It’s In The Cards: Starting the CONversation on Childhood Obesity

CONversation CardsObesity is not an easy topic to talk about – especially not to families with children who carry excess weight.

Not only does starting a conversation about this delicate topic require professional tact and sensitivity but it is also often difficult for providers and families to know quite where to begin.
In addition, the many topics that one could possibly talk about are seemingly endless – ranging from “I fear my child is being teased” to “I have a hard time eliminating junk food from our home“.

The Canadian Obesity Network has now co-produced a deck of “CONversation Cards™” that can be used to facilitate conversations between health care professionals and parents of children with overweight or obesity.

The extensive process of developing these cards and the preliminary results from their application in clinical practice are now described by Geoff Ball and colleagues from the University of Alberta in a paper published in the Journal of Nutrition Education and Behaviour.

The project began with interviews and focus groups to explore elements of collaboration between health care professionals and parents and describe common barriers faced by families when trying to make healthy lifestyle and behavioural changes.

This exercise served to generate a preliminary deck of CONversation Cards™, which were further reviewed for content, language and clarity. The identified barriers were organized into six themes: communication, weight management, physical activity, nutrition, interpersonal relationships, and parenting.

Using a group-based Delphi technique rank-ordering process, the initial 130 cards were reduce to 45 by merging cards with similar statements and eliminating cards with statements that were not perceived as common or salient.

Finally, the cards were independently tested in the clinical setting of a multidisciplinary paediatric obesity program and further fine tuned with regard to acceptability, likeability, and relevance.

This test not only demonstrated that it was easily feasible to incorporate the cards into day-to-day clinical practice by offering the cards to parents while they waited for appointments. On average parents picked 16 cards (range: 5-30 cards), with the five most frequent choices pertaining to goal setting, exercise schedules, involving the child in discussion, tracking and monitoring, and making healthy foods fun.

Parents rated the likability and relevance of the cards as high and universally agreed that the statements were easy to understand and were open to using the cards during future appointments, commenting that the use of these cards was :

“Good activity to do while waiting in the waiting room.’’

‘Good way to generate ideas for discussion.’’

‘Better than going through a long list of questions’’

‘‘They’re nice—and reminded me of a card game.’’

The authors suggest that the cards may be best used by asking parents select three or four cards for each visit that reflect issues they find most challenging or that they are more able and willing to address, thereby substantially reducing some of the complexities of paediatric obesity management.


“Given the difficulty that many health care professionals have in initiating conversations about obesity and weight management, CONversation Cards provide an opportunity to explore issues, many of which are complex and sensitive in nature, in a more neutral and family-focused manner.”


“The cards are aligned with the tenets of motivational interviewing, which encourage health care professionals to roll with their clients’ resistance to change, understand their motivations, listen actively, and empower them.”

The CONversation Cards™ will be available for purchase at the 3rd Canadian Obesity Summit in Vancouver (May 1-4, 2013) or can be ordered through the Canadian Obesity Network.

Vancouver, BC