Weighty Conversations: Caregivers', Children's, and Clinicians' Perspectives and Experiences of Discussing Weight‐Related Topics in Healthcare Consultations

Abstract

Children with autism spectrum disorder (ASD) are at a higher risk of having obesity than their typically developing peers. Although it has been recommended that health care providers (HCPs) speak to caregivers and children about the risk of higher weights, no research has examined how HCPs communicate weight‐related information. Furthermore, there is a dearth of evidence regarding how to approach and deliver optimal weight‐related discussions among children with ASD and their caregivers. Given these knowledge gaps, 21 in‐depth interviews were conducted with children with ASD, their caregivers, and HCPs. Using a qualitative analytic approach, data from interviews were analyzed thematically. Results suggest that HCPs at times projected weight stigma during clinical encounters, which did not motivate children and caregivers to work toward work loss or wellness. HCPs also described reticence in engaging families in weight‐related conversations due to limited training, and lack of clinical tools to guide these conversations. All stakeholders identified a need to work together to establish a therapeutic partnership to discuss weight‐related issues without blame or shame. The combination of strength‐based communication approaches, establishing a strong therapeutic partnership, and development of clinical tools facilitating weight‐related discussions for HCPs outlined in this article are potential vehicles to foster successful weight‐related discussions while promoting lifelong wellness. Autism Research 2018, 11: 1500–1510. © 2018 International Society for Autism Research, Wiley Periodicals, Inc. Lay Summary Children with autism spectrum disorder (ASD) are at a higher risk of having obesity. Yet, it is unknown how healthcare providers (HCPs) should deliver weight‐related information. Findings suggest children and caregivers experienced weight stigma and were uncomfortable discussing weight‐related issues. HCPs identified that they did not have sufficient training, and did not feel confident identifying/addressing weight issues. Tools are needed to facilitate weight‐related discussions among children, caregivers and HCPs.

Putting positive weight‐related conversations into practice: The pilot implementation of a Knowledge Translation Casebook

“…Although HCPs play a vital role in preventing and managing obesity in children and youth, they often report feeling ill‐equipped to do so, especially with populations with special needs (Jachyra, Anagnostou, Petta, et al, ; McPherson, Swift, et al, ). As such, a pre‐implementation pilot study was developed to explore the adoption of a novel KT Casebook into clinical settings, in order to reduce the research‐to‐practice gap around weight‐related communication best practices.…”

“…Participants were drawn from two samples: (a) a team of clinicians at a large paediatric teaching hospital in Ontario who focus on medication management and overall treatment planning for clients with ASD (herein referred to as the “psychopharmacology clinic”) and (b) clinicians participating in a distance learning programme across Ontario that uses case‐based training to educate primary‐care providers in best practice care for ASD. The selection of these groups was based upon previous work indicating their need for support in addressing weight management with paediatric‐ASD clients (Jachyra, Anagnostou, Petta, et al, ). Both of these groups comprise paediatricians, nurses, and dieticians, all of which are heavily involved in having weight‐related conversations.…”

“…However, empirically supported weight‐related communication strategies are woefully lacking (McPherson, Hamilton, et al, ); this is notable given that communication has been identified as a key clinical skill in paediatric obesity treatment and patient–provider trust and rapport (Carcone, Jacques‐Tiura, Hartlieb, Albrecht, & Martin, ). Further, HCPs within the field of paediatric obesity have identified a strong need for supportive tools on discussing weight with patients (Carcone et al, ; Jachyra, Anagnostou, Petta, et al, ).…”

“Fat is really a four‐letter word”: Exploring weight‐related communication best practices in children with and without disabilities and their caregivers

“…Despite evidence of increased risks of obesity in children with physical and developmental disabilities (2–3 times that of typically developing children; Neter et al, ), the topic is seldom addressed in clinical consultations (McPherson, Swift, Yung, Lyons, & Church, ). The long‐standing relationships developed with families in rehabilitation care and complex nature of many disabilities can deter HCPs from addressing weight‐related topics in this population (Jachyra et al, Under review; McPherson, Swift, et al, ). Therefore, many children (both with and without disabilities) and caregivers who could potentially benefit from weight counseling and support are not receiving it (Hansen et al, ).…”

“It’s not a simple answer.” A qualitative study to explore how healthcare providers can best support families with a child with autism spectrum disorder and overweight or obesity

“…For example, they often experience challenges and barriers accessing mainstream health promotion and/or weight management programs [10]. Parents also experience time constraints and competing priorities, which can be exacerbated by routines that often include multiple medical appointments and specialized therapies [11,12].…”