How best to improve management of childhood obesity and related health problems?
Paediatricians do not feel overly confident about being able to make a difference to obese children’s weight, and many also lack confidence in managing children’s health problems related to obesity, such as hypertension, insulin resistance and fatty liver disease.
These findings are from a recent Australian study, which also found that most of the paediatricians surveyed said they had not been trained in managing obesity-related health problems in children.
The study, published in Archives of Diseases in Childhood, links patient-level data from a national prospective audit of outpatient practice with an online survey of paediatricians’ self-perceived competence and training in managing obesity.
One of the interesting questions raised by the authors is whether the most useful response to such findings is to develop better clinical training and support tools, or to develop shared care models linking secondary and tertiary practitioners.
Or, they suggest, another option “is to argue that public health measures, rather than physician-directed management, may be the best long-term investment to address the problem of paediatric obesity itself”.
They say: “Under this scenario, paediatrician training and research would focus on co-morbidities that could benefit from skilled medical management (eg insulin resistance, obesity-related hypertension), rather than concerted efforts to boost paediatricians’ role in weight management and lifestyle guidance.”
Thanks to the Primary Health Care Research and Information Service (PHC RIS) for providing this report on the study.
Australian paediatricians’ management of obesity
Amanda Carne writes:
Obesity in Australia is a major contributor to the burden of chronic disease and disability on the health system. Studies have shown that once children become obese, they are more likely to stay obese into adulthood, increasing their risk of developing major health concerns such as Type 2 diabetes and cardiovascular disease.
According to this recent article by Australian researchers, despite nearly a decade of national guidelines for managing childhood obesity, only a small percentage of overweight or obese Australian children receive weight management when they attend primary care services. Barriers such as inadequate treatment access and health workforce training are limiting provision of optimal care for this cohort.
The low level of primary care uptake and efficacy, coupled with very limited tertiary services, indicate secondary care is possibly the optimal sector for the majority of clinical management of child and adolescent obesity and its complications.
In Australia, paediatricians play a central role in assessing and treating chronic conditions as well as developmental/behavioural issues in young people.
However, the authors found little is known about how paediatricians currently approach obesity or how well-equipped they are to manage obesity and its complications. Similarly, little is known about whether training and self-perceived competencies in various aspects of weight management affect the degree to which paediatricians address obesity in their clinical practice.
In a recent national survey, the researchers found Australian paediatricians named effective management of childhood obesity and its comorbidities as their foremost clinical research priority, but revealed no studies had examined the types of research in which paediatricians may be willing to participate.
Therefore the authors sought to investigate this issue by linking national data from an online survey of Australian paediatricians’ self-perceived competence and training in managing obesity with a prospective patient-level practice audit. Just over 1,000 general paediatricians registered in 2007 were recruited, with all Australian states and territories proportionally represented.
Overall, the authors found healthcare practitioners commonly express a desire for more training in childhood obesity, but in Australia (and, they suggest, other developed countries) there is no systematic approach to doing so.
They recommend childhood obesity be addressed during paediatric training and in subsequent continuing medical education, particularly with respect to co-morbidities.
However, training alone may not greatly influence obesity management as practitioners also experience substantial challenges in operationalising detailed expert guidelines.
While they conclude that there is a clear need for better paediatrician training in obesity management, the researchers observe that care and outcomes for obese children are unlikely to improve unless effective management models can be operationalised successfully.
• Amanda Carne is Research Associate at the Primary Health Care Research & Information Service (PHC RIS)
Wake M, Campbell MW, Turner M, Price A, Sabin MA, Davis E, and Baur LA. How training affects Australian paediatricians’ management of obesity Arch Dis Child 2012; 0:1-6.
This article, which can be accessed at http://adc.bmj.com/content/early/2012/07/12/archdischild-2012-301659.long, features in the 26 July 2012 edition of PHC RIS eBulletin, available at http://www.phcris.org.au/publications/ebulletin/index.php.
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