Implementing a family-focused lifestyle programme for

treating childhood obesity in the community setting in

Ireland – pitfalls and promise

Prof Ivan Perry, Department Epidemiology and Public Health, University College Cork

Two continuums for public health

interventions

Childhood Obesity

•In Ireland, almost 1 in 4 children are carrying excess weight

•Programmes to treat childhood obesity should ideally be family-based and should combine healthy eating, physical activity and behavioural components

W82GO

W82GO

Aim Reduce obesity in children with BMI ≥98th percentile, improve children’s dietary intake, physical activity levels and weight status while also increasing psychosocial health

Intervention Details

12 month duration

Participants Children aged between 5-7 years; obese (BMI ≥98th centile); had no apparent medical conditions, had at least one parent/carer who was able to attend each of the programme sessions

Intervention facilitators

Community-based dietitians (n=3), physiotherapists (n=3), public health nurses (n=13), psychologists (n=2), health promotion officers (n=4), area medical officers (n=4), administrators (n=1) and local area management (n=2)

Community Pilot

Pilot HSE Child Weight Measurement Programme

Site A

Total

n (%)

Female

n (%)

Male

n (%)

Total measured 698

Overweight 64 (9%) 29 (4%) 35 (5%)

Obese 41 (6%) 14 (2%) 27 (4%)

Overweight or obese 105 (15%) 43 (6%) 62 (9%)

Normal weight 593 (85%)

Site B

Total measured 1366

Overweight 108 (8%) 54 (4%) 54 (4%)

Obese 80 (6%) 27 (2%) 53 (4%)

Overweight or obese 188 (14%) 81 (6%) 107 (9%)

Normal weight 1078 (80%)

Total

Total measured 2064

Overweight 172 (8%) 83 (4%) 89 (4%)

Obese 121 (6%) 41 (2%) 80 (4%)

Overweight or obese 293 (14%) 124 (6%) 169 (8%)

Normal weight 1671 (81%)

3 Key Issues in Implementation

1. Recruitment and Uptake

2. Multidisciplinary approach

3. Limited resources i.e. staff & time

1. Recruitment and Uptake – A Key Issue

• Obesity has become the norm

• Parents unaware of their child's excess weight

• Parental resistance towards discussing weight or weight-related programmes

• Staff low-perceived self-efficacy in dealing with childhood obesity

Factors influencing attendance…

Barriers Facilitators

Enrolment

- Stigma- Parental denial- Personal & programme logistics

i.e. changing family circumstances, location etc.

- Parental concern for child’s psychological wellbeing

- Social interaction- Lifestyle-focused approach

Continued Attendance

- Personal & programme logistics i.e. changing family circumstances, location etc.

- Programme staff

- Social interaction & support- Practical sessions- Programme staff- Family-centred approach

Kelleher et al., 2016

2. Multidisciplinary approach

• Complex etiology of obesity requires a multifaceted approach to treatment

• Differing perspectives & priorities

• Lack of understanding of other disciplines – Role uncertainty

• Logistics

MDT Approach…

Different perspectives & priorities

“I suppose the other main challenge was the multi-disciplinary nature of the programme. I think the challenge is when you put together a team obviously from all different backgrounds not with different agendas but with different experiences and knowledge and different perspectives”, W82GO026

Lack of understanding of other disciplines

“There was quite a lack of understanding of the various discipline roles and responsibilities and some were even unsure of what some disciplines did”, W82GO012

Role uncertainty “From the outset we didn’t know where we would fit in nor was that clarified. And that was worrying. I was concerned leaving saying 'ok am where do we fit in?”, W82GO018

Logistics “I suppose one of the challenges definitely is that the health professionals are all in different places so in terms of co-facilitating like you know the fact that I was based in one area and they were based in another. Actually just having to arrange to meet”, W82GO004

3. Limited Resources

• Staff in the community are ready and willing to take part in new initiatives to treat and manage childhood obesity

• Limited resources i.e. staff and time – “needs to be addressed if government are serious about tackling childhood obesity”

• Some stakeholders “didn't want to get involved because of existing workloads” however the provision of incentives i.e. equipment and laptops motivated many to get on board

Recommendations• Strategies and campaigns to increase awareness of childhood

overweight and obesity, and to simplify means of explaining measurement and classification are needed at a policy level

• Community programmes should move away from weight management programmes and focus on lifestyle and skills

• Practical training with motivational interviewing techniques specific to childhood obesity

• Develop dedicated obesity teams with appropriate training and resources to tackle the issue on the ground

For consideration

• What is role of family based intervention programs for childhood obesity ?

• How should we select the best approach ?

• Implementation and evaluation frameworks ?

• How to fund in the face of uncertainty and limited resources ?

Thank you for your attention