Family by Family: Addressing childhood obesity through local understandings and local solutions

Chief Investigator: Professor Megan Warin

Funding Amount: $74,517

Recipient: University of Adelaide

Overview:

Innovative ways of tackling childhood obesity in disadvantaged communities are urgently needed. This mixed-methods research will evaluate a new South Australian model of family support (Family by Family) in a community where childhood obesity is a significant problem. Family by Family comprises a network of families who have themselves come through hardship and mentor other families to be healthy and thrive. This project is significant as it addresses childhood obesity and disadvantage from the perspective of local understandings and local solutions, and not from a ‘one size fits all’ model.

Research Outcomes:

Researchers: Dr Tanya Zivkovic, Prof JaneMaree Maher

Research Completed: 20

Research Findings: This project was co-designed by TACSI and anthropologists/sociologists at The University of Adelaide and Monash University. The project aimed to explore how the Family by Family (Fbf) program supports change, with a particular focus on everyday food and eating practices in circumstances of disadvantage. In order to understand the complexities of how food and eating happens in people’s lives, Family by Family use a systems theory approach. This approach emphasises the complex environments in which people live, and collective work of community that enables families to be inter-dependent. The program is intimately tied to local environments and does not have a single focus intervention (i.e. obesity prevention) but rather considers the family holistically, taking a ‘sideways’ approach to build skills and confidence in and between families. It is only through this attention to the context, and through understanding local contexts and challenges, that issues around eating and food practices can begin to be addressed.

Key Outcomes:

Innovative ways of tackling childhood obesity in disadvantaged communities are urgently needed. The overall aim of this ethnographic project was to investigate the ways in which a unique family empowerment program in the northern suburbs of Adelaide approaches healthy eating behaviours and activities in a community where childhood obesity is a significant problem. Based in SA (Adelaide) and previously in NSW (Mt Druitt), Family by Family is an initiative of the Australian Centre for Social Innovation and presents a different model to current childhood obesity interventions, situating food and eating in everyday contexts and acknowledging the many competing priorities that families in crisis may face (e.g. family violence, precarious housing and low income). Family by Family comprises a network of families who have themselves come through hardship and mentor other families to be healthy and thrive.

This project identified some of the key aspects of Family by Family (Fbf) which are unique and enables change to be family led:

• An overarching characteristic of the Fbf program is that it operates with a systems theory approach. Systems theory recognises that people are always located in cultural, socio-economic and political systems, which can be complex, uncertain and multi-layered. Food, eating and obesity is understood within a complex network of relationships, economies, situations and material resources. Obesity cannot be addressed without attending to the situations and contexts in which people live.
• Fbf centres and values relationships which develop over time. These relationships are hinged on practices of care and reciprocity, attending to significant social determinants of health such as social isolation. The way relationships are engendered in the Fbf model also acknowledges power dynamics and imbalances, taking a holistic, shared approach to power rather than a top-down model.
• Fbf is grounded in self-determination approaches. The strength in the self-directed approach is illustrated through the self-referral system, the way families are encouraged to identify and set their own goals in order to achieve positive outcomes. The processes and practices of the Fbf model are strengths-based, enabling reflection and ongoing feedback so that families can recognise and celebrate their achievements, thus facilitating empowerment.
• The Fbf model fosters a supportive and safe environment. In developing a multi-layered, informed and responsive support network Fbf is able to wrap support around all of the families involved (including children and staff). This inclusivity and care is essential to the success of the program.
• A key asset is the in-built flexibility of the program. Although Fbf processes follow a framework, the model is designed to be adaptable to each family situation. This flexibility enables personalised and tailored approaches to supporting families, acknowledging and respecting their priorities. It also extends to an understanding of how a series of small changes within families can lead to skills which enable people to navigate wider social systems.
• The Fbf model avoids blame, shame and stigmatisation. Families are not positioned as failing to make ‘informed’ choices, rather they are seen as experiencing hardship which constrains their choices. The families that are enlisted to support Fbf (sharing families) have themselves experienced hardship and come through and these shared experiences enable empathy, encouragement and destigmatisation. The two way street of families sharing their experiences of hardship – of sleeping, breathing and living through hard times – and knowing you can come through and thrive, provides important opportunities to exchange key skills and build confidence. This is a valuable asset of the program.
• An additional strength of the Fbf program is that it understands its own limitations. Understanding when a family is too complex for the Fbf model is important because it ensures that they are not over-promising and under-delivering, which can be detrimental to families in crisis.
• Children are explicitly incorporated into the Fbf model. They are seen as leaders and enablers of change through their role modelling and creative contributions to family and community.

