An examination of association of parental feeding practices with childhood obesity among school children aged 6-12 years in Ghana: A mixed method study.

Childhood obesity is a growing public health concern in developing countries, with consequences for children's lives and limited healthcare resources. This research examined how parental involvement in child feeding affects their risk of developing childhood obesity. The study employed an explanatory sequential research mixed methods design where data was collected and analysed in two phases. The first phase of the research involved the use of a survey approach in tandem with multiple structured research instruments- including the Demography questionnaire, Food Frequency questionnaire, Comprehensive Feeding Practice Questionnaire and Child Eating Behaviour Questionnaire from 434 randomly sampled respondents, comprising school children aged 6-12 and their parents/carers/guardians. In addition, anthropometric measures were adopted to gather data on the body composition of the school children. Then, qualitative data were collected through focus group discussions and interviews to capture cultural nuances and perceptions of parents/carers/guardians (n=24) and children (n=16). The qualitative data was analysed using a thematic analysis approach. Quantitative analysis revealed that parental feeding practices encompassed various dimensions, including child control, emotional regulation, and food restriction for weight control. The largest intake of sweetened food was found in healthier weight categories; however, mean score comparisons showed no significant correlation between high consumption of sweetened food and obesity. Additionally, milk, yoghurt, and cocoa beverages were consumed at high levels, Rice, tubers (Yam), and legumes were among the staple foods, whilst bread and biscuits were some of the commonly consumed foods, influenced by household dynamics and cultural factors. Further, parents were found to adopt different strategies to manage their children's emotional responses to food. Parents used food as a reward or comfort, while others encouraged alternative coping mechanisms. Parents' approaches to limiting their children's food intake differed across weight categories. Parents of underweight children were less concerned about restricting junk food intake. In contrast, parents of overweight and obese children exerted more control to limit their consumption of less healthy foods and sweets. The qualitative data revealed a strong preference for traditional foods among parents who considered them essential for maintaining cultural identity and connecting children to their ancestry. Again, parents cited worries about addiction and health risks associated with sweetened products. They implemented disciplinary measures to limit their children's sweet consumption, including restrictions and, in some cases, negative reinforcement was used on children for consumption of excessive sweet products. Parents identified several challenges in promoting physical activity among children, like limited indoor and outdoor spaces for exercise, contemporary work schedules that reduced active playtime with children, and societal expectations that often-discouraged active sports among girls. The study recommends that policymakers should consider holistic strategies to promote healthier dietary habits among school children, including awareness campaigns on sweetened food risks and healthier alternatives; ensuring the availability and affordability of nutritious foods in schools is crucial. Theoretically, the study challenges the ecological systems model which dwelt on interpersonal/individual by highlighting the complexity of socio-cultural influences and on childhood obesity. It calls for a broader examination of all systems by adopting the whole system approach in childhood obesity research to reduce this burden.