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

Table 4

Factors affecting childhood obesity by the Six C’s spheres.

Codes	Cell	Child	Clan	Community	Country	Culture
Causes	Heredity	(i) Eating habits; (ii) Food preferences; (iii) Sedentarism; (iv) Screen time; (v) Skipping meals; (vi) “Happiness”	(i) Force feeding; (ii) Parenting styles (and Grandparents); (iii) Spoiling children	(i) Child-minders’ feeding styles; (ii) Lack of play infrastructure; (iii) Access to junk food; (iv) Lack of role models	(i) Socio economic status; (ii) Media advertising; (iii) Food availability and affordability; (iv) Food packaging; (v) Geographic location	(i) Cultural foods; (ii) Traditional practices; (iii) Food preparation; (iv) Political (Historical)
Consequences	Cancer	(i) Gaining weight; (ii) Health risks; (iii) Negative body image; (iv) Weight stigma; (v) Eating disorders; (vi) Stress; (vii) Delayed development; (viii) Tiredness; (ix) Low self-esteem; (x) Laziness; (xi) Suicide	(i) Happiness; (ii) Strict parental routines; (iii) Lack of participation in sports; (iv) Bullying	(i) Healthcare sector profit; (ii) Scholastic performance	(i) Childhood obesity incidence; (ii) Malnutrition; (iii) Population outcomes	(i) Protective factor of HIV stigma; (ii) Cultural beliefs about weight and diet
Strategies	—	(i) Limiting feeding; (ii) Monitoring weight status; (iii) Increasing knowledge; (iv) Playing, dancing, exercising; (v) Weight loss; (vi) Increasing F & V consumption; (vii) Limiting screen time; (viii) Snack variety	(i) Cooking; (ii) Workshops; (iii) Family mealtimes; (iv) Breastfeeding; (v) Serving sizes; (vi) Love & Hope; (vii) Role modeling; (viii) Social support; (ix) Reward systems; (x) Home visits by dietitians	(i) Health counseling; (ii) Health education; (iii) Community gardening; (iii) Building fitness facilities; (iv) Meal routines at childcare; (v) Healthcare stakeholders’ meetings; (vi) Support groups	(i) Dietary guidelines; (ii) Subsidizing food products/supplements; (iii) Fortified food offering; (iv) Food stamps; (v) Gardening; (vi) Built environment; (vii) Media-related; (viii) Food production; (ix) Access to media outlets; (x) Collaborations across sectors	(i) Walkability; (ii) Access to nature; (iii) Traditional dances
Barriers		(i) Emotional eating; (ii) Palatable/desirable foods	(i) “Clean your plate”; (ii) Family structure; (iii) Lack of quality time	(i) Living conditions; (ii) Lack of neighborhood safety; (iii) Time constraints; (iv) Lack of training; (v) People’s attitudes	(i) Lack of options; (ii) Funding; (iii) Soil contaminants; (iv) Food insecurity	(i) Myths about women/black culture; (ii) “Big,” “Fat” as healthy, endearing

There were no questions exploring perceptions about the cell-level contribution to childhood obesity prevention.