A qualitative study examining medical provider advice, barriers, and perceived effectiveness in addressing childhood obesity to patients and families from a low-income community health clinic

Supporting healthcare professionals to address child weight with parents: a qualitative study

BACKGROUND

Primary care and community healthcare professionals (HCPs) are well placed to discuss child excess weight with parents and support them to make changes. However, HCPs have concerns about addressing this issue. There is a need to understand the factors that influence HCPs in initiating these conversations to inform strategies to support them.

AIM

To explore with HCPs, working in primary care and community settings, their experiences of having conversations about child weight with parents, and the factors that create barriers or facilitate them to have these conversations.

DESIGN AND SETTING

A qualitative study with GPs, primary care nurses (PNs), and school nurses (SNs) in England.

METHOD

GPs and PNs were recruited to participate in semi-structured interviews. SNs from a community healthcare NHS trust were recruited to participate in focus groups. Vignettes were used to stimulate discussion. Data were analysed guided by the Framework approach.

RESULTS

Thirteen GPs, seven PNs, and 20 SNs participated. The following three themes were identified regarding barriers to HCPs having conversations about child excess weight: structural and organisational; HCP related; and parent or family related. The themes identified for the factors that facilitate these conversations were: structural changes (for example, dedicated appointments, access to weight assessment data, joined-up working across agencies); HCP approaches (for example, providing appropriate dietary and physical activity advice); and HCP knowledge and skills (for example, enhancing HCPs' general and weight management-related skills and knowledge of child weight management services).

CONCLUSION

A range of barriers exist to HCPs addressing child excess weight with parents in primary care and community settings. Actions to effect structural changes and support HCPs in developing relevant knowledge and skills are required to overcome these barriers.

Adherence to a healthy lifestyle behavior composite score and cardiometabolic risk factors in Spanish children from the CORALS cohort

To assess the associations between the adherence to a composite score comprised of 6 healthy lifestyle behaviors and its individual components with several cardiometabolic risk factors in Spanish preschool children. Cross-sectional analyses were conducted in 938 participants included in the CORALS cohort aged 3-6 years. Six recognized healthy lifestyle behaviors (breastfeeding, sleep duration, physical activity, screentime, adherence to the Mediterranean diet, and eating speed) were assessed in a composite score. Multiple linear and logistic regression models were fitted to assess the associations with cardiometabolic risk factors (weight status, waist circumference, fat mass index, blood pressure, fasting plasma glucose, and lipid profile). In the adjusted multiple linear and logistic regression models, compared with the reference category of adherence to the healthy lifestyle behavior composite score, those participants in the category of the highest adherence showed significant decreased prevalence risk of overweight or obesity [OR (95% CI), 0.4 (0.2, 0.6)] as well as significant lower waist circumference, fat mass index (FMI), systolic blood pressure and fasting plasma glucose concentration [β (95% CI), - 1.4 cm (- 2.5, - 0.4); - 0.3 kg/m2 (- 0.5, - 0.1); and - 3.0 mmHg (- 5.2, - 0.9); - 1.9 mg/dL (- 3.5, - 0.4), respectively]. Slow eating speed was individually associated with most of the cardiometabolic risk factors.   Conclusions: Higher adherence to the healthy lifestyle behavior composite score was associated with lower waist circumference, FMI, other cardiometabolic risk factors, and risk of overweight or obesity in Spanish preschool children. Further studies are required to confirm these associations. What is Known: • Lifestyle is a well-recognized etiologic factor of obesity and its comorbidities. • Certain healthy behaviors such as adhering to a healthy diet, increasing physical activity, and decreasing screentime are strategies for prevention and treatment of childhood obesity. What is New: • Higher adherence to the healthy lifestyle behavior composite score to 6 healthy behaviors (breastfeeding, sleep duration, physical activity, screentime, eating speed, and adherence to the Mediterranean diet) was associated with decreased adiposity, including prevalence risk of overweight or obesity, and cardiometabolic risk in preschool children. • Slow eating and greater adherence to the Mediterranean diet were mainly associated to lower fasting plasma and serum triglycerides concentration, respectively.

Barriers to Behavior Change in Parents With Overweight or Obese Children: A Qualitative Interview Study

Overweight and obesity among children and adolescents are global problems of our time. Due to their authority and role modeling, parents play an essential part in the efficacy of prevention and intervention programs. This study assessed the barriers that parents of overweight/obese children face in preventive and interventional health care utilization. Sixteen parents were qualitatively interviewed. A content analysis was performed, and barriers to change were allocated to their stage of change according to the transtheoretical model. Among the main barriers is the underestimation of health risks caused by overweight/obesity in association with diminished problem awareness. Parents seem not necessarily in need of theoretical knowledge for prevention and interventions. They do however need support in evaluating the weight status of their child and the knowledge of whom to turn to for help as well as specific and hands-on possibilities for change. The results extend past studies by adding specific barriers to change that parents commonly experience. Possibilities to address these barriers, e.g., through trainings at the pediatric practice or adoption of conversation techniques, are discussed. Future studies might identify subgroups experiencing specific barriers and thus be able to address these in an individualized way.

A Mobile-Based Tailored Recommendation System for Parents of Children with Overweight or Obesity: A New Tool for Health Care Centers

Childhood obesity is associated with unbalanced lifestyle patterns, and new strategies are needed to support parents in the compliance with the guidelines for children's age. Tailored automatic recommendations mimic interpersonal counseling and are promising strategies to be considered for health promotion programs. This study aimed to develop and test a mobile recommendation system for parents of preschool children identified with overweight/obesity at health care centers. Evidence-based recommendations related to children's eating, drinking, moving, and sleeping habits were developed and tested using a questionnaire. A pilot study was conducted in a health care center to test how using an app with those tailored recommendations, in video format, influenced parents' perceptions of the child's weight status and their knowledge about the guidelines, compared to a control group. The chi-squared test was used for categorical variables and the Mann-Whitney U test for continuous variables (p < 0.05). A high proportion of parents were already informed about the guidelines, but their children were not meeting them. After watching the tailored recommendations, there was an increased knowledge of the guideline on water intake, but there was no improvement in the perception of the child's excessive weight. Parents may benefit from a mobile-based tailored recommendation system to improve their knowledge about the guidelines. However, there is a need to work with parents on motivation to manage the child's weight with additional strategies.

Psychosociocultural Contributors to Maladaptive Eating Behaviors in African American Youth: Recommendations and Future Directions

Childhood overweight and obesity disproportionately affects African Americans, and these children benefit less from standard pediatric weight management treatment programs compared to other racial/ethnic groups. Maladaptive eating behavior has been identified as a behavioral contributor to obesity and is also associated with the development of nonrestrictive eating disorders over time. Unique psychosociocultural factors have been identified that may promote higher risk for maladaptive eating behaviors in African American children beyond the effects of economic disparity. To best treat this group, it is important for practitioners to have a thorough understanding of these factors. We review several of these considerations and describe ways they may interact to contribute to the subsequent development of maladaptive eating behaviors and increased weight. Recommendations are made regarding how attention to these factors could be incorporated into current pediatric weight management treatments to better serve this population via a patient-centered care approach. Future directions will also be discussed.