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

Abstract

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. Howevertheir 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.

Mindful Eating Questionnaire: Validation and Reliability in Romanian Adults

“…In Romania, the recognition of obesity by the general population as a health issue is still a problem, while recently, 58.6% of adults and 30.6% of children reported as overweight and obese [ 1 ]. Interventions aiming reduction of excess weight are hindered by the late perception of obesity—the tipping point of excess weight being obesity-related stigma or comorbidities—and by communication barriers between patients and health professionals due to conflicting beliefs on excess weight [ 2 ]. Weight loss techniques based on diets focusing exclusively on rules of eating are difficult to follow, and their success is limited in the long run [ 3 , 4 ].…”

School nurses’ experience of communicating growth data and weight development to parents of children 8 and 10 years of age

“…The communication between the school nurse and the parents should not only concern negative issues, and they found positive encounters were helpful. This result was confirmed in another study where health care professionals recognised that trust is built up step by step only when a channel of communication is open, and positive language and a gentle approach is crucial [ 27 ].…”

Weight-biased attitudes about pediatric patients with obesity in Dutch healthcare professionals from seven different professions

“…First, offering adequate information and tools to address underlying causes of obesity could reduce negative perceptions and stereotypes about patients with obesity ( Mastrocola et al, 2020 ; Bradbury et al, 2018 ; Serban et al, 2021 ). Second, offering interdisciplinary courses to raise awareness about obesity stigma and its harmful impact on health and treatment outcomes is encouraged ( Puhl et al, 2020 ).…”

“…Preferably a combination of clinical characteristics, health indices, and patient-reported outcome measures is used, including quality of life ( Ciemins et al, 2021 ). Fourth, education on patient-centered communication strategies, including motivational interviewing and use of carefully chosen weight-related terminology, is advised to implement as mandatory course in training programs of HCPs ( Mikhailovich and Morrison, 2007 ; Bradbury et al, 2018 ; Serban et al, 2021 ; Stuij et al, 2020 ; Van Maarschalkerweerd et al, 2020 ; Nnyanzi, 2016 ). Fifth, it is recommended to promote sensitive and supportive communication about weight-related health among HCPs, including respectful language and neutral weight-related terminology, with people-first language, when talking about weight ( Auckburally et al, 2021 ; Van Maarschalkerweerd et al, 2020 ; Stuij et al, 2020 ).…”