Promoting conversations between physicians and families about childhood obesity: evaluation of physician communication training within a clinical practice improvement initiative

Abstract

Childhood obesity rates have incrementally increased since the 1980s, sparking calls for initiatives focused on addressing this public health concern. In response, the family medicine residency clinic profiled in this research designed, executed, and evaluated a practice improvement initiative focused on physician communication behaviors and clinic processes that impact the management of unhealthy pediatric weight. The results of the evaluation effort demonstrated increased physician knowledge of communication principles, improvements in weight management counseling rates, and opportunities for health delivery system changes to promote the effective clinical management of unhealthy pediatric weight.

Communicating with children and families about obesity and weight‐related topics: a scoping review of best practices

“…Two articles in particular proposed that weight‐related topics are best raised by a HCP with a long‐term, trusting relationship and knowledge of the family , which was also endorsed by an obesity guideline article . Focusing upon practical strategies, two papers recommended that nurses assessing children's weight should highlight any concerns so that physicians can address them when they see children and their families . A complementary strategy suggested that ‘prompts’ be incorporated into children's electronic medical records, which could result in increased likelihood of counselling .…”

“…Focusing upon practical strategies, two papers recommended that nurses assessing children's weight should highlight any concerns so that physicians can address them when they see children and their families . A complementary strategy suggested that ‘prompts’ be incorporated into children's electronic medical records, which could result in increased likelihood of counselling .…”

“…Weight‐related terminology was mentioned in all three categories of studies, with the use of appropriate terminology considered to communicate respect and caring, and promote engagement with families . Six studies specifically addressed language and terminology that participants perceived as desirable, representing lived experience , guideline dissemination and therapeutic communication technique literature. For instance, Puhl et al .…”

“…Rao proposed that using overweight and obese in relation to BMI percentile and its associated health risks, along with a non‐judgmental approach, reduced the risk of stigma associated with the terms, although this was based on expert opinion and does not necessarily reflect parent and child preferences. The sensitivity around the term obese is reflected in a study by Shue et al ., who provided training to family medicine residents to promote positive conversations between physicians and families about childhood obesity . They provided a ‘script’ for HCPs as part of the training, which deliberately avoided the word obese and instead, framed the discussion in terms of health and growth, providing wording such as: ‘Most children are still growing in height and our goal is to slow [child's name] weight gain or maintain his/her weight.…”

Weighty Conversations: Caregivers', Children's, and Clinicians' Perspectives and Experiences of Discussing Weight‐Related Topics in Healthcare Consultations

“…Open questioning, active listening, eliciting personally meaningful goals and providing affirmation, avoiding assumptions (about weight status), strength‐based approaches can all support caregivers and children by understanding the various contextual factors (as described in the findings) that mediate their lives (Tyler & Horner, ). Other factors recommended by families in this study and emerging peer reviewed evidence include discussing weight‐related issues early and regularly throughout the child's life (Shue et al, ); using terminology preferred by the caregiver/child (Puhl et al, ); avoiding idioms or euphemisms to describe overweight and obesity (Bolling et al, ); clarifying any meanings of terms being used (Barlow et al, ); and talking about growth and health rather than size and weight (Toftemo et al, ).…”