How Should We Approach and Discuss Children's Weight With Parents? A Qualitative Analysis of Recommendations From Parents of Preschool-Aged Children to Physicians

Clinicians navigating moral accountability when discussing parental behaviors in the care of the child in the hospital

OBJECTIVE

The purpose of this study was to explore how moral accountability is navigated when clinicians talk about parental behaviors to support the health of the hospitalized child.

METHODS

We conducted a secondary data analysis of 74 conversations during daily rounds video recorded as part of a randomized controlled trial of an intervention to advance family-centered rounds in one children's hospital. Conversations involving children under the age 18 who were cared for by a pediatric hospitalist service, pulmonary service, or hematology/oncology service were recorded. We used conversation analysis to analyze sequences in which physicians engaged in talk that had implications for parent behavior.

RESULTS

Two phenomena were apparent in how physicians and parents navigated moral accountability. First, physicians avoided or delayed parental agency in their references to parent behaviors. Second, parents demonstrated and clinicians reassured parental competence of parents caring for their children.

CONCLUSION

Physicians appeared to be oriented toward the potential moral implications of asking about parental behavior.

PRACTICE IMPLICATIONS

Avoiding attributions of agency and moral accountability as well as providing reassurance for the parents' competence may be useful for clinicians to maintain a good relationship with the parents of children in their care in the hospital setting.

Supporting healthcare professionals to address child weight with parents: a qualitative study

BACKGROUND

Primary care and community healthcare professionals (HCPs) are well placed to discuss child excess weight with parents and support them to make changes. However, HCPs have concerns about addressing this issue. There is a need to understand the factors that influence HCPs in initiating these conversations to inform strategies to support them.

AIM

To explore with HCPs, working in primary care and community settings, their experiences of having conversations about child weight with parents, and the factors that create barriers or facilitate them to have these conversations.

DESIGN AND SETTING

A qualitative study with GPs, primary care nurses (PNs), and school nurses (SNs) in England.

METHOD

GPs and PNs were recruited to participate in semi-structured interviews. SNs from a community healthcare NHS trust were recruited to participate in focus groups. Vignettes were used to stimulate discussion. Data were analysed guided by the Framework approach.

RESULTS

Thirteen GPs, seven PNs, and 20 SNs participated. The following three themes were identified regarding barriers to HCPs having conversations about child excess weight: structural and organisational; HCP related; and parent or family related. The themes identified for the factors that facilitate these conversations were: structural changes (for example, dedicated appointments, access to weight assessment data, joined-up working across agencies); HCP approaches (for example, providing appropriate dietary and physical activity advice); and HCP knowledge and skills (for example, enhancing HCPs' general and weight management-related skills and knowledge of child weight management services).

CONCLUSION

A range of barriers exist to HCPs addressing child excess weight with parents in primary care and community settings. Actions to effect structural changes and support HCPs in developing relevant knowledge and skills are required to overcome these barriers.

Head Start Health and Nutrition Managers' Perceptions of the Process of Measuring BMI and Communicating Preschooler's Weight Status

Body mass index (BMI) screenings are conducted as part of Head Start's (HS) health and nutrition assessments. Weight status classifications, which rely on the accuracy of the BMI measurements, are communicated to caregivers to engage them in health behavior change. Limited qualitative research has been conducted on the procedures for BMI measurement and reporting in HS programs. Interviews (n=28) were conducted with HS health/nutrition managers in Ohio and North Carolina to understand the processes used to conduct BMI screenings and disseminate reports and identify related needs. Themes included Personnel, Equipment, and Training for BMI Measurements; Classifying and Communicating BMI and Referrals; Professional Development Opportunities; and Resource, Training/Policy Needs to Support BMI Practices. Programs need additional resources to implement BMI measurement training and improve data accuracy and entry. Clarification of the referral/follow-up process and training around communicating with caregivers is also needed to better support families in implementing behavior change.

Parent and carer experiences of health care professionals' communication about childhood obesity: a qualitative systematic review protocol

OBJECTIVE

The objective of the systematic review is to identify, critically appraise, and synthesize the best available qualitative evidence on parent and carer experiences of health care professionals' communication about childhood obesity.

INTRODUCTION

Parents and carers play a key role in a child's environment and healthy development, which is why they can find it confronting to discuss their child's weight. This review will provide an insight into the experiences of parents and carers with health care professionals' communication about their child's overweight or obesity.

