Childhood Obesity Risks and Parental Motivations to Make Changes The Promoting Healthy Families Proj

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Childhood Obesity Risks and Parental
Motivations to Make Changes The Promoting
Healthy Families Project

• Ardis L.Olson MD,
• Cecelia Gaffney MEd, Pam Lee PhD, Pam Starr MS
• Clinicians Enhancing Child Health (CECH) practice
  based research network
• Depts. of Pediatrics, Community and Family
  Medicine,
• Dartmouth Medical School, Lebanon, NH

Supported by NICHD funding
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Background

• Childhood Obesity has been identified as a major
  public health problem where we are making little
  progress.
• During childhood the primary care office is the
  only setting that accesses both parent and child
  over time.
• Pediatric clinicians are urged to counsel to
  prevent and treat obesity but feel ineffective
  and frustrated.
• Restructuring the well visit is needed to discuss
  specific obesity risks while still addressing
  other topics.

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Promoting Healthy Families Study Design
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Healthy Families Project

• 4 community practices in rural New Hampshire with
  Pediatric and Family Medicine health providers
  (population 2,000 to 15,000)
• 1585 parents at well visits of their children
  ages 4 to 10 years have completed pre-visit
  screening utilizing a hand held computer (PDA)
• Clinicians training to use brief motivational
  interviewing techniques and provided via the PDA
• 1) childs BMI and BMI Percentile
• 2) obesity related health risks,
• 3) each parents motivation to change for
  nutrition and activity,
• 4) counseling prompts for motivational
  interviewing
• Enrollment of parents of children with obesity
  risks and BMI gt85 is completed and now
  collecting follow up data on the cohort at 6
  months after enrollment

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What Clinician knows at start the visit using
the PDA



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Changes in the Visit with the PDA

• Parental data routinely gathered for major areas
  of well child visit are determined before the
  start of the visit for clinician review
• More obesity risk factors assessed than routine
  visits
• Clinician can expand on topics
• Can support good choices
• Prepares parent for discussion
• Concerns re common topics
• Clear than eating and activity important to
  clinician
• Readiness to make change for childs eating and
  activity
• Efficient use of visit time
• Completed in 3-4 minutes
• Children often have hearing/vision screening in
  this age group and can complete then.

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Clinician Counseling cues if ready to change
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Nutrition risks by weight category



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Physical activity risks by weight category



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The Ingredients of Readiness to Change
Importance (Why should I change?)
Readiness
Confidence
(Can I do it?)
Rollnick, Mason, Butler, 2003
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Parental interest and confidence to make
nutrition changes



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Parental interest and confidence to change their
childs physical activity



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Importance and Confidence Reflect Commitment to
Change
Success
High
10
Moving helping
Frustrated
Importance
Unaware or Cynical
Skeptical
0
10
Confidence
Low
High
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If interested in making a change, Who is ready to
take action?

Nutrition
Importance
Physical Activity

Importance
Confidence
Children with BMI gt 95

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Parental concerns by child weight category



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Implications for clinical care

• Parental stage of motivation varies and needs to
  be addressed to more effectively engage parents
  in making family changes in nutrition and
  activity
• Few clinicians have received training in brief
  motivational interviewing approaches
• The common approach of giving information and
  handouts not likely to be effective for families
  who consider issue of low importance or lack
  confidence

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Implications for clinical care

• Challenges
• Multiple specific nutrition and activity risk
  factors need to addressed during obesity related
  counseling in all well visits
• Limited time in well visits and more concerns of
  parents of obese children are more likely to
  have other concerns as well
• Low cost technology assists by
• Visit changed from majority of time on data
  gathering to discussion of issues
• Allow clinician to prioritize issues and plan
  counseling approach and understand which families
  may need another visit
• Parents have been prepared to discuss these
  issues
• Knowing if other psychosocial and developmental
  issues are playing a role

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Conclusions

• Obesity risk factors are very common in children
  and primary care interventions are needed for
  both normal weight and overweight children
• Parental interest in taking action, as well as
  motivational factors, vary by weight status and
  differ for nutrition and activity
• New approaches that use low cost technology to
  efficiently gather data are feasible in busy
  primary care settings
• This is a major clinical and public health
  problem that is important for practice based
  research networks to study creative, practical
  approaches