Challenges in Pediatric Obesity ManagementTuesday, March 25, 2014
Now, a seminal paper by Jill Avis and colleagues (representing a virtual who-is-who of pediatric obesity management in Canada), published in Expert Reviews in Diabetes and Metabolism, with the fitting title, “It’s like rocket science…only more complex“, explores the many challenges in pediatric obesity management in Canada.
The thoughts and analyses presented in this narrative review are largely based on the responses to a national survey of folks providing pediatric “weight-management” services across Canada. Responses were sought to a range of questions, including:
In regards to managing pediatric obesity in Canada, what lessons have you learned related to: Caring for children?; Collaborating with clinicians and/or researchers?; and Working within the health care system? In addition, what do you consider to be important future directions for clinical care and research in Canada?
Apart from noting the importance and challenges of adopting a family centred approach, the paper highlights the importance of factors that go well beyond “eat-less-move-more” platitudes.
Thus, the authors note that,
“Internalizing (e.g., anxiety, depression) and externalizing (e.g., hyperactivity, aggression) disorders are common in children and adolescents with obesity, which can make management strategies more difficult to implement…..these realities highlight the need for mental health professionals to assume active roles in pediatric obesity management to explore, identify and manage families’ unique mental health concerns.”
With regard to the importance of weight bias, the authors state,
“Many parents in our care have experienced shame and blame from other family members, friends, coworkers and health professionals regarding the weight status of their children….The underlying assumption in this instance is that individuals with obesity just need to eat less and move more….a sentiment that demonstrates a lack of understanding and empathy.”
” There is a clear need to shift from a singular focus on physical weight status to define the health of individuals with obesity to a nonjudgmental and unbiased appreciation of the complex causes and consequences
Despite all efforts, the authors describe the outcomes of childhood obesity interventions as “modest”.
This has prompted a number of collaborative research initiatives including the Canadian Pediatric Weight Management Registry (CANPWR), the Should I Stay or Should I Go study and (in partnership with the Canadian Obesity Network) the development of a national network called Treatment and Research of Obesity in Pediatrics in Canada (TROPIC), whose purpose is to promote knowledge translation and dissemination of issues related to pediatric obesity management in Canada.
All of these activities demonstrate a high degree of collaboration and coordination among the pediatric obesity management community in Canada.
The paper also addresses the challenges of providing childhood obesity management services within the health care systems (which vary across provinces).
“…there is substantial heterogeneity across the multidisciplinary clinics we lead and work within; some are well-resourced (i.e., physical space, clinical, and administrative personnel), while others struggle with limited budgets to provide comprehensive and long-term care for families.”
“…relatively small numbers of patients (compared with other outpatient pediatric clinics [e.g.,general pediatrics]) and a lack of substantial weight loss for most children and adolescents with obesity…necessitate education, contextualization and justification to colleagues and administrators within the health care system so that obesity is viewed not as a simple problem that requires a quick fix in order to achieve weight loss, but as a chronic disease that requires ongoing support and management.”
Important work to aid clinicians include the adaptation of the Edmonton Obesity Staging System for pediatric populations (EOSS-P), the family centred adaptation of the 5As of Obesity Management for managing pediatric obesity in primary care, and CONversation cards, a tool to facilitate discussions between clinicians, parents and kids on issues related to healthy lifestyle changes.
Finally, the paper discusses the many barriers to accessing timely obesity management including costs (travel, parking, time off work), geography (distances) and wait times.
Clearly, despite all progress, significant challenges remain to be addressed – “it’s like rocket science…only more complex.”