Childhood obesity prevention in China: a mixed-methods approach to inform development of theoretically based interventions

Background: Childhood obesity is increasing rapidly in China. However, research into environmental contributors to the problem is limited. Formative research that informs theoretically based prevention interventions is also lacking. Objectives and Methods: To inform the development of obesity prevention interventions among urban Chinese primary school students by: 1.exploring perceived factors contributing to obesogenic behaviours (17 focus groups and 4 interviews, n=99 including 42 males), 2. exploring preferred components and delivery strategies for future preventive interventions (17 focus groups), 3. examining the relationship of family and neighbourhood environmental factors, to child weight status as well as related dietary and physical activity behaviours (cross-sectional study, n=497). Results: Inter-related social, historical, regulatory, policy, knowledge and economic factors emerged as factors influencing attitudes, social norms and perceptions of control in relation to obesogenic behaviours. Among those, grandparents emerged as a dominant but relatively easy- to- modify theme. In parallel, the presence and role of grandparents were significantly correlated with child weight status and snacking behaviour. Conclusions: The family environment has important influences on childhood obesity and obesegenic behaviours. Drawing on the overall findings, potential targets, components and delivery strategies are discussed using a Social Marketing framework for future prevention intervention