Childhood obesity is a public health epidemic; 22 million children under the age of 5 are affected [1
]. In Canada 21.5% of children aged 2–5
] and 13.5% of four-year-olds in Quebec (Canada) are overweight [3
]. The prevalence doubled between 1978 and 2005. Though self-reported data suggests a more recent stabilization in prevalence, Lamontagne and Hamel [4
] caution against over-confidence in this trend because of the social-desirability bias of self-reported data. Although many factors are involved, lifestyle is at the heart of the problem. In the first years of life, parents play a leading role in the development of a healthy lifestyle [5
Lifestyle and thus modifiable factors associated with overweight in preschool children include frequent consumption of sweetened beverages [8
], high-calorie processed foods [9
], dietary restrictions [10
], hours of sleep [12
], physical inactivity, and hours spent in front of a screen [13
]. So it is not surprising that prevention efforts focus on adopting a healthy lifestyle, namely a healthy diet and increased physical activity [14
In 2006 Quebec adopted a six-year action plan to promote healthy lifestyles and prevent weight-related problems in children [6
]. Priorities include promoting a healthy diet and physically active lifestyle. The plan is aimed at various authorities, including daycare and early childhood educational services, but no direct action with families is envisaged nor have strategies to promote healthy lifestyles in families been defined. One of the objectives of the Quebec program “Integrated perinatal and early childhood services for families living in vulnerable situations” is to improve family lifestyles. However, this program is aimed at a specific group and not the entire population [15
]. The vulnerable target population presents health risks such as substance abuse, alcoholism and violence.
The preschool period is a good time to act. This is confirmed by longitudinal studies on the growth curve. The aim is to delay the adiposity rebounda
since if it occurs early (before age 6), the risk of being overweight later increases [16
The results of a study by Nader et al. [16
] indicate that if a child is overweight at age 5, i.e. has a BMI >85th
percentile, he/she is five times more likely to be overweight at age 12. However, normal changes in body form and structure at this age [19
], complicate accurate perception of overweight.
Being overweight has serious consequences: children can develop low self-esteem and be socially isolated [20
] and have a poor self-image as young as age 5 [21
]. They also are at risk of cardiovascular disease, modification of the lipid profile, sleep apnea, hypertension and type 2 diabetes in adulthood [22
]. Economically, obesity costs the Canadian health care system about $4.3 billion in 2000–2001 [23
Despite the consequences of overweight for the child and for society, few parents view their children as overweight [24
]. Few studies have attempted to do an in-depth analysis of the reasons for this erroneous view. The representation of childhood overweight and a healthy lifestyle from the parents’ point of view, which has received little or no attention to date, could shed light on the reasons for this misperception. Representation consists of beliefs, attitudes, opinions and knowledge about something [26
]. Thus it guides the actions of parents and, in this case, behaviours and lifestyles of children.
In Quebec, nurses regularly see children for vaccinations and other services prior to school entry. These contacts present an opportunity to take action in early childhood. But how can nurses support families in adopting healthy habits? To answer this question, we have designed an action research study involving nurses, parents and experts to identify the views of parents and healthcare professionals regarding the promotion of a healthy lifestyle and to develop clinical tools based on new knowledge derived from the description of the parents’ representation.
Relevance of the study
Currently, in the absence of systematic interventions to promote a healthy lifestyle among parents of preschoolers, it is imperative for nurses to understand the parents’ point of view in order to provide them with adequate support. The relevance of this study is that it is important to understand the representation of overweight and healthy lifestyles among preschoolers’ parents in order to intervene early and meet their needs effectively. This study is justified because these elements must be clarified in order to tailor interventions to promote healthy lifestyles accordingly. Moreover, the development of healthy lifestyles, healthy development in childhood and the health services available are three determinants of health that need to be targeted to prevent overweight in Canada [7
]. Developing a clinical tool for public health nurses will facilitate the provision of evidence-based services and is likely to improve the quality of services. Professional practices will be relevant and based on the viewpoint of parents as key players in adopting healthy lifestyles for their children and helping to address overweight, which is a serious public health problem.