Review of evidence to guide primary health care policy and practice to prevent childhood obesity

Abstract

Objectives: To identify key barriers to effective engagement of primary health care (PHC) providers and families in promoting healthy weight among children aged 2–6 years, and to examine promising interventions to identify policy goals to overcome these barriers. Methods: We conducted a literature review of published and unpublished articles from January 1990 to February 2006 using keywords relating to childhood obesity, risk factors, prevention, populations and primary care provider interventions, constraints and models. We identified barriers to engagement by PHC providers. Appraisal of “promise” was based on best available evidence and consideration of strengths and weaknesses of interventions in specific contexts and settings. Results: Of 982 interventions aimed at the primary prevention of overweight and obesity among children, few related to 2–6‐year‐olds, with only 45 interventions meeting the inclusion criteria and 11 ranking highly on key criteria. Areas of weakness were low‐level engagement by PHC providers, focus on single risk factors rather than a multidimensional approach, and lack of a population focus. A range of administrative, attitudinal, knowledge, skills and training issues were identified as barriers to effective engagement of different PHC providers with parents and other early childhood service providers. Conclusions: Engagement of PHC providers in prevention of childhood obesity requires a systematic approach involving practice protocols, assessment tools, client support material and referral pathways, as well as adequate training and sufficient staff for implementation. A more comprehensive approach could be promoted by increased collaboration, agreed role delineation, consistent public health messages and better coordination between PHC providers and other service providers, facilitated at service policy and administration level.

Barriers to and facilitators of nurse-parent interaction intended to promote healthy weight gain and prevent childhood obesity at Swedish child health centers

“…Several studies have observed that childhood obesity is a sensitive topic because healthcare professionals fear offending parents [17,18,33]. Our study supports these findings.…”

Interventions to Prevent Obesity in 0–5 Year Olds: An Updated Systematic Review of the Literature

“…The 23 included studies were delivered through a variety of settings: preschool/childcare, home, group, primary care, and mixed settings. Approximately two‐thirds involved multifaceted interventions ( n = 14) and a similar proportion were conducted in the United States ( n = 15). Just over half of the studies targeted socioeconomically disadvantaged families ( n = 12) and three quarters were published from 2003 onward ( n = 17).…”

“…The small number and recency of the early childhood obesity‐prevention literature suggests this is a new and developing research area. A number of reviews of obesity prevention during early childhood have been published in recent years (13,14,15,16,17), all with differing inclusion criteria and predominantly focusing on the preschool age group. The current review was conducted to provide an update of the emerging evidence in this area and to assess the quality of studies reported.…”

Bringing evidence to bear on policy processes: the challenge of the Australian Primary Health Care Research Institute

“… Chronic disease management ( Cranston et al, 6 Dennis et al 7 ); Integration, coordination and multidisciplinary care ( Jackson et al, 8 Mitchell et al, 9 Powell Davies et al 10 ); Innovative models for comprehensive primary health care delivery ( McDonald et al, 11 Naccarella et al, 12 Humphreys et al 13 ); Innovative models for the management of mental health in primary health care settings ( Griffiths and Christensen 14 ); Children and young Australians, health promotion and prevention ( McDonald et al, 15 Hearn et al 16 ); and Workforce (focus on competency‐based training) ( Glasgow et al 17 ). …”