Healthy curiosity

?As the taxi passed through the rundown urban landscape on the way to a notoriously deprived area of North Tyneside, I thought about my mission: spending two days with a family to explore the underlying causes of childhood obesity. This was the first stage of the research, commissioned by the Central Office of Information, that would eventually feed into the Department of Health’s Change4Life campaign.

It was our feeling that the brief required an ethnographic methodology, one that could dig deep and unearth meaningful and contextualised insights in a way that would be sensitive to the families taking part. It was also important that the findings delivered an understanding of real behaviour, which can often only be revealed through observation over a period of time, as a rapport is developed with the participants. This was not the sort of topic that lends itself to group discussion.

Nevertheless I still worried that ‘my’ family, the family who were welcoming me into their lives, would judge me for judging them. I was essentially going into their house to understand how, why and where parenting skills can lead to such unhealthy outcomes. What if they hated me? Suddenly the safety of the group discussion environment, no matter how strained, was appealing: two hours, get in, get out, thanks very much and goodbye, versus 48 hours of real-life exposure where I would be under the spotlight as much as them. Feeling rather apprehensive, I knocked on the door of what would be my home for the next two days.

Moving in
I was welcomed into the front room where Alan, an 11-year-old boy, was eating his breakfast (consisting of a very large mixing bowl of Coco Pops) in front of the TV before school. Alan’s grandmother, who insisted I called her Nana, and who pops in every morning to deliver two banana and peanut butter sandwiches to Alan’s mother Mary for her breakfast, was hunched over a piece of equipment on the living room floor. “It’s definitely broken,” she said. The family looked gloomily on – it was the deep fat fryer. “There’ll be no dinner without it,” Mary moaned. “We’ll just have to get a new one.”

Over the next two days through a process of observation, fridge and cupboard audits, informal questioning and structured interviews conducted with both Mary and Alan, I was able to learn a huge amount about their behaviour and the motivations behind it.

Dinner time
The family’s main evening meals were made up almost entirely of junk food: chips every day accompanied by some kind of frozen processed food, usually Turkey Twizzlers. Friday night was Alan’s favourite mealtime, when Mary would treat them both to chicken and chips - covered in curry sauce from the local chip shop. This diet was topped up with constant grazing from the ‘sweet cupboard’. Although Alan was supposed to ask for sweets, he admitted that he often sneaked things from the cupboard, and even when he did ask, I never saw Mary say no. Fresh fruit and vegetables rarely featured in their diet, and Mary said she had given up trying to encourage Alan to eat them.

As my time with the family progressed, some interesting insights emerged. It turned out that Mary was extremely fearful of deviating from her usual repertoire: fear that she would cook something inedible (since she didn’t know what half the stuff in the fresh food section of the supermarket actually was); fear that her family would go hungry; and worst of all, fear that she would make her family unhappy by giving them food they didn’t want.

There was a similar story behind Alan’s exercise and activity levels. He was a quiet and introspective little boy who had been bullied at school, so Mary had moved him to a different school further away. This meant crossing a busy main road, so Mary felt it was safer to drive Alan there and back. This also meant that going to see the friends he did have would mean ‘going across the field’ (a notorious spot for drinking and drug-taking). Better for Alan to stay indoors and play in his room – equipped with a TV, PlayStation and DVD player.

I realised that much of this unhealthy behaviour was not due to a lack of consideration for Alan’s health, but was a result of love expressed the only way Mary knew how. When your child is being bullied, when the father is violent and often absent, when money is tight, when the local neighbourhood is too unsafe to play outside, it became clear to me that food is love. Although deep down Mary knew that her actions could have long-term health implications for her child, ensuring his happiness in the short term was far more meaningful and empowering. She was unable to provide Alan with a holiday or expensive swimming lessons and she lacked the skills to cook a nutritious meal, so why should she deny him a chocolate bar as well?

Fitting in
It was a sad situation and I felt hugely sympathetic to the motivations that were clearly at its root. I also felt extremely warm to the family for allowing me such an open and honest insight into their lives. My ability to dig down and discover their actual behaviour and motivation was not just down to process and methodology – I had to work at making the whole family feel comfortable enough to let down their guard and reveal their true selves.

In an effort to prove to them that I was not there to judge them, I ate more chocolate and fatty processed foods, drank more fizzy drinks and smoked more cigarettes than I would do in a year. I listened to their stories and revealed some of mine. I also played and spent time with Alan and even managed to get him on the trampoline in the garden that he had not used in over a year.

Saying goodbye
The work I did was one of twelve ethnographies and four depth interviews conducted by 2CV with a range of different families at risk of childhood obesity. It became obvious from this project that tackling the causes was going to require more than just a straightforward communications campaign, and the strategic insight from this work fed directly into the creation of the Change4Life initiative (see box below). When the time came to say goodbye I was walking away not only with rich insights, but also with the friendship of the family I had adopted, and who had adopted me. The family were keen to tell me how much they had enjoyed me being there, and I realised that just by listening I had given them back something in return. Although an ethnographic methodology requires time and effort, and can often be emotionally draining, it is also hugely rewarding both personally and professionally.

The Change4Life campaign: from insight to action

Findings from the research carried out for the Department of Health by agencies including 2CV, TNS and Ethnic Dimension drove the development of the Change4Life campaign, which aims to stem the rising tide of obesity. The government is grandly referring to Change4Life as a ‘movement’ – not just a marketing campaign. So how are the insights gathered being used to bring about real change?

• Firstly, the research identified that the issue of obesity needed to be reframed in a way people could relate to. Parents are quick to disassociate themselves and their families from extreme terms like ‘obese’ or ‘fat’. As a result Change4Life is not ‘about obesity’, and focuses instead on the behaviours that lead to obesity.
• The research informed the campaign’s focus on happiness, recognising the difficulty that many parents have in balancing their children’s long-term and short-term happiness.
• However, it also identified that parents don’t want to be lectured to. The marketing push needed to form part of a broader initiative providing real ways for parents to make changes in their family’s lives.
• Segmentation work pinpointed the families at greatest risk. These were defined as: ‘pressured’ – those who feel too busy to lead healthy lives and value convenience food as a pleasure; ‘inexperienced’ – those who lack knowledge of how diet and activity affects their families; and ‘treaters’ – those who enjoy their food and overlook or deny the risks.