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If a primary care team has decided that a child has, in effect, ‘simple obesity’ and does not meet the criteria for referral to a specialist secondary team, then a suitable intervention plan needs to be devised.
It must be remembered that, as highlighted by Barlow and Dietz (1998), obesity is a chronic disease. Therefore, frequent visits, continuous monitoring and reinforcement will be required for success, but will not ensure it.8 They caution that:
“‘…providers who lack the time required to implement interventions or who find themselves annoyed or easily frustrated by obese children or the parents of obese children should refer these patients elsewhere for care because of the potential adverse effect the providers response may have on the child and family.”
The decision to intervene should be reached jointly by the health professional, the child’s carers and, in the case of older children, the child themselves.
- The support of parents/guardians and other family members (e.g. grandparents) is crucial if an intervention is to achieve success
- The focus of the treatment should be placed on changing eating habits and patterns of physical activity with weight maintenance as an acceptable goal
- Health professionals who care for these families should treat them with sensitivity and compassion
It is important that the term ‘dieting’ is avoided and that children are gradually and positively re-educated to change their eating habits. This can involve a change in the attitude for the whole family towards meals and patterns of snacking. The child should not be singled out from the rest of the family by having restrictive ‘rules’ about eating applied solely to them. In addition, referring to certain foods as ‘treats’ or ‘bad foods’ is not a helpful way to develop a healthy attitude to food.
- Questions about food intake should be phrased in a non-judgmental way
- To help gain a better picture of eating habits, encourage the child and/or their parents to keep a track of their food and drink intake
- Highlight the importance of considering portion sizes, snacking habits and the energy density of foods
- Encourage a reduction in periods of physical inactivity - help the child to become more aware of the time currently spent playing computer games or watching television
- Discuss ways in which more physcial activity can be built into the daily life of the child e.g. can the family go for more walks together, are there any clubs which the child could take part in, do they enjoy cycling, skating or swimming
- Arrange to review progress on a regular basis
- If appropriate involve other professionals e.g. dieticians, psychologists, school nurses, teachers, dentists
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