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How best to improve management of childhood obesity and related health problems?

Paediatricians do not feel overly confident about being able to make a difference to obese children’s weight, and many also lack confidence in managing children’s health problems related to obesity, such as hypertension, insulin resistance and fatty liver disease.

These findings are from a recent Australian study, which also found that most of the paediatricians surveyed said they had not been trained in managing obesity-related health problems in children.

The study, published in Archives of Diseases in Childhood, links patient-level data from a national prospective audit of outpatient practice with an online survey of paediatricians’ self-perceived competence and training in managing obesity.

One of the interesting questions raised by the authors is whether the most useful response to such findings is to develop better clinical training and support tools, or to develop shared care models linking secondary and tertiary practitioners.

Or, they suggest, another option “is to argue that public health measures, rather than physician-directed management, may be the best long-term investment to address the problem of paediatric obesity itself”.

They say: “Under this scenario, paediatrician training and research would focus on co-morbidities that could benefit from skilled medical management (eg insulin resistance, obesity-related hypertension), rather than concerted efforts to boost paediatricians’ role in weight management and lifestyle guidance.”

Thanks to the Primary Health Care Research and Information Service (PHC RIS) for providing this report on the study.

***

Australian paediatricians’ management of obesity

Amanda Carne writes:

Obesity in Australia is a major contributor to the burden of chronic disease and disability on the health system.  Studies have shown that once children become obese, they are more likely to stay obese into adulthood, increasing their risk of developing major health concerns such as Type 2 diabetes and cardiovascular disease.

According to this recent article by Australian researchers, despite nearly a decade of national guidelines for managing childhood obesity, only a small percentage of overweight or obese Australian children receive weight management when they attend primary care services. Barriers such as inadequate treatment access and health workforce training are limiting provision of optimal care for this cohort.

The low level of primary care uptake and efficacy, coupled with very limited tertiary services, indicate secondary care is possibly the optimal sector for the majority of clinical management of child and adolescent obesity and its complications.

In Australia, paediatricians play a central role in assessing and treating chronic conditions as well as developmental/behavioural issues in young people.

However, the authors found little is known about how paediatricians currently approach obesity or how well-equipped they are to manage obesity and its complications.  Similarly, little is known about whether training and self-perceived competencies in various aspects of weight management affect the degree to which paediatricians address obesity in their clinical practice.

In a recent national survey, the researchers found Australian paediatricians named effective management of childhood obesity and its comorbidities as their foremost clinical research priority, but revealed no studies had examined the types of research in which paediatricians may be willing to participate.

Therefore the authors sought to investigate this issue by linking national data from an online survey of Australian paediatricians’ self-perceived competence and training in managing obesity with a prospective patient-level practice audit.   Just over 1,000 general paediatricians registered in 2007 were recruited, with all Australian states and territories proportionally represented.

Overall, the authors found healthcare practitioners commonly express a desire for more training in childhood obesity, but in Australia (and, they suggest, other developed countries) there is no systematic approach to doing so.

They recommend childhood obesity be addressed during paediatric training and in subsequent continuing medical education, particularly with respect to co-morbidities.

However, training alone may not greatly influence obesity management as practitioners also experience substantial challenges in operationalising detailed expert guidelines.

While they conclude that there is a clear need for better paediatrician training in obesity management, the researchers observe that care and outcomes for obese children are unlikely to improve unless effective management models can be operationalised successfully.

• Amanda Carne is Research Associate at the Primary Health Care Research & Information Service (PHC RIS)

***

Wake M, Campbell MW, Turner M, Price A, Sabin MA, Davis E, and Baur LA. How training affects Australian paediatricians’ management of obesity Arch Dis Child 2012; 0:1-6.

This article, which can be accessed at http://adc.bmj.com/content/early/2012/07/12/archdischild-2012-301659.long, features in the 26 July 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.

The eBulletin is designed to inform readers of recently published articles and reports, news items, media releases, upcoming conferences and courses, research grants, scholarships and fellowships, PHC RIS products and services and relevant websites in the primary health care field. Those interested in receiving the weekly eBulletin are invited to subscribe to the free service at http://www.phcris.org.au/mailinglists/index.php.

