in foreign domestic helpers and teachers; construction of genograme; analysis of dietary diary and questionnaire to primary caregiver were used. These were nested in a wider quantitative study of body image perceptions and attitudes to food and child rearing in 200 primary caregivers of preschoolers. Based on the research questions, SPSS was used to analyse quantitative data, multi-level theory was used to approach the quantitative data analysis first to generate individual case description and second thematic analysis, and third historical and policy studies. Findings: The findings affirm previous research that the onset of obesity is mutlfactorial and involves a highly complex interplay between inherited predisposition, physiology, and individual behaviour which is itself influenced by personality, attitudes and preferences. All of these are shaped and constraints and opportunities and the wider social and economic context. The data suggest that the knowledge, attitudes and confidence of the primary caregiver (typically the mother) is critically important in determining behaviour predisposing to obesity in the very young. Family structure, whether the family eat together regularly, and norms about mealtime behaviour, also seem critical. Conclusions: There are neither simple causes nor simple solutions to the obesity problem. Mixed method research driven by mutlilevel theories can help generate hypothesis about how multiple antecedents interact to cause obesity in an individual.