Exploring young child feeding practices & perceptions in Tower Hamlets, with a focus on sugar

Introduction: The aim of this qualitative research was to gain a greater understanding of the factors that influence young child feeding perceptions and practices in families with children under the age of five years old in London Borough of Tower Hamlets, in the context of rising childhood obesity levels in England. Methodology: The target group were mothers with children under five, mother in laws, service providers and carers. The participants were selected using purposeful, convenience and snowball sampling methods. Data were collected from 21 key informant interviews, 2 direct observations of health promotion sessions and 18 focus groups. The focus group discussions included 119 participants: 95 women who were mothers, 3 mother in laws and 21 service providers. A thematic analysis was used to identify four themes: knowledge not leading to changes, communication challenges, barriers to improving family healthy eating practices, and the lack of public health nutrition services. Findings:  Knowledge had not led to behaviour change: Participants demonstrated high levels of knowledge on what constitutes healthy eating such as increasing the amount of fruit and vegetables their children eat while reducing sugar, salt and fat intake. Information was sought mainly from the internet, friends and family, but participants would prefer a one-to-one session with a health worker. Communication challenges: Misleading messages negatively affected food choices. Participants raised the problem of mixed messages regarding what was a healthy snack, as many food labels targeting young children carry misleading health claims such as “two of your five a day” or “organic,” despite having extremely high levels of sugar.   Barriers to improving family healthy eating practices: The challenges experienced when trying to improve their children’s eating habits included the cost of healthy food options, the lack of time to buy and prepare healthy options, unhealthy treats given by family and friends, and the unhealthy takeaway food environment. Lack of public health nutrition services and support: There was a lack of clarity regarding who mothers and service providers should refer to regarding nutrition problems such as fussy eating, portion sizes, and diet diversity. Half of the early years’ service providers that were interviewed had no training on healthy eating guidelines, although training had been planned. Parents did not think the sugar tax would have a significant impact on the consumption of sugar or on childhood obesity levels.