Childhood Obesity: Barriers to Treatment and Prevention

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As described in the previous blog post, childhood obesity has recently been deemed a national public health crisis due to its prevalence and the significant lifelong impacts obesity can have on children’s physical and psychosocial well-being.1,2 Despite health care professionals being aware of this problem and its associated potential consequences, many report a sense of reluctance and lack of confidence in treating this issue.3In this week’s post the perceived challenges health care workers have reported dealing with this health issue will be discussed.

 

Parental Involvement

        Good communication between parents and the health care professional is essential since the parents play a significant role in choosing and preparing the meals their child will be consuming. This becomes complicated when the parents of an overweight or obese child are dealing with weight-related issues themselves, or when parents won’t accept that the child has a weight issue.

Studies have shown that children with overweight or obese parents are more likely to have these issues themselves, so health care workers may perceive that their efforts to induce changes in the lifestyle of the children may be futile, produce a negative response from the parents, and ultimately risk the professional-parent relationship.4,5,6Additionally, the rise in the number of overweight and obese American’s in society has in a sense caused a normalization of overweight youth.7A consequence of this phenomenon is that some parents may not recognize or accept that their child has a weight issue if most of their peers also fall into the overweight or obese categorization.

For these reasons, parents should be made aware of the results of weight assessment tools used to classify their child as overweight, as well as the implications of their child’s weight status. The importance of the shared family environment and lifestyle of the whole family also needs to be highlighted. Rather than shy away from discussing matters of weight with parents who are overweight or obese themselves, health care professionals should view these situations as an opportunity to encourage family-wide lifestyle changes that could benefit all members.

 

Organizational Factors

        Another grouping of challenges health care workers face when attempting to treat this epidemic is administrative difficulties. Primary care providers commonly report “time crunches” leaving insufficient available time to discuss each of the matters they would like to due to the relatively short time constraints placed on them.4The average length of time for pediatric visits to primary care doctors is only 16 minutes.8Due to the amount of time it takes to obtain a history and perform each appropriate test/measurement doctors are often left with only a short time to discuss the meanings of their findings. As a result, a perceived lack of adequate time is often considered a deterrent to discussing weight management strategies with patients.

The frequency of contact opportunities primary care physicians have with children to identify a weight problem and discuss the child’s weight with parents is also often limited. According to one physician’s narrative on this subject, “We don’t meet our children. We meet the kids quite regularly during the first year, perhaps at 15 months, then 18 months, then 2½ years, 4 years, and then 5½. So much can happen between those ages”.5Further complicating matters, following these earlier years visits with primary care physicians are often limited to annual visits or appointments focused on treating an acute illness/condition.

 

Lack of Consensus and Educational Resources

        Because the medical school curriculum is very crowded, nutrition education and health behavior counseling for obesity is quite limited.9Further complicating matters, diet trends and recommendations are frequently changing in our society. Often even the nutrition experts disagree with one another. It may come as no surprise then that physicians report patients commonly describe receiving conflicting information regarding diet and nutritional recommendations between health professionals and from the vast amount of other informational sources throughout society.10An inability to find relevant, accurate patient-education resources regarding childhood obesity has also been cited as a barrier to discussing this issue with parents.7

 

An Integrated, Multidisciplinary Approach

Health care professionals should not be as hesitant as the research currently shows to discuss issues of weight, and should rather view these interactions as opportunities for health promotion. However, fighting the obesity epidemic for children and adults alike is not a one-person job and will require the combined efforts of many individuals across multiple professional disciplines.

         

References:

  1. “Facts and Figures on Childhood Obesity.” World Health Organization, 29 Oct. 2014, www.who.int/end-childhood-obesity/facts/en/. Accessed February 28, 2019.
  2. Moglia P PhD, Dill K MD. Childhood obesity. In: Magill’s Medical Guide (Online Edition). Salem Press; 2017.
  3. Bouch AB. Childhood obesity: an overview of the existing barriers to the health practitioner’s role in providing effective intervention. Communitypractioner.co.uk. https://www.communitypractitioner.co.uk/resources/2017/07/childhood-obesity-overview-existing-barriers-health-practitioner’s-role-providing. Published July 26, 2017. Accessed February 28, 2019.
  4. Walker O, Strong M, Atchinson R, Saunders J, Abbott J. A qualitative study of primary care clinicians’ views of treating childhood obesity. BMC Family Practice. 2007;8(1):50. doi:10.1186/1471-2296-8-50
  5. Regber S, Mårild S, Johansson Hanse J. Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers. BMC Nursing. 2013;12(1):27. doi:10.1186/1472-6955-12-27
  6. Findholt NE, Davis MM, Michael YL. Perceived barriers, resources, and training needs of rural primary care providers relevant to the management of childhood obesity. J Rural Health. 2013;29 Suppl 1:s17-24. doi:10.1111/jrh.12006.

7.Jones KM, Dixon ME, Dixon JB. GPs, families and children’s perceptions of childhood obesity. Obes Res Clin Pract. 2014;8(2):e140-148. doi:10.1016/j.orcp.2013.02.001

  1. Merline A, Olson L, Cull W. Length of pediatric visits actually increasing. Aap.org. https://www.aap.org/en-us/professional-resources/Research/Pages/Length-of-Pediatric-Visits-Actually-Increasing.aspx. Accessed March 6, 2019.
  2. Antognoli EL, Seeholzer EL, Gullett H, Jackson B, Smith S, Flocke SA. Primary Care Resident Training for Obesity, Nutrition, and Physical Activity Counseling: A Mixed-Methods Study. Health Promot Pract. 2017;18(5):672-680. doi:10.1177/1524839916658025
  3. Chamberlin LA, Sherman SN, Jain A, Powers SW, Whitaker RC. The challenge of preventing and treating obesity in low-income, preschool children: perceptions of WIC health care professionals. Arch Pediatr Adolesc Med. 2002;156(7):662-668.