<i>It’s like rocket science…only more complex</i>: challenges and experiences related to managing pediatric obesity in Canada

Avis, Jillian L. S.; Bridger, Tracey; Buchholz, Annick; Chanoine, Jean‐Pierre; Hadjiyannakis, Stasia; Hamilton, Jill; Jetha, Mary; Legault, Laurent; Morrison, Katherine M.; Wareham, Anne; Ball, Geoff D.C.

doi:10.1586/17446651.2014.897605

Cited by 21 publications

(13 citation statements)

References 33 publications

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“…For example, in a recent study, adolescents expected to achieve a median weight loss of 50 pounds and those who had higher expectations were more likely to discontinue weight management prematurely compared to their peers with lower expectations [ 17 ]. Given these unrealistic expectations and the well-documented challenges of losing and maintaining weight loss over time [ 18 ], it may be productive to shift families’ attention from a singular focus on weight loss to emphasize lifestyle and behavioral changes that can improve health outcomes and minimize the risk of obesity-related comorbidities [ 19 ]. This type of health-centred approach was practiced by HCPs in our study who reported encouraging adolescents to adopt healthy lifestyle behaviors irrespective of weight loss and defined ‘success’ based on improved health.…”

Section: Discussionmentioning

confidence: 99%

Health care providers’ weight management practices for adolescent obesity and alignment with clinical practice guidelines: a multi-centre, qualitative study

Kebbe

Perez

Buchholz

et al. 2020

BMC Health Serv Res

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Background Clinical practice guidelines (CPGs) include evidence-based recommendations for managing obesity in adolescents. However, information on how health care providers (HCPs) implement these recommendations in day-to-day practice is limited. Our objectives were to explore how HCPs deliver weight management health services to adolescents with obesity and describe the extent to which their reported practices align with recent CPGs for managing pediatric obesity. Methods From July 2017 to January 2018, we conducted a qualitative study that used purposeful sampling to recruit HCPs with experience in adolescent weight management from multidisciplinary, pediatric weight management clinics in Edmonton and Ottawa, Canada. Data were collected using audio-recorded focus groups (4–6 participants/group; 60–90 min in length). We applied inductive, semantic thematic analysis and the congruent methodological approach to analyze our data, which included transcripts, field notes, and memos. Qualitative data were compared to recent CPGs for pediatric obesity that were published by the Endocrine Society in 2017. Of the 12 obesity ‘treatment-related’ recommendations, four were directly relevant to the current study. Results Data were collected through three focus groups with 16 HCPs (n = 10 Edmonton; n = 6 Ottawa; 94% female; 100% Caucasian), including dietitians, exercise specialists, nurses, pediatricians, psychologists, and social workers. We identified three main themes that we later compared with CPG recommendations, including: (i) discuss realistic expectations regarding weight management (e.g., shift focus from weight to health; explore family cohesiveness; foster delayed vs instant gratification), (ii) personalize weight management (e.g., address personal barriers to change; consider developmental readiness), and (iii) exhibit non-biased attitudes and practices (e.g., de-emphasize individual causes of obesity; avoid making assumptions about lifestyle behaviors based on weight). Based on these qualitative findings, HCPs applied all four CPG recommendations in their practices. Conclusions HCPs provided practical insights into what and how they delivered weight management for adolescents, which included operationalizing relevant CPG recommendations in their practices.

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Section: Discussionmentioning

confidence: 99%

Health care providers’ weight management practices for adolescent obesity and alignment with clinical practice guidelines: a multi-centre, qualitative study

Kebbe

Perez

Buchholz

et al. 2020

BMC Health Serv Res

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“…Mobile devices increase the potential to promote healthy nutrition behaviors, and today nutrition and diet apps represent the fastest growing field of health promotion apps [4]. Mobile health (mHealth) apps for nutrition education can be suitable solutions to support parents’ involvement in childhood weight management interventions provided in primary care, as this is often the families’ first point of contact with the health care system [5,6]. The delivery of a primary care intervention by leveraging on digital and mobile support facilitates a higher compliance to it by the target users such as parents, who might have tight daily agendas, difficulties in tracking children’s weight-related behaviors over a day per week on paper diaries, and location difficulties [7].…”

Section: Introductionmentioning

confidence: 99%

Design of a Mobile App for Nutrition Education (TreC-LifeStyle) and Formative Evaluation With Families of Overweight Children

