Evidence
Alert

British-Bangladeshi parents offer better nutrition to their children when interventions involve the community

Participants discuss the Nurture Early for Optimal Nutrition (NEON) study.  The video transcript is available here.

 

Efforts to help parents feed and care for young children should be developed with the input and assistance of relevant ethnic communities, a new study shows. Different generations within the British-Bangladeshi population of East London offered key information that is helping public health researchers reach and influence new parents.

The study examined features of this community and environment that influence parents’ approaches to caring for their infants. These include a widespread belief that a chubby baby is a healthy baby, as well as the availability of fast food and a tendency to over-feed.

The information is being used to tailor community interventions with parents that aim to improve nutrition for pre-school children, and, in the long term, to tackle rising rates of obesity.

What’s the issue?

New parents receive advice and encouragement on breastfeeding their infants. But there is less support available when children reach six months of age and are typically weaned onto solid foods. Yet this is a key time in their development, when suboptimal feeding practices can set up children to become obese and/or deficient in nutrients such as iron and vitamin D.

This is an area of public health where one size definitely does not fit all. Different cultural practices and attitudes heavily influence both infant feeding styles and whether attempts to intervene will be accepted or rejected.

The British-Bangladeshi community in East London is at high-risk of poor health and of obesity. But adequate descriptions of public health interventions that could help are lacking. Research has tended to consider all South Asian populations together, which limits understanding of the relevant cultural and social factors within individual groups.

What’s new?

Some 141 people from the British-Bangladeshi community in Tower Hamlets, London, were interviewed as part of this community-based research. They included parents and grandparents of children aged 6-23 months, as well as community leaders and health professionals.

The study identified infant feeding and care practices, and features of this community and environment, that could be targeted to improve children’s health.

It described:

  • practices such as the premature introduction of solid and semi-solid foods, overfeeding, and prolonged parent-led feeding. Occasionally, caregivers reported adding sugar or biscuits to milk bottles to encourage calorie intake between solid feeds. Members of the community offered insights; one mother described kheer, a sweet dish made from milk, rice and sugar. She said of her son: “He absolutely loves it. Any time of the day you feed him that, he’ll eat it.”
  • sociological factors including the cultural tendency to associate chubby babies with healthy babies. Mothers were anxious that family or friends would say their baby was too skinny or too chubby
  • environmental factors such as fast-food outlets and advertising. First-time parents were especially keen to have more support and information from health professionals
  • cultural insights such as that hand feeding by parents is seen as a symbol of love for the child and may continue for years, potentially causing over-feeding.

Overall, the researchers found that consulting the community led to more appropriate and better-quality interventions than ‘top-down’ approaches devised at a distance.

Why is this important?

The research was part of a multi-phase programme called Nurture Early for Optimal Nutrition (NEON). The results have already been incorporated into a public health intervention scheme that aims to change behaviour in the community and to encourage more nutritious feeding

Involving the community in identifying problems and framing possible solutions has helped secure “buy-in” from participants. It also led to some material benefits in how the intervention was designed. For example, a series of picture cards have been developed to try to challenge the idea held by parents that babies should be chubby.

Such interventions are critical if public health researchers are to reduce the one-third of children who currently leave UK primary schools as obese or overweight.

What’s next?

The researchers plan to further develop the intervention and extend its reach to the wider South Asian community in London. They want to link the scheme to the digital version of the familiar “red book” used to record childhood progress. And they aim to set up a YouTube channel that includes healthy recipes suggested by people within the community.

The end goal of the research is to change feeding practices and improve nutrition, and the researchers want to test what difference these interventions make in practice. To do so, they will carry out trial, starting next year in the London boroughs of Tower Hamlets, Newham, and Waltham Forest. The trial design is not yet finished but it will assess whether sessions with parents change feeding practices and ultimately leave fewer children obese.

The ongoing COVID-19 pandemic, and the restrictions on people’s movements, may reduce participation in health-intervention programmes. The researchers are exploring whether the new trial could also measure and compare the benefit of using digital technology such as video-conferencing to work remotely with interested parents.

You may be interested to read

The full study: Lakhanpaul M, and others. The Nurture Early for Optimal Nutrition (NEON) programme: qualitative study of drivers of infant feeding and care practices in a British-Bangladeshi population. BMJ Open. 2020;10:e035347

Website providing information about the multi-phase NEON project

YouTube video about the NEON project

 

Funding: The study was funded by the NIHR Collaboration for Leadership in Applied Health Research and Care North Thames.

Conflicts of Interest: The study authors declare no conflicts of interest.

Disclaimer: NIHR Alerts are not a substitute for professional medical advice. They provide information about research which is funded or supported by the NIHR. Please note that views expressed in NIHR Alerts are those of the author(s) and reviewer(s) and not necessarily those of the NHS, the NIHR or the Department of Health and Social Care.

Commentaries

Study author

The study validated some of the things we knew, or thought we knew, about practices in this community. But it was very positive to hear how open and willing the parents were to discuss challenges, especially how much fathers wanted to get involved, even though they can’t always be there at feeding time.

These families are confronted with lots of conflicting information at present, and that is not helpful. They are given information that is not tailored to their cultural needs. One family told us how they eat with their hands, so advice on how to feed children with forks and spoons just is not appropriate for them.

Monica Lakhanpaul, Professor of Integrated Community Child Health, UCL Great Ormond Street Institute of Child Health, London

Researcher

The impact of this paper will depend on how it is disseminated to and received by public health practitioners and commissioners, midwives, health visitors, GPs, families, and community influencers in the Bangladeshi and other South Asian communities, as well as policy makers and politicians in the fields of health, food and nutrition.

The paper identifies the specific nutritional challenges faced by the Bangladeshi community in London but it also highlights the issues for all low-income families in the UK where similar challenges have been reported. They include societal barriers such as misleading advertising and marketing.

The research therefore has the potential to inform and educate professionals and commissioners, and to be used to inform public health guidance and policy, but actually having an impact will depend on priorities and resources. Changing behaviour in regard to children’s food and nutrition needs a combination of individual, community, professional, and policy change.

Mary Renfrew, Professor of Mother and Infant Health, University of Dundee