KEY THEMES

Vulnerability

Through the ethnographic fieldwork, we have observed how the concept of vulnerability is reframed and reconceptualised as a productive resource and a practice of care. Vulnerability is recognised as part of everyday life and not something to be overcome or contained. Through working with Fbf we have found that being vulnerable relies on time and trust and is a tool for building relationships – a foundational aspect which supports change in families.

Change

Fbf understands change not just by quantitative measures and statistics but as dynamic and nuanced. In the Fbf program change is recognised as: dependent on relationships, as something that occurs slowly over time, as holistic and as a catalyst for other changes (unintended outcomes). Changes are tracked through goals and constant reflections of what can be celebrated as an achievement (emphasising how the strengths-based approach operates). Importantly, change is attributed to and owned by those making the change and emphasises ‘showing not telling’, role modelling, and activities practiced together.

Context matters (#notjustdiets)

Fbf is cognisant of the contextual and structural factors influencing people’s lives, with a complex understanding of local environments that views families in-situ and as active within the local environment. Attending to the broader context means that when required, Fbf is able redirect the focus and recognise unintended outcomes. This is done by not isolating or problematising one thing or person but addressing the family as a whole and as a part of the community and environment they are operating in.

Implications for policy

• Programs that address a single focus may not resonate with families who are often experiencing a multitude of concerns and stressors. In order to address specific issues, as this research with Family by Family has demonstrated, a ‘sideways approach’ maybe be more beneficial.
• Programs that are family-led, that prioritise an empowerment approach where people are in control of their own lives and seen as experts in their own lives, have much better outcomes. Families reported that this empowerment model enabled support to be tailored and family-led so that power dynamics were reconfigured and not coming to families through a top-down approach.
• The Family by Family model encourages families to be flexible, to take responsibility for each other and to position relationships as central. This wrap-around care, developing children as ‘change agents’ and attention to people’s everyday lives is unique to the program. It is through this model that attention to eating and health can be addressed.

Research Papers:

In-Press

• Warin, M. (2020) Beyond carrot sticks and sermons: The practice of education in obesity interventions in D Leahy, K Fitzpatrick and J Wright (eds) Social Theory and Health Education. London: Routledge.

Submitted for Publication – under review

• Zizzo, G, Zivkovic, T., Warin, M. and J Maher (Submitted August 2020 and under review) Productive exposures: Vulnerability as a parallel practice in ethnographic spaces. The Australian Journal of Anthropology.
• Warin, M. (Submitted Jan 2021 and under review) No Appetite for Change: Culture, Liberalism and other Acts of Depoliticization in the Australian Obesity Debate. Sociological Research Online.

In preparation

• Zizzo, G, Zivkovic, T., Warin, M. and J Maher (2021) Care, change and ‘positive deviance’.

Presentations (local, national and international):

• Zizzo, G, Zivkovic, T. & Warin, M. (2019) Productive exposures: Vulnerability as a method and resource in embodied food research. The Fifth Australian Food, Society, and Culture Network Symposium, 15 November 2019. The University of Sydney, NSW. (Photograph 1)
• Zizzo, G., Warin, M., Zivkovic, T. (2020) Family By Family – Key findings. Team Meeting with Family by Family, TACSI and Uniting Communities. 21 February 2020. Uniting Communities, Flinders Street, Adelaide, SA. (Photograph 2).

Related Publications:

Future Outcomes: