Obese mother, obese child: A convergent mixed methods study of intergenerational obesity in low-income households in Malaysia.

Maternal and child overweight and/or obesity (OW/OB) are growing public health concerns, especially in low-income households, where they contribute to intergenerational transmission and increased financial burden. Using a convergent mixed methods design, this study aimed to investigate the determinants of intergenerational obesity among low-income families in Malaysia. Quantitative data were derived from the Malaysian National Health and Morbidity Survey for the years 2006, 2011, and 2015, while qualitative insights were obtained through in-depth interviews. The quantitative study included 2,057, 994, and 952 mother-child pairs from low-income households in 2006, 2011, and 2015, respectively classified based on body mass index categories. Factors associated with overweight mother/overweight child pairs (OWM/OWC) were analyzed using multiple logistic regressions. To explore the factors contributing to OW/OB, the qualitative study involved 27 in-depth interviews with mothers, and the data were analyzed using thematic analysis and findings from both studies were integrated through a narrative approach. Maternal ages between 41-50 years (2006: AOR = 2.35, 95% CI = 1.21-4.60, p = 0.012) and above 50 years (2006: AOR = 2.29, 95% CI = 1.06-4.98, p = 0.036; 2015: AOR = 3.23, 95% CI = 1.14-9.13, p = 0.025) were associated with higher odds of OWM/OWC. Children aged between 10-14 years had higher risk (2006: AOR = 2.38, 95% CI = 1.63-3.47, p < 0.001; 2011: AOR = 1.76, 95% CI = 1.05-2.96, p = 0.032). Chinese (2006: AOR = 0.46, 95% CI = 0.23-0.92, p = 0.027; 2015: AOR = 0.40, 95% CI = 0.19-0.83, p = 0.014), other ethnicities (2006: AOR = 0.49, 95% CI = 0.32-0.73, p = 0.001; 2011: AOR = 0.46, 95% CI = 0.25-0.83, p = 0.010; 2015: AOR = 0.53, 95% CI = 0.31-0.91, p = 0.020), and large household size (2015: AOR = 0.19, 95% CI = 0.04-0.94, p = 0.041) were protective against OWM/OWC. Four major themes emerged from the in-depth interviews: (1) personal factors (demographics, cognitions, and skills), (2) social environment (parent-child relationships), (3) physical environment (home and built environments), and (4) macro-level environment (food price and media influence). The findings suggest that intergenerational OW/OB in low-income households is influenced by interconnected personal factors, as well as social, physical, and macro-level environments. This study not only provides a comprehensive understanding of how such factors interact within real-life contexts but also highlights the importance of multi-level interventions that address individual behaviors and broader environmental and socio-economic constraints.