Are Chinese grannies a health hazard?

Ingrained Chinese memories of famine and starvation could be helping create a nation of overweight children

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The Roman poet Virgil may have warned of Greeks bearing gifts, but in modern China it is grandparents clutching cookies that are the sleeper threat, according to a team of Chinese and British researchers. A threat to the health of their grandchildren, that is.

A recently published study¹ has found the children of internal Chinese migrants are less likely to be obese than non-migrant children because their absent grandparents aren’t around to spoil them.

The University of Birmingham researchers worked with the Guangzhou Centre for Disease Control and Guangzhou Health Care Promotion Centre for Primary and Middle Schools on the study, which was published in PLOS ONE in May.

Study lead Dr Bai Li, of the University of Birmingham, had previously identified overindulgent grandparents as an obesity risk, but this is thought to be the first time perceived obesity drivers among so-called “local” children have been compared with those among “migrant” children, whose grandparents are generally not living close by.

The study sheds light on cross-generational Chinese attitudes to lifestyle diseases, a growing concern in a rapidly modernising nation where more than 30 million children aged between seven and 18 are considered to be obese.

Though the study was small and interpretive the researchers say the findings could help with the better targeting of public-health interventions.

Live-in Chinese grandparents were likely to overfeed their grandchildren because fat children represented health and success to them, said the researchers, who interviewed 148 members of migrant and non-migrant school communities in the southern Chinese manufacturing city of Guangzhou.

The study cohorts included 137 participants from 16 primary schools (including three segregated migrant schools) who took part in 20 focus groups broken down by identity – parents, grandparents, teachers — though in a few cases school staff were also parents. Additionally, 11 school principals were individually interviewed.

“We see grandmothers and grandfathers arriving [after school] with cookies, eggs, milk et cetera,” said one interviewee, a local teacher. “We expect that the amount of food our children are given is equivalent to four or more meals a day.”

Chinese grandparents commonly take on significant childcare responsibilities while both parents work. Their own hardship during China’s catastrophic mid-20th century famine, in which near 30 million perished, is thought to be one explanation for the tendency to overindulge their grandchildren with food.

“Many grandparents are proud of their ‘big’ grandchildren and often say that the ‘big’ child is the outcome of their successful hard work,” said one interviewed parent. “Busy parents do need help from their parents so they often struggle to express their worries, let alone challenging their parents.”

And while there was some awareness of the issue of overindulgence, there was also a lack of will to address the problem.

“We [grandparents] have a common characteristic,” confessed one local grandmother, “We like to pamper our grandchildren. Sometimes I know he is eating too much, but I am so happy to see him keep eating and getting bigger. We can’t ask the little one to stop eating if that’s what he likes to do … so we are a problem. I think the child’s obesity is directly related to us.”

Other perceived obesity risks were identified for both cohorts. For migrant children, parental absence after school, as well as perceived lack of neighbourhood safety (including the threat posed by child trafficking) and limited outdoor space were all thought to deter children getting sufficient exercise.

An earlier major diet study of 3368 adolescents in the nearby technology manufacturing hub of Shenzhen, in southern China, found migrant children ate more meals away from home, skipped breakfast more, and were more likely to eat unhealthy street snacks than locals. They also ate less fruit and vegetables.

But the Guangzhou interviews suggested local children had more opportunities to eat unhealthy street food, such as deep-fried tofu on sticks, on the way home from school, as they were less likely to be bussed from their schools to their homes. There was also evidence of less pressure on migrant children to get good grades, compared with local children, which had an associated impact on recreational physical activity time.

But are China’s grandparents getting an unfair share of the blame for the rise in obesity levels? Earlier joint Australian and Chinese research⁴ suggests the picture could be more complicated.

Colin Binns, emeritus professor of public health at Curtin University, co-authored a 2014 Chinese-Australian joint study of Chinese mothers’ perceptions of infant obesity found a worrying disconnect. Binns’ team interviewed nearly 2000 mothers in the Chinese cities of Chengdu and Wuhan, and 91 ethnically Chinese mothers living in Perth, all with children aged between two and four. In China, 89% of the Chinese mothers of overweight or obese children did not consider their children to have a problem. In Australia, the number was 86%.

Professor Binns told The Medical Republic he thought Dr Li’s study was “basically correct” and that “perceptions of grandparents are important”. But he questioned the sample size and nutrition methods. Professor Binns’ work has concentrated on a link between obesity and inadequate breastfeeding and early solids. He has also looked at the role of a microbiome altered through, for instance, Caesarean section or the use of antibiotics by the mother and/or the infant.

CHANGING ATTITUDES?

But Dr Li’s research findings ring true for Professor Xinyue Zhou, a Chinese research psychologist and mother of eight-year-old Anzhou, who lives in the eastern Chinese coastal city of Hangzhou.

“You can see grandparents chasing their grandchildren around with a bowl and spoon in their hands, trying to feed the running children,” says Professor Zhou, whose mother has been living with her and caring for Anzhou since she was born.

“My mum always says that if you let children feed themselves, they won’t eat enough. If my daughter says, ‘I am not hungry any more,’ she will say, ‘nonsense, you hardly eat!’ She will chase my daughter around, sometimes to the neighbours’ home, to feed her.”

If her mother thinks Anzhou has not eaten enough, she’ll cook another meal between meals. But Professor Zhou is more concerned about how her mother’s behaviour might affect her daughter’s autonomy and independence, than her weight.

“[My mother’s] generation experienced famine when they were adolescents. They are terrified of hunger. And they worry constantly whether their grandchildren have enough.

“I guess she doesn’t want my daughter to ever feel hungry.”

Not everyone agrees with the studies, however.  Chinese mother of two Merry Li moved to Sydney from Nanjing, China, two-and-a-half years ago.

She believes Chinese attitudes to child health are changing, and singles out the growth of childhood sport.

Li’s two sons, 16 and 11, are keen basketball players. The fact her eldest is already 1.83cm tall helps, she says.

“China is becoming stronger and stronger because Chinese parents pay more attention to their children in terms of education and sport,” Li says.

Even when her family heads back to Nanjing to visit her parents, she says the grandparents don’t spoil or overfeed her sons. “You must have the wrong information,” she tells The Medical Republic.

References:

1. journals.plos.org/plosone/article?id=10.1371/journal.pone.0177505

2. data.worldbank.org/share/widget?indicators=SP.URB.TOTL.IN.ZS&locations=CN )

3. care.diabetesjournals.org/content/34/6/1249.long

4. apjcn.org/update%5C-Online%20First.pdf