A new paper says that Chinese grandparents tend to indulge, overfeed and protect grandchildren in their care from physical chores, thus increasing their risk of obesity. The underlying motive for the action of grandparents may be affection for their treasured grandchild and stems from their personal experiences, misunderstanding and poor recognition of the adverse health effects of childhood obesity.

It's also the case that, like in other countries, science has made it possible for poor people to be fat for the first time in world history and so Chinese children who are mainly cared for by their grandparents are more than twice as likely to be overweight or obese, compared with those who are mainly looked after by their parents or other adults. Children who are mainly cared for by a grandparent also consume unhealthy snacks and drinks more frequently. 

The research says it is the first qualitative study in China to explore the views of a wide range of stakeholders on causes of childhood obesity. The study was conducted in the southern Chinese cities of Guangzhou and Hechi, and participants invited to focus groups included parents, grandparents, teachers, school nurses, PE teachers, catering staff responsible for children's school meals and shop retailers. The qualitative study was complemented by a cross-sectional study examining the association between children's weight and health behaviours, and the presence and role of grandparents in the household.

Current knowledge regarding childhood obesity is predominantly based on studies in western populations and the focus of the family environment has been the role of parents in obesity prevention. However, in many countries, particularly in China, grandparents are key providers of child care. Culturally, Chinese grandparents are held in great respect and often live in three-generation households.

Co-author of the study, Dr Bai Li, Postdoctoral Research Fellow in Public Health, Epidemiology and Biostatistics at the University of Birmingham said, "Our study reveals that grandparents contribute to childhood obesity in China through inappropriate perception, with many sharing the belief that fat children are healthy and inaccurate knowledge, believing that obesity-related diseases only happen in adults. Grandparents will often assess weight status by comparing their grandchildren with their peers, rather than seeking professional opinion.

"The inappropriate behaviour of grandparents, including overfeeding and indulging through excusing the children from household chores, is another contributing factor, and differs greatly from that of parents, carers and school teachers. Conflicting child care beliefs and practise between grandparents and parents, and between grandparents and school teachers, are felt to undermine efforts to promote healthy behaviours in children."

It is thought that the lag in health-related knowledge among China's older generation also stems from the fact that many experienced underweight, under-nutrition, food shortage, physical hardship and deprivation in their early lives before China's economic reform. This older generation are the grandparents of the current cohort of Chinese children, predominantly in single child families (widely known as the 'single family treasure'). As a result of China's One-Child Family Planning Policy being introduced in 1979, there are nearly 150 million single-child households in the country.

Professor of Public Health, Peymane Adab, University of Birmingham and co-author of the study said,  "Childcare provided through grandparents is a growing social trend across the world and, in China, around half of urban families have grandparents involved in the care of children. Our study highlights the need to include grandparents in future interventions to promote healthy behaviors among children.

"The rate of increase in childhood obesity over the last decade in Chinese urban areas exceeds that seen in many Western populations. Therefore, it is imperative that we now work with families, stakeholders and Chinese governmental bodies to tackle this pandemic."

The University of Birmingham has already begun to address their research, incorporating engagement with grandparents in to a public health programme that is currently being trialled in Guangdong province. The trial involves over 61,000 children at 43 primary schools. As well as engaging with carers to help tackle childhood obesity the programme, CHInese pRimary school children PhYsical activity and DietaRy behAviour chanGe InterventiON (CHIRPY DRAGON), also involves improving the nutritional quality and taste of school meals. CHRIPY DRAGON facilitators will further encourage parents to engage in more physical activity with children at home and better implement the national requirement for one hour of exercise per day at school. CHIRPY DRAGON is endorsed by the Education Bureau and Bureau of Health for the city of Guangzhou in Guangdong province and supported by the Guangzhou Centre of Disease Prevention and Control.