Reasons for non-participation in the National Child Measurement Programme: An interview study with parents

Public Health Dissertation Prize Winner

Abstract

Childhood obesity has reached epidemic levels. The causes are complex and varied, with lasting impacts on whole-life health outcomes. Since 2006 the National Child Measurement Programme (NCMP) has collected height and weight data on primary school age children in Reception and Year 6 to monitor prevalence and trends of obesity in England and Wales. This data is used to develop interventions and target support to areas of need. The programme is voluntary, requiring parents to actively withdraw consent, and rates of participation have been decreasing since 2016/17. The aim of this study was to uncover the reasons why parents withdraw consent for their children to participate in the NCMP through interviews with parents who had refused consent for their children to take part. Participants were recruited through parenting forums and social media posts, self-selecting to take part in a semistructured online interview to discuss their thoughts and feelings towards the NCMP. Seven participants were involved across six interviews.

Thematic analysis of the interview data revealed five themes. Parents cited concerns over causing harm to their child’s body image or triggering eating disorders as a primary reason for non-participation. Many attributed their reluctance to their own experiences of weight-related issues to growing up in the 1990s and early 2000s in a “toxic diet culture” surrounded by media portrayals of “super skinny women” and societal expectations around female appearance and beauty standards. The use of Body Mass Index (BMI) as an indicator of child health was problematic for all participants, including those from a health professional background. There was no identified link between non-participation in the NCMP and withdrawal from childhood vaccinations although this would need wider investigation given the limitations of a small-scale study.

Recommendations from this study include an information and education campaign promoting the programme benefits including addressing the concerns raised by non- participatory parents and highlighting some of the targeted initiatives informed by NCMP data. There is an argument to be made for increasing the number of screenings to three to include secondary school children in year 8 or 9 to further monitor and track children identified as overweight or obese, allowing for an assessment of the efficacy of the programme in weight reduction and behaviour change. Considering a move from BMI to waist-to-height ratio (WHtR) could provide more accurate data on obesity prevalence in children as well as address the concerns of parents who do not feel BMI is an appropriate measure for use in children. A recommendation for further study on a larger scale would address a gap in the current knowledge around the NCMP and childhood obesity, to include the impact of Covid-19 with regards to obesity prevalence and NCMP engagement.