Why are Chinas little emperors getting so fat? Blame the grandparents, study says

China's getting fatter, but it's not because kids are super-sizing their food or playing too many video games. It's because of the grandparents.

While grandparents aren't the sole reason for the country's obesity epidemic, they play a unique and outsize role, according to a study published in the International Journal of Behavioral Nutrition and Physical Activity on Thursday by researchers at Britain's University of Birmingham.

The role of grandparents in a child's life in China tends to be greater than in a typical U.S. household. It isn't unusual for multiple generations to live in one home, and in some rural areas, many of the migrant workers who travel hundreds, or even thousands, of miles to work in factories in the cities leave their children behind to be cared for by their grandparents for large parts of the year.

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The study's lead author, Bai Li, said the problem is that many grandparents in China believe fat children are healthy and that obesity-related disease strikes only adults. The grandparents also tend to overfeed and overindulge by excusing their "huang di" (or "little emperors," as they are commonly known) from household chores that could give them some physical exercise.

Li and his colleagues convened focus groups and conducted in-depth interviews with grandparents. They then examined the relationship between the grandparents' role in a child's care and the weight, diet and physical activity of the child. They found that the grandparents tended to counter attempts by parents and school staff to promote healthy eating and exercise.

"These attitudes and beliefs largely stem from the historical context of famine and poverty in China during their childhood, where being slim represented poverty and poor health," Bai and his co-authors wrote.

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A public health program covering 61,000 children in the southern province of Guangdong has already begun to incorporate some of the study's findings by adding a component that involves engagement with grandparents.

As China's obesity rates have skyrocketed — it's now ranked No. 2 after the United States for the most obese residents — global public health officials have been trying to determine what types of educational campaigns and interventions might work in the country of nearly 1.4 billion. Previous research into the underlying social, cultural and economic causes of childhood obesity also supports the idea that there are major differences between East and West in the reasons why kids are getting fatter in China versus the United States.

A 2011 study in the American Journal of Health Behavior by University of Southern California researchers had a surprising finding: Children from well-off Chinese families with advanced education who said they were physically active and ate plenty of vegetables were more likely to be overweight than other children.

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Some theories why include the idea that these families in China may have had more money to feed the children and that as a result the children may have been consuming more rice and deep-fried and stir-fried food -- dishes that tend to be staples in the Chinese diet. They may also have been able to afford more cars, televisions and computers as compared to poorer Chinese families.

Ya-Wen Janice Hsu, a research assistant in the Department of Preventive Medicine at USC's Keck School and a co-author of the study, said at the time that “one potential explanation is that the unhealthy lifestyle changes, driven by the rapid shifts in Chinese economic climate, are choices available primarily to the wealthier population."

"As the Chinese economy continues to grow, it is crucial to track these paradoxical relationships, which may or may not ‘flip’ to match relationships we now see in Western countries," Hsu said.

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