INCLUSION CRITERIA

This qualitative review will consider participants who are parents and carers with a child with overweight or obesity (birth to 12 years). The phenomenon of interest is parents' and carers' lived experiences of childhood obesity communication from a health care professional, and the context is health care settings. Communication includes verbal or written communication about a child's obesity from health care professionals received by a parent or carer.

METHODS

The proposed review will systematically search the following databases: MEDLINE (EBSCO), CINAHL (EBSCO), PsycINFO (Ovid), Scopus, LILACS, and the Finnish health sciences database MEDIC. ProQuest Dissertations and Theses (ProQuest) will be searched for unpublished articles. A manual search will supplement the database searches. The quality of included studies will be assessed independently by 2 reviewers, and the qualitative data will be extracted from papers by 2 independent reviewers using the standardized JBI data extraction tool. The recommended JBI approach to critical appraisal, study selection, data extraction, and data synthesis meta-aggregation will be used.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42022297709.

Dynamo Kids!/¡Niños Dinámicos! A Web Site for Pediatric Primary Care Providers to Offer Parents of Children 6-12 Years Old With Overweight and Obesity: Web Site Development and Protocol for Pilot Study

INTRODUCTION

A self-guided web site offered by pediatric primary care providers could help parents implement healthy behaviors.

METHOD

The Dynamo Kids/¡Niños Dinámicos program was developed with input from parents and health care professionals, creating a bilingual site for parents to learn why and how to implement healthy behavior changes for their children. A single-arm pilot will enroll parents with children 6-12 years with body mass index (BMI) ≥ 85th percentile seen in safety-net practices. Electronic health record modifications alert providers to eligible children at well-child encounters. Consented parents complete online surveys before accessing the site. At 3 months, the providers see children in weight-focused encounters. Outcomes include change in Family Nutrition and Physical Activity parent survey score (primary) and change in child relative BMI (secondary). Additional data include time spent on site, provider surveys, and provider and parent interviews.

RESULTS

Pending implementation.

DISCUSSION

If program shows promise, a large, controlled study could further evaluate with a goal of broad dissemination.

Parents' experiences following conversations about their young child's weight in the primary health care setting: a study within the STOP project

BACKGROUND

In primary healthcare, conversations between clinicians and parents about young children's overweight are key to providing support and initiating weight management. However, given the sensitivity of this topic, these conversations are difficult for both clinicians and parents and are sometimes delayed or avoided. To understand the emotional impact of these conversations, this study aims to shed light on parents' experiences following conversations with primary care nurses about their child's overweight.

METHODS

Participants were recruited through a childhood obesity randomized controlled trial (RCT) conducted in Sweden. Telephone-based semi-structured interviews were conducted with 17 parents (mean age 40; the majority were women (n = 12/17), had a university degree (n = 14/17) and were born in Sweden (n = 13/16)). Their children were between 3 and 7 years old (mean age 4.8 years) with overweight (n = 7) or obesity (n = 10). The interviews were recorded, transcribed, and analyzed using thematic analysis.

RESULTS

Two main themes were developed. Theme 1, 'Receiving the overweight/obesity diagnosis', explores parents' reactions to the conversation with the primary care nurse. Depending on how the nurse presented the topic, conversations either fostered an alliance between the parent and the nurse, encouraging parents to reflect and develop insights about the child's and the family's needs (subtheme Conversations that empower), or felt limited, uncomfortable, or belittling (subtheme Conversations that provoke resistance). Theme 2, 'Parenting a child with a formal diagnosis of obesity', explores challenges parents faced following the weight conversations, including managing their own feelings and concerns (subtheme Fear of transferring weight anxiety), dealing with others' reactions (subtheme Involve family and manage surroundings) and asking for and receiving support from health care professionals (subtheme Obtain support from health care professionals).

CONCLUSIONS

While conversations with primary care nurses about children's weight were often emotional, most parents felt these conversations were ultimately helpful, as they encouraged them to enact positive lifestyle changes. Importantly, when nurses initiated conversations in a responsive, non-blaming way, inviting parents to reflect on their situation, parents felt more supported and empowered. These findings convey the importance of providing communication skills training to pediatric healthcare professionals, with particular focus on childhood overweight and obesity.

TRIAL REGISTRATION NUMBER

ClinicalTrials.gov NCT03800823 ; 11 Jan 2019.

