“Culture Is So Interspersed”: Child-Minders’ and Health Workers’ Perceptions of Childhood Obesity in South Africa

Table 3

Thematic content of participants’ perceptions.

Themes	Example excerpts
Perceived biological contributing factors	“Some of them they are fat because of they were born with a fat family.”
	“Other factors contributing to obesity include genetic factors and high rates of stunting in children who later become obese.”
	“But maybe, assuming there is a gene that causes you to want to be, like, you know. But if that same gene were a cancer gene, then you would make a plan to avoid it.” “But when it’s a fat gene, like it could possibly that easy, then you’re just like: well, my mother was fat. I’m just gonna [inaudible] weigh more. So it’s the same concept. Because once they overeat, there are many other problems. It is going to break you down and it’s going to be a lot sooner than cancer was going to.”
Perceived behavioral contributing factors	“One is when they are finished to eat the food, there is no exercise. That’s what they do, is eat the food, after that they do sleeping, so its going to gain the weight faster because there is no activity.”
	“Of course this sometimes contributes to obesity and also if you don’t watch a child, he’s going to eat and eat and eat.”
	“One is [fat] when they are finished to eat the food, there is no exercise. That’s what they do is eat the food, after that [what] they do [is] sleeping so it’s [the child] going to gain the weight faster because there is no activity.”
Perceived familial contributing factors	“I think it’s the way that parents feed their children. They overfeed them.”
	“If my grandmother’s fat, I’m fat, oh well, we’re just a fat family.”
	“They come across psychological things where they emotionally eat. Mother are, ‘Oh, you’re crying, I’ll give you chocolate, I’ll give you food.’”
Perceived environmental contributing factors	“Obviously the crime and that kind of thing does play a role because all the mother ensures that the child is safe while she’s at work, so she encourages the child to stay at home because it’s safer in the house than on the outside of the house.”
	“Most of the time in low socioeconomic systems... They only have minimal to feed the children, so it’s usually the high carb things that sort of fill them up very quickly... So they just feed them what they can afford and it’s usually the high carb things that make you pick up very quick weight.”
Perceived cultural contributing factors	“That’s very hard to talk about. Culture is so interspersed. You can’t distinguish anymore what was cultural and what was choice. It might not have been the choice of people, just to eat mealie-meal and all that stuff. Part of your culture was to have lots of meat and lots of veggies.”
	“We have many different cultures. Here in South Africa, we’ve got many people, living their own ways. We’ve got Muslims, as well. I think our culture doesn’t care about what the children eat. They like the children to be big, in order for people to see that this child’s family, they come from a very well–off family, and they are fed all the time, which is not good. It is really not good.”
	“… I said black culture, like myself, so I was born in an age that a man has to get married to a person heavy, not the slim. (Unclear) And whenever you’re sick, your wife can head back to bring to the hospital, and if there is any problem, she can… When you’re obese, you got power. People don’t think there’s power in someone that’s slim.”
Perceived consequences	“Consequences I am concerned about? ALL of them! Diet and level of physical activity affects every aspect of one’s body- so this list could actually be much longer… Coronary heart disease, Type 2 diabetes, cancers (endometrial, breast, and colon), hypertension (high blood pressure), high total cholesterol, stroke, liver and gallbladder disease, and osteoarthritis (a degeneration of cartilage and its underlying bone within a joint).”
	“The children you will see they not like, you know children they will always feeling tired, you will see them tired and the children, they get sick. Most of the time that will cause a heart attack and that will cause as well diabetes because diabetes also is caused by obesity. When you eat not good food you will gain a lot of weight and that will cause diabetes.”
Perceived contextual contributing factors	“It also encourages the children to eat more and more, because we’ve got some of the shops where they sell that goods, and then you try to control the nutrition for a child at home but when she or he is at school they can eat everything that has been sold.”
	“The unfortunate thing is, the way we prepare the food is not ok. Steamed, and cooked and boiled in water. Soup is food for poor people. That is something in colored communities, whereas we know that soup is a great way of getting nutrition. But for the longest time, soup wasn’t associated with health. It was associated with poverty.”
	“It’s unsafe to play in the park.”
Perceived priorities regarding childhood obesity prevention/treatment	“Insufficient attention is given to teaching school children about healthy diets and lifestyle. Not enough physical activity is promoted or engaged in at schools.”
	“In some communities, there aren’t even sidewalks, so how can you tell mothers to go for a walk to take the children for a walk? How can you walk to the park when you’re likely to be assaulted or raped?”