Chislett, Wai-Kwan (2019) Perceptions of health professionals and parents of children undergoing weight-management therapy: childhood obesity management, treatment and policy implications. PhD thesis, Victoria University.

Abstract

Background: Childhood obesity is a global phenomenon and public health problem. It is a chronic health condition associated with a body composition of excessive fat impacting on a child’s physical and social development. Public health initiatives addressing childhood obesity have had little success in reducing the prevalence of obesity or of returning children to a ‘normal’ BMI. Clinical guidelines recommend that health professionals from primary, secondary and tertiary settings should manage paediatric obesity. However, little is known about the current landscape of childhood obesity management: who is involved, what approaches are used, or what the main enablers or barriers to effective management are. Research has focused on the perceptions and practices of Australian general practitioners, but little is known about the experiences of other health professionals who manage childhood obesity. The purpose of the study was to explore and describe how Australian health professionals and parents experience and perceive childhood obesity management. The aim was to access information that related particularly to facilitators and barriers of management. Methods: Interpretative phenomenological analysis was used as an approach to examine and describe factors that influenced the ways in which health professionals and parents experienced and perceived the phenomenon of childhood obesity management. Semi- structured interviews were undertaken with health professionals and parents. The research comprised two studies. Study 1 involved health professionals from private practice, weight-management clinics, hospital and community services in three Australian states. Participants were dietitians, paediatricians, psychologists, physiotherapists and endocrinologists. Study 2 presents four case studies of parents who had attended a paediatric weight management clinic. Findings: Health professionals described childhood obesity as a body size that put children at risk of poor health outcomes; the psychological impacts were particularly of concern. They discussed their perceptions of their role in diagnosis, assessment and treatment; and shared their experiences of carrying out these roles. Each perceived role was described in the context of barriers that presented both internal and external to the clinical management setting. This included a paucity of services to refer children with obesity, insufficient resources to support treatment and their inadequate knowledge/training to engage families and effectively implement prescribed changes to health behaviours. Furthermore, health professionals believed changes made during clinical interventions were unsustainable because of the impact of the wider environment, particularly ease of access to calorie-dense foods, sedentary activities and family circumstances. The implications of the obstacles health professionals faced in treating childhood obesity were evident in parents’ interviews. Parents reported: difficulties accessing services due to limited availability and work hours; problems getting the whole family to attend sessions; resistance from other family members, including the children themselves. They believed health professionals played an integral role in gaining the entire family’s support. Parents wanted better strategies that would help their family more readily accept changes; however, they also acknowledged ensuring every meal for children was healthy was difficult due to the impact of an obesogenic environment. Ultimately, parents felt more in control of their family environment but were not confident these changes could be sustained, particularly when children were out of their direct care. Conclusion: Childhood obesity management may benefit from a systems approach. This includes having a health infrastructure and training that supports the practices of health professionals so that optimal management can be achieved. Additionally, policies that address the environmental and social determinants of childhood obesity are required to support sustainable behaviour change initiated by clinical management.

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