# “It’s Not Healthy to Be Too Large”—A Qualitative Study Using Participatory Methods to Explore Children’s and Adolescents’ Perspectives on Obesity Treatment and Body Image

## TL;DR

This study explores how children and teens with obesity feel about treatment and body image through workshops and discussions.

## Contribution

The study provides new insights into children's and adolescents' perspectives on obesity treatment and body image using participatory methods.

## Key findings

- Participants desired more direct communication and involvement in their treatment discussions.
- Healthy diet was emphasized more than physical activity in obesity treatment.
- Weight loss was seen as success, while weight gain was perceived as failure, influenced by societal body ideals and stigma.

## Abstract

Background/Objectives: Qualitative child-centered research on pediatric obesity treatment and body image remains limited. This study aimed to explore children’s and adolescents’ experiences with hospital-based obesity treatment and how these experiences relate to body image. Methods: A full-day workshop including three main participatory tasks was conducted in two groups of children (9–13 years) and adolescents (14–18 years), focusing on their experiences with obesity treatment and body image. Data were audiotaped, transcribed verbatim, and analyzed using reflexive thematic analysis. Results: Four main themes emerged, reflecting different aspects of participants’ experiences. The first theme, Talk with me and not my parents, encompassed participants’ desire for greater agency, as children described lacking information and feeling excluded from consultations. The second theme, Experiences of communication with healthcare professionals (HCPs) about obesity, concerned participants’ perceptions of trust, support, and non-judgmental communication, with some adolescents expressing a need for additional psychological support. The third theme, Internalization of lifestyle advice, indicated that healthy diet was viewed as the primary focus of obesity treatment, while physical activity received less attention. The final theme, Perceptions of the body, conveyed mixed experiences with weighing and most participants perceived weight loss as success in treatment and weight gain as failure. The participants shared experiences of weight-based bullying, perceived stigma, and challenges with maintaining a positive body image in a society with stereotypical thin and muscular body ideals. Conclusions: Body image was influenced by HCPs’ emphasis on health and body size, and by their own internalized perceptions, influenced by societal ideals and experiences of stigma.