Implementing a family focused lifestyle programme for treating childhood obesity in the community setting in Ireland - Pitfalls and promise.

1. 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

2. Two continuums for public health
interventions

3. 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

4. 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

5. 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%)

6. 3 Key Issues in Implementation
1. Recruitment and Uptake
2. Multidisciplinary approach
3. Limited resources i.e. staff & time

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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 ?

14. Thank you for your attention