Exploring primary school years interactions around child weight: A qualitative meta-synthesis of school staff, parent and child views and experiences.

Interactions about children’s weight and weight-related behaviours occur from an early stage in school settings between various stakeholders, and are often intended to facilitate weight-related behavioural change in children and/or families. This meta-synthesis (PROSPERO - CRD42019133231) aimed to investigate stakeholder reported experiences and challenges of these encounters. Studies were eligible if they included school stakeholders (teaching or non-teaching staff, parents, caregivers or children), explored communication topics related to child obesity (weight, diet or activity), were conducted within an early school setting (primary school stage or international equivalent), and used qualitative methods. Database searches conducted March - July 2019 (updated November 2020), identified 40 studies (2,324 participants) from seven countries. Included studies were assessed for quality using the Critical Appraisal Skills Programme. Using inductive thematic analysis, we identified four core themes across this database: (1) ‘Conversation characteristics and consequences’, (2) ‘Missing components’, (3) ‘Avoiding stigma’, and (4) ‘School responsibilities’. Overall, stakeholders recognised that schools are well-positioned to provide positive influential messages about childhood obesity and reported that discussions on this topic do occur in early school settings but that stakeholders find them difficult, complex, and lack the necessary skills to deliver the non-judgemental, consistent and tailored support that they desire.