What do we want to know?

There are high levels of concern about obesity in children in the UK. Children are likely to experience immediate physical and psychosocial problems as a result of being obese and are at a higher risk of obesity as they grow older. Children’s attitudes to and beliefs about their bodies, which can include high levels of body dissatisfaction, have also raised concern. This systematic review examines recent research findings from the UK where children aged from four to eleven provide views about their own body sizes or about the body sizes of others.

Who wants to know?

This review will inform policy-makers, commissioners, practitioners, and researchers who have a remit to explore policy issues or to promote or conduct research on children and obesity.

What did we find?

Recent research was found to be limited in its scope. No studies were found, for example, that explicitly asked children what they thought might help them to achieve or maintain a healthy weight. Nonetheless, when synthesised, these studies provide a coherent collection of children’s views and experiences.

Children experience obesity largely as a social problem. Children, whatever their body size, often may not consider the health consequences of obesity to be important.

Body size varies in relevance. Children who have a healthy body size often may not have body size very high on their everyday agendas. Very overweight children in contrast, experience body size as a big problem. They are likely to experience unhelpful responses to their own body sizes from other children, as well as adults. Fat-related name calling and bullying is considered to be a normal occurrence.

Children are highly aware about body size and our society’s attitudes towards it. Children appear to be aware of the actual size of their own bodies and are likely to have judged the acceptability of their own body. Many are dissatisfied and some feel anxious despite having a healthy body size. Girls are likely to want to be leaner, regardless of their size. Many boys and girls aspire to very lean body shapes that are unattainable and likely to be unhealthy.

Very overweight children encounter many barriers, and a lack of support, when they try to take action to reduce their size. Parents and friends appear to be the most helpful source of support, but this is not always unproblematic.

While very overweight children and girls bear the brunt, the combined impact of our obesogenic environment and our society’s ongoing preoccupation with body size appears now to be affecting the body image ideals and body satisfaction of boys as well. Girls and boys aged under 12, however, differ considerably, both in their aspirations for their bodies and ideas about others’ bodies.

What are the implications?

The findings suggest there is a need:

• for those who run or develop initiatives to increase understanding about the limits to an individual’s control over their own body size, to consider emphasising the positive social outcomes of initiatives that aim to promote health, and to develop materials and processes that respond appropriately to the differing values, aspirations and concerns held by girls and boys around their own body sizes;
• at the policy level, for population-level efforts to counter the stigma associated with very large body size and target commonplace, unhelpful attitudes and discriminatory behaviours, and for initiatives to address the support needs of parents, other adults and children in their discussions of children’s body sizes;
• for research to actively engage diverse groups of children, in particular very overweight children, in identifying forms of support around body size that they consider might be appropriate;
• for fuller attention in research on children’s views to description and analysis of study findings, and to the context and generalisability of those views;
• for research on children’s views to be influenced more by the children who participate, and be more sensitive to children’s rights and engagement.

How did we get these results?

The review addressed the following questions:

• What are children’s views about the meanings of obesity or body size, shape or weight (including their perceptions of their own body size), and what experiences do they describe relating to these issues?
• What are children’s views about influences on body size?
• What are children’s views about changes that may help them to achieve or maintain a healthy weight

We located studies through sensitive searches of a large number of databases, as well as specialist websites and contact with experts. Studies needed to have provided findings for children in the UK aged four to eleven and to have described basic aspects of their study methods. They needed to have been published since the start of 1997. Included studies were coded and quality-assessed by two reviewers independently.

Findings were synthesised in two, separate analyses. One synthesis was of findings where children had been asked open-ended questions. The second synthesis was of findings where children were asked to select from responses already set by researchers. The findings from the two syntheses were then juxtaposed. A consultation was held with young people that explored the credibility of a subset of the findings and their possible implications.

This summary was prepared by the EPPI Centre

This report should be cited as:

Rees R, Oliver K, Woodman J, Thomas J (2009) Children’s views about obesity, body size, shape and weight: a systematic review. London: EPPI Centre, Social Science Research Unit, Institute of Education, University of London.