Primary care providers' perspectives on initiating childhood obesity conversations: a qualitative study

BACKGROUND

Primary care physicians (PCPs) are in a critical position for identifying, preventing and treating childhood obesity. However, a one-size-fits-all approach does not exist for having conversations about weight with families. A better understanding of how PCPs can address paediatric patients' weight concerns is needed in order to develop effective guidelines and trainings.

OBJECTIVE

To describe PCPs preferences and behaviours regarding weight-related conversations with paediatric patients' and their families.

METHODS

Twenty PCPs affiliated with the University of Minnesota, USA, were recruited to participate in semi-structured interviews. Transcripts were analysed using inductive thematic analysis.

RESULTS

PCP's identified well-child visits as the most appropriate time for weight-related discussions with families. Physicians described what approaches/elements they perceived to work best during conversations: collaboration, empathy, health-focused and objective measures.

CONCLUSIONS

Overall, PCPs were more comfortable with weight-related discussions during annual well-child visits and rarely initiated them during an acute visit or the first encounter with a patient. Objective measures, such as growth charts, were often utilized to start discussions. Considering a large proportion of well-child visits are missed, alternative opportunities to have discussions about healthy lifestyle behaviours should be explored. The integral role PCPs play in paediatric obesity warrants further research.

Making Childhood Obesity a Priority: A Qualitative Study of Healthcare Professionals' Perspectives on Facilitating Communication and Improving Treatment

In Romania, one in four children has excess weight. Because childhood obesity is a sensitive topic, many healthcare professionals find it difficult to discuss children's excess weight with parents. This study aims to identify barriers and facilitators in childhood obesity-related communication, as perceived by healthcare professionals in Romania. As part of the STOP project, healthcare professionals (family physicians, pediatricians, and dieticians) who treat children with excess weight were invited to a telephone interview. The semi-structured questions were translated from a questionnaire previously used at the Swedish study site of the STOP project. Interviews were transcribed and then used for thematic analysis. Fifteen doctors and three dieticians (16 females and 2 males), with average 18.2 ± 10.1 years of experience, were interviewed. Four main themes were identified. Professionals reported that when children began experiencing obesity-related stigma or comorbidities, this became the tipping point of weight excess, where parents felt motivated to begin treatment. Barriers in communication were part of several layers of distrust, recognized as tension between professionals and caregivers due to conflicting beliefs about excess weight, as well as lack of trust in medical studies. Most respondents felt confident using models of good practice, consisting of a gentle approach and patient-centered care. Nonetheless, professionals noted systemic barriers due to a referral system and allocation of clinical time that hinder obesity treatment. They suggested that lack of specialized centers and inadequate education of healthcare professional conveys the system does not prioritize obesity treatment and prevention. The interviewed Romanian doctors and dieticians identified patient-centered care as key to treating children with obesity and building trust with their caregivers. However

their efforts are hindered by healthcare system barriers, including the lack of specialized centers, training, and a referral system. The findings therefore suggest that, to improve childhood obesity prevention and treatment, systemic barriers should be addressed.

Trial Registration:ClinicalTrials.gov, NCT03800823; 11 Jan 2019.

What words should we use to talk about weight? A systematic review of quantitative and qualitative studies examining preferences for weight-related terminology

Evidence of weight stigma and its harmful consequences have led to increased attention to the words that are used to talk about obesity and body weight, including calls for efforts to carefully consider weight-related terminology and promote respectful language in the obesity and medical fields. Despite increased research studies examining people's preferences for specific words that describe body weight, there has been no systematic review to synthesize existing evidence on perceptions of and preferences for weight-related terminology. To address this gap, the current systematic review identified 33 studies (23 quantitative, 10 qualitative) that examined people's preferences for weight-related terminology in the current research literature (from 1999 to 2019). Across studies, findings generally suggest that neutral terminology (eg, "weight" or "unhealthy weight") is preferred and that words like "obese" and "fat" are least acceptable, particularly in provider-patient conversations about weight. However, individual variation in language preferences is evident across demographic characteristics like race/ethnicity, gender, and weight status. Of priority is future research that can improve upon the limited diversity of the existing literature, both with respect to sample diversity and the use of culturally relevant weight-related terminology, which is currently lacking in measurement. Implications for patient-provider communication and public health communication are discussed.