Children’s views about obesity, body size, shape and weight A systematic review Report written by Rebecca Rees, Kathryn Oliver, Jenny Woodman and James Thomas EPPI-Centre Social Science Research Unit Institute of Education University of London EPPI-Centre report no. 1707 • December 2009 REPORT The authors of this report are: Rebecca Rees (RR), Kathryn Oliver (KO), Jenny Woodman (JW), James Thomas (JT) (EPPI-Centre). Acknowledgements It is important to acknowledge the work of the authors of studies included in this review and the children who participated in them, without which the review would have had no data. Particular thanks also go to Theo Lorenc (TL) and Claire Stansfield (CS), who participated in searching and screening for the review; to members of the Steering Group of the EPPI-Centre’s Health Promotion and Public Health Reviews Facility for their helpful suggestions and material for the review; to the participants in the NCB Young People’s Public Health Group for their work reflecting on the review’s findings; to the NCB’s Louca-Mai Brady and Deepa Pagarani for facilitating workshops with the Group; to Sandy Oliver for commenting on the report; to Angela Harden (AH), Josephine Kavanagh (JK), Ann Oakley (AO) and Helen Roberts (HR) for their input into the protocol; and to Jenny Caird and other members of the Health Promotion and Public Health team for their support and advice. This work was undertaken by the EPPI-Centre, which received funding from the Department of Health (England). The views expressed in the report are those of the authors and not necessarily those of the Department of Health. Conflicts of interest There were no conflicts of interest in the writing of this report. Contributors* The protocol was developed by AH, JK, AO, RR, JT and JW. TL, RR, CS and JW conducted searches and screened studies. AH, RR, JW and KO developed the data extraction tool. Data extraction, quality appraisal and synthesis were conducted by RR and KO. The NCB Young People's Public Health Group commented on interim findings. The report was written by RR, KO and JT. (*Full names can be found under acknowledgements above.) 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. © Copyright Authors of the systematic reviews on the EPPI-Centre website (http://eppi.ioe.ac.uk/) hold the copyright for the text of their reviews. The EPPI-Centre owns the copyright for all material on the website it has developed, including the contents of the databases, manuals, and keywording and data-extraction systems. The Centre and authors give permission for users of the site to display and print the contents of the site for their own non- commercial use, providing that the materials are not modified, copyright and other proprietary notices contained in the materials are retained, and the source of the material is cited clearly following the citation details provided. Otherwise users are not permitted to duplicate, reproduce, re-publish, distribute, or store material from this website without express written permission. CONTENTS Preface ................................................................................................................ 1 Executive summary ............................................................................................... 2 Part I: Background and findings of the review ........................................................ 8 1 Background ............................................................................................. 9 1.1 Why body size is an issue ................................................................................ 9 1.2 Understanding children’s body sizes............................................................. 10 1.3 Children-centred frameworks for health ...................................................... 12 1.4 Policy background ......................................................................................... 12 1.5 Existing research ........................................................................................... 13 1.6 A note on the terminology used in this report ............................................. 15 2 Aims and research questions .................................................................. 16 2.1 Aims ............................................................................................................... 16 2.2 Research questions ....................................................................................... 16 3 Review methods .................................................................................... 17 4 Findings: interpretive synthesis .............................................................. 19 4.1 The children and studies in the interpretive synthesis ................................. 20 4.2 What were the views of the children in these studies? ................................ 20 5 Findings: aggregative synthesis .............................................................. 39 5.1 The children and studies in the aggregative synthesis ................................. 40 5.2 What were the views of the children in these studies? ................................ 41 6 Findings: how do the two syntheses answer our review questions? ........ 46 6.1 Which children have contributed to the findings of this review? ................ 46 6.2 How robust are the synthesis findings to differences in study quality? ....... 47 6.3 How credible are the review findings? Results from the consultation with young people about the findings of the interpretive synthesis. ....................................... 47 6.4 Which of the review’s questions have been answered by the two syntheses? ....................................................................................................................... 48 7 Discussion .............................................................................................. 53 7.1 Discussion of principal findings ..................................................................... 53 7.2 Strengths and weaknesses of this review ..................................................... 55 8 Conclusions and implications for policy, practice and research ............... 58 8.1 Conclusions and general implications ........................................................... 58 8.2 Implications for specific ongoing initiatives .................................................. 61 Part II: Technical description of the review .......................................................... 65 1 Detailed methods .................................................................................. 66 1.1 User involvement .......................................................................................... 66 1.2 Inclusion and exclusion criteria ..................................................................... 68 1.3 Searching ....................................................................................................... 69 1.4 Screening for eligibility .................................................................................. 69 1.5 Characterising the studies and extracting their findings .............................. 69 1.6 Appraising the quality of study findings ....................................................... 70 1.7 Synthesising study findings ........................................................................... 70 2 Detail of studies encountered in the review ........................................... 73 2.1 Flow of studies through the review .............................................................. 73 2.2 The quality of the study findings in the syntheses ........................................... 74 2.2 The quality of the study findings in the syntheses ........................................... 75 References .......................................................................................................... 83 Appendix A. Details of interpretive studies: aims and sample characteristics (N=15) .............................................................................................................. 91 Appendix B. Details of interpretive studies: methods and study quality (N=15) ........ .............................................................................................................. 95 Appendix C. Themes from the interpretive synthesis: the contribution of each study ............................................................................................................ 105 Appendix D. Details of aggregative studies: aims and sample characteristics (N=16) . ............................................................................................................ 106 Appendix E. Details of studies in aggregative synthesis: methods, findings and quality (N=16) ) ........................................................................................................... 111 Appendix F. Themes from the aggregative synthesis: the contribution of each study ............................................................................................................ 130 Appendix G. Search strategies and sources ........................................................ 131 Appendix H. Criteria used for appraisal of study quality ..................................... 140 Preface Preface Scope of this report This report describes the