 ***

Previous PHC RIS columns at Croakey

Sustaining small rural primary health care services

What is the evidence on knowledge translation strategies?

• Should your doctor be asking after your pet too?

• Nurses add value to chronic disease management

• For patients to play a more active role in managing chronic health conditions, some changes are needed

• Some useful tips for finding health policy information on the web

• Pros and cons of telehealth for people in rural areas

• What helps GPs provide better mental healthcare (and what doesn’t)

• Improving collaboration in diabetes care

• Improving dementia management in general practice

 Pets and what they do for our health

• Improving the diagnosis of ovarian cancer

• Chronic health problems and depression

• Helping older patients with chronic diseases to navigate the health system

• Tackling overuse of antibiotics

• When doctors prescribe exercise, does it make any difference?

• Caring for country is also good for Aboriginal people

• The perils of surrogate markers

• Are Australians willing to pay more for better oral health?

• What helps encourage self-care for those with chronic illness?

• More effort needed to strengthen shared care for people with serious mental illness

 

 

Comments 1

  1. Joy Heads says:

    I find it interesting that in all the discussion about obesity one of the easily modifiable factors never gets a mention. The research that early feeding directly affects obesity outcomes has been around for a long time.(1) The quoted paper has 120 references.

    The effect happens in two ways. Firstly, the product: infant formula versus breastmilk, two completely different foods one ordinary/normal, one man-made. Secondly, in the actual process of feeding: the breastfeed baby controls its own intake, varies the amount taken each feed and finishes when satiety is reached.

    The 11 billion dollar formula industry has sufficient skill and money to market their product so effectively that woman are encouraged to introduce infant formula, as it is ‘close to breastmilk’. What we forget is that infant formula is the sole food non-breastfed babies get in their early deveolping months. It is not part of a mixed diet – like full cream milk versus skim milk – it is their only food. It is not as amazingly complex as human milk so this clever marketing really shortchanges women and their children

    To quote from “Regulating Infant Formula” by George Kent. Hale Publishing (2011) “feeding with formula might be claimed to be good enough for some purposes, but it should never be said or implied to be as good, or nearly as good, as breastfeeding”. (page 83)

    This effective marketing has the effect of reducing exclusive breastfeeding, recommended for at least six months, which research shows is effective in the obesity battle. Maybe we should introduce the so called ‘ fat tax’ and start with the formula industry. The money raised can go towards supporting women to breastfeed in the workplace and by developing more Donor Human Milk Banks of which there are none in NSW. This will give women a real choice to modify their baby’s risk of obesity.

    1. Spatz DL , Lessen R. (2011) “Risks of not Breastfeeding” International Lactation Consultant Association. http://www.ilca.org

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Croakey Conference News Service 2013 – 2019
2013 conferences
Australian Centre for Health Services Innovation Forum 2013
Australian Health Promotion Association Conference 2013
Closing the Credibility Gap 2013
CRANAplus Conference 2013
FASD Conference 2013
Health Workforce Australia 2013
International Health Literacy Network Conference 2013
NACCHO Summit 2013
National Rural Health Conference 2013
Oceania EcoHealth Symposium 2013
PHAA conference 2013
2014 conferences
#IPCHIV14
AIDA Conference 2014
Congress Lowitja 2014
CRANAplus conference 2014
Cultural Solutions - Healing Foundation forum 2014
Lowitja Institute Continuous Quality Improvement conference 2014
National Suicide Prevention Conference 2014
Racism and children/youth health symposium 2014
Rural & Remote Health Scientific Symposium 2014
2015 conferences
#CPHCEforum
#CRANAplus15
#HSR15
#NRHC15
#OTCC15
Population Health Congress 2015
2016 conferences
#AHHAsim16
#AHMRC16
#ANROWS2016
#ATSISPEP
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#cphce2016
#CPHCEforum16
#CRANAplus2016
#IAMRA2016
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#VMIAC16
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2017 conferences
#17APCC
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