Influences on excess weight gain amongst 0-5 year old  children: A Stakeholder produced systems map

Background: There is an increase globally in the proportion of young children (0-5 year olds) who are living with excess weight. Causal inter-relationships of key influences on obesity (called systems maps) exist for adults and school-aged children. However, there are no maps focused on young children, where unique factors may operate including the influence of childcare providers. We developed a systems map with stakeholders to identify key factors contributing to excess weight gain in 0–5 year olds. Methods : We used an iterative stakeholder engagement approach, starting with a workshop with 23 stakeholders in the United Kingdom to produce an initial map. We ran a further discussion group with six parents, a second workshop with 22 additional stakeholders, and consulted literature to develop a final systems map. Results: The final systems map consists of 20 domains of influence and 153 factors. These influences operate at six embedded levels. Level 1 (at the centre): ‘child’ includes influences related to a child’s physiology, food preferences, and specific health and social needs. Level 2: ‘parents’ includes income and resources, mental health, life pressures, parenting style and skills, and support received on feeding. Level 3 focuses on the influence of ‘Wider family and social networks’. Level 4: ‘local’ includes the physical environment, availability of early years services, and local government services. Level 5: ‘national’ includes government policies and funding, food suppliers and retailers, and societal pressures. Level 6: ‘global’ includes events affecting food supply and prices. Financial considerations drive the majority of connections within the systems map, for example parent’s income or the funding of early years services. Conclusions: There are multiple interacting influences on excess weight gain in 0–5 year olds. Some are unique to young children, particularly the influence of parents and other caregivers. The systems map can be used to support the development and evaluation of interventions aiming to prevent or reduce excess weight amongst 0–5 year olds. For example, any intervention focused on improving parents’ knowledge and confidence around food would need to be cognisant of the multiple other influences at play.