Gabrielli¹,

Dianti²,

Maimone³

et al. 2017

JMIR Mhealth Uhealth

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BackgroundNutrition and diet apps represent today a popular area of mobile health (mHealth), offering the possibility of delivering behavior change (BC) interventions for healthy eating and weight management in a scalable and cost-effective way. However, if commercial apps for pediatric weight management fail to retain users because of a lack of theoretical background and evidence-based content, mHealth apps that are more evidence-based are found less engaging and popular among consumers. Approaching the apps development process from a multidisciplinary and user-centered design (UCD) perspective is likely to help overcome these limitations, raising the chances for an easier adoption and integration of nutrition education apps within primary care interventions.ObjectiveThe aim of this study was to describe the design and development of the TreC-LifeStyle nutrition education app and the results of a formative evaluation with families.MethodsThe design of the nutrition education intervention was based on a multidisciplinary UCD approach, involving a team of BC experts, working with 2 nutritionists and 3 pediatricians from a primary care center. The app content was derived from evidence-based knowledge founded on the Food Pyramid and Mediterranean Diet guidelines used by pediatricians in primary care. A formative evaluation of the TreC-LifeStyle app involved 6 families of overweight children (aged 7-12 years) self-reporting daily food intake of children for 6 weeks and providing feedback on the user experience with the mHealth intervention. Analysis of the app’s usage patterns during the intervention and of participants’ feedback informed the refinement of the app design and a tuning of the nutrition education strategies to improve user engagement and compliance with the intervention.ResultsDesign sessions with the contribution of pediatricians and nutritionists helped define the nutrition education app and intervention, providing an effective human and virtual coaching approach to raise parents’ awareness about children’s eating behavior and lifestyle. The 6 families participating in the pilot study found the app usable and showed high compliance with the intervention over the 6 weeks, but analysis of their interaction and feedback showed the need for improving some of the app features related to the BC techniques “monitoring of the behavior” and “information provision.”ConclusionsThe UCD and formative evaluation of TreC-LifeStyle show that nutrition education apps are feasible and acceptable solutions to support health promotion interventions in primary care.

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“…Parents reported that scheduling appointments at regular intervals, which included monitoring their progress, improved their accountability and helped them to stay focused on maintaining healthy changes and continue their participation. Families' preferences regarding the frequency and duration of clinical contact will vary, highlighting the need to offer a menu of therapeutic options for families enrolled in PWM . Indeed, a programme that is too demanding can lead families to drop out from care .…”

Section: Discussionmentioning

confidence: 99%

“…Families' preferences regarding the frequency and duration of clinical contact will vary, highlighting the need to offer a menu of therapeutic options for families enrolled in PWM. 16,31 Indeed, a programme that is too demanding can lead families to drop out from care. 11,28 That said, following through with the commitment to complete a programme can enhance engagement in PWM 20 and be interpreted as an example of parents acting as positive role models for their children.…”

Section: Discussionmentioning

confidence: 99%

Continued attendance for paediatric weight management: A multicentre, qualitative study of parents' reasons and facilitators

et al. 2019

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Although prolonged engagement in paediatric weight management (PWM) is associated with positive treatment outcomes, little is currently known about enablers of long‐term programme attendance. The purpose of our study was to explore families' reasons for and facilitators of their continued attendance at health services for PWM. Semi‐structured, individual interviews were conducted with parents of children (10‐17 year old; body mass index ≥85th percentile) who completed the active phase of treatment in one of four Canadian multidisciplinary clinics for PWM. Interview data were recorded digitally, transcribed verbatim and analysed thematically. Parents' (n = 40) reasons for continued clinic attendance included ongoing concerns (eg, parental concern about their child's health), actual and expected benefits from treatment (eg, lifestyle improvements) and perceived quality of care (eg, structured, comprehensive, tailored health services). Several logistical and motivational factors contributed to continued attendance, including flexible work schedules, flexible appointment times, financial resources and children's motivation for treatment. Helping families address treatment barriers and ensuring that weight management services meet families' treatment expectations are promising strategies to enhance retention in PWM to optimize health outcomes.

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It’s like rocket science…only more complex: challenges and experiences related to managing pediatric obesity in Canada

Cited by 21 publications

References 33 publications

Health care providers’ weight management practices for adolescent obesity and alignment with clinical practice guidelines: a multi-centre, qualitative study

Health care providers’ weight management practices for adolescent obesity and alignment with clinical practice guidelines: a multi-centre, qualitative study

Design of a Mobile App for Nutrition Education (TreC-LifeStyle) and Formative Evaluation With Families of Overweight Children

Continued attendance for paediatric weight management: A multicentre, qualitative study of parents' reasons and facilitators

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