GP Connect clinical feature by Dr Stephen Paull, General Paediatric Advanced Trainee, Child and Adolescent Community Health and Prof Yvonne Anderson, Professor of Paediatrics and Child Health, Child and Adolescent Community Health, Curtin University, and The Kids Research Institute Australia
Childhood obesity remains a persistent issue, and GPs are uniquely positioned to help support families with long-term wellbeing and attainment of healthy lifestyles by having respectful, compassionate and non-judgemental conversations with families. As with all areas of medicine, strengths-based conversations are critical to earning trust. Yet raising weight with parents and children can be tricky and it’s easy to shy away from broaching the subject for fear of causing offence. So, what do families want out of these conversations?
One in four children and young people are affected by overweight or obesity, and the World Obesity Federation predicts that by 2035, over half of the global population will be affected by overweight or obesity. There is a disproportionate impact on Aboriginal and Torres Strait Islander communities, families from culturally and linguistically diverse backgrounds and those living in socioeconomic disadvantage. Often this is due to limited access and appropriateness of services and the ubiquitous oversupply of cheap, ultra-processed foods in today’s food environment. Higher weight is accompanied with an increase in weight-related comorbidities in childhood and adolescence, including type 2 diabetes, obstructive sleep apnoea, dyslipidaemia, hypertension and metabolic dysfunction-associated steatotic liver disease. Teens with obesity are five times more likely to die from coronary heart disease within 40 years compared with healthy-weight peers.
Based on research and engagement with families living with higher weight, here are some tips for GPs to help with patient and caregiver conversations:
When and how to raise the topic:
- Try not to let the issue appear out of nowhere. Instead, raise healthy growth early on during routine care, ensuring that trust and rapport have already been built before discussing sensitive topics.
- Always ask consent to talk about weight issues and healthy lifestyles – “Is it OK if we talk about [child]’s growth and overall health?”
- Try and frame the conversation around curiosity and care, not concern or alarm.
Language and framing:
- Try not to focus on BMI, obesity, weight, weight loss or diet. Instead, focus on health, habits, healthy eating/nutrition and physical activity.
- While person-centred language is crucial (“i.e. children living with obesity” rather than “obese children”), the terms obesity or overweight can still have negative associations for some families. Talking about children being “above a healthy weight” can be a more acceptable approach for many. However, take the family’s lead on the language to use.
- We all come to these conversations with our own weight biases, so it is important to acknowledge these and recognise our standpoint in these conversations.
Focus of the discussion:
- Explore the family’s strengths, interests and routines – what’s already working, what the child or young person enjoys.
- Emphasise family-based change, rather than isolating the child or young person.
- The conversation is always easier if you have somewhere to refer to:
- If you do, know your options and talk them through, and ensure the referral is agreed to by families, rather than being something they feel obliged to attend.
- If there is no suitable service, ask for consent to set one or two achievable goals.
- If there is a child or young person in the room, include them in the conversation in a positive way, focusing on the positive things they are doing. They will be taking it all in, and it is vital they feel supported rather than shamed.
For more information on the science and reality of obesity, and how to have conversations with any patient experiencing weight and health issues, the Obesity Collective in partnership with the Weight Issues Network have developed a CPD-accredited, one-hour eLearning module that can help healthcare workers improve their practice.
For paediatric exercise and healthy eating programs available in Perth and regional WA, see Clinician Assist WA – Child Exercise and Healthy Eating Programs.
Related:
WA GP education to support conversations about weight
Free programs supporting WA families to establish healthy habits