Table 2.
The structure of the main themes, their sub-themes and the codes that make up the sub-themes
| Main theme | Sub-theme | Code |
|---|---|---|
| 1) Sources of legitimate feedback | ‘Parents know what is best for their child and do not need outside input’ | Result is wrong (child is not overweight) |
| External input in inappropriate/unnecessary | ||
| Feelings (shock, fury, upset, angry, annoyed) | ||
| Parenting failure, perceiving being told off | ||
| More factors need to be considered (family background, lifestyle, puberty) | ||
| Interventions should target other aspects of children’s life (school, neighbourhood) | ||
| Parent identity | ||
| Some parents need a reminder | Feedback letter is gentle/friendly reminder | |
| Overweight is perceived as the new normal in children, it became harder to notice a weight problem | ||
| Letter contains useful advice and weight loss programmes | ||
| Parents can be blind/biased in relation to their child and need an objective opinion | ||
| It is better to intervene early (in childhood) than struggling with weight in adulthood | ||
| The initial emotional harm to children is less than the overall harm of living excess weight | ||
| BMI is a reliable tool for weight, appropriate for population level | ||
| Health or educational professional identity | ||
| 2) Intrusion versus intervention | ‘Nanny state’ | Distrust in government collecting this data |
| The state intrudes into family life | ||
| Nanny state (the state telling people what to do) | ||
| Concerns about anonymity and confidentiality of children’s data | ||
| The measurements should not be done in schools (perception of schools being behind the programme) | ||
| Evidence based policy …how can that be wrong?’ | The NHS needs statistical data to plan services locally and nationally | |
| Treating health problems due to excess weight costs the NHS money | ||
| Participating is important for everyone for the sample to be representative | ||
| Overweight in childhood can lead to overweight and health problems in adulthood | ||
| Data collecting does not link to individual children, but is used for population statistics | ||
| 3) Weight obsession versus weight discussion | Unhealthy weight obsession | Over-emphasising the importance of weight is wrong |
| Measurements lead to discussing weight and upset children | ||
| Discussing weight will lead to 'complexes' or even eating disorders | ||
| BMI charts are one-size-fits-all and idealise a slim body shape | ||
| Emotional harm on children is worse than being overweight | ||
| Parents will deal with real problems when they arise (i.e. childhood overweight is not real problem) | ||
| Parents’ own history of childhood weight complexes and/or eating disorders | ||
| Healthy weight discussion | Weight is natural part of life and discussing it will not do harm | |
| Parents themselves decide whether they conduct healthy discussion about weight | ||
| Weight is not important in relation to an ideal appearance but in relation to health | ||
| Measurements are done sensitively and results not discussed with children to avoid harm | ||
| The BMI chart allows for a wide range of normal, and is not trying to fit different shapes into the same size |