Key Stakeholders perspectives towards childhood obesity treatment programmes

1
Key Stakeholders perspectives towards childhood
obesity treatment programmes

• Leanne Staniford
• Dr J.Breckon
• Dr R.J. Copeland

2
Introduction

• Global increase in childhood obesity
• In UK alone predicted 2/3 children will be
  overweight/obese
• Lifestyle interventions best available treatment
  option
• Nutrition
• Physical activity
• Behavioural component
• Family/ parent involvement
• Only modest results with limited sustainability
  of weight loss(Summerbell et al, 2003).
• Development of effective treatment strategies can
  contribute to halting this rise.

3
Why a qualitative study?

• Treatment interventions have largely overlooked
  stakeholder views (Flynn et al., 2006)
• Qualitative methods could ask questions of
  stakeholders to contribute to develop client
  centred treatment (Summerbell et al., 2003)
• Small number of qualitative studies
• Children (Murtagh et al., 2006)
• Parents (Stewart et al., 2008)
• Health professionals (Walker et al., 2007)
• First study to consider a range of key
  stakeholders views.
• Implications will be relevant for UK based
  childhood obesity treatment programmes.

4
Research Aims

• To gain key stakeholders perceptions towards
  childhood obesity treatment programmes.
• Specifically towards
• (i) The effectiveness of lifestyle based
  interventions and their typical components
• (ii) Sustaining and maintaining weight loss
• (iii) Promoting adherence to lifestyle behaviour
  change

5
Methods

• Participants 26 Stakeholders including
• 10 Children age 7-13 yrs old (5 pre treatment, 5
  post treatment)
• 7 parents (4 pre treatment, 3 post treatment)
• 9 Health professionals (including
  paediatricians, health promotion experts,
  treatment deliverers)
• Children and parents recruited from MEND a
  community based treatment program at Hillsborough
  Leisure Centre (Sacher et al., 2005)
• Participants completed qualitative
  semi-structured interviews (25-30minutes).
• Semi structured interview informed by topic
  guide
• - Based on review findings (e.g. Summerbell et
  al., 2003, Flynn et al., 2006.)

6
Methods

• Data Collection and Analysis
• Ethics approval from Sheffield Hallam University
• Informed consent and parental consent gained
• Data was tape recorded
• Transcribed into MS word format
• Transferred into Nvivo 7 (Qualitative data
  analysis software)
• Nvivo facilitates dealing with the large quantity
  of qualitative data
• Analysis of data used the framework analysis
  approach (Ritchie Spencer, 1994)
• Systematic approach to qualitative data analysis
• Framework approach suits coping with large
  quantities of qualitative data (Murtagh et al.,
  2006).

7
Framework Analysis Technique
Ritchie Spencer (1994)
8
Methods

• Next, arranged key themes into chart display
  (matrix format)
• Charts laid out on thematic basis
• Stored matrix coding queries facilitate easy
  referral back to data
• From this
• Started to look for patterns and associations.
• Different cases within and between subgroups
  could be compared and contrasted in search of
  connections in search for explanation and
  meaning.
• Deviant cases

9
Results Thematic Framework

• Maintaining and sustaining weight loss
• - Adherence to behaviour change key
• - Potential for computer support
• - Positive outcomes ? maintenance
• Social support channels
• - Professional Support
• - Post program support
• - Importance of group support
• - Support of similar others
• - Peer support
• - Importance of family support
• Psychological issues
• - Psychosocial impacts of obesity
• - Emotional impact of obesity

• Motivational Issues
• - Readiness to change
• - Motivational tools and behaviour change
  techniques
• - Importance of motivation for change
• Barriers to treatment
• - Lack of support from health professionals
• - Genetic reasons for obesity
• - Challenges to maintenance
• - Barriers to exercise and healthy eating
• Tailoring treatment
• - Tailor treatment to individual or specific
  groups
• - Appropriate level for education
• - Age considerations designing programs

10
Results Thematic Framework

• Specific Treatment Recommendations
• - Parenting issues
• - Increase available treatment programs
• - Healthy role models
• - Family therapy
• - Empowering child to make healthy choices
• - Child education on health consequences
• - Change family habits
• Overall views regarding treatment
• - Tackle wider society issues
• - Prevention in early years over treatment
• - Positive attitude to treatment
• - New more imaginative approach to treatment
• - Negative attitude to UK obesity treatment
• - Learn from European treatment approaches

• Context and design features of treatment
  programmes
• - Program location
• - One to one counseling
• - Non medicalised treatment
• - Non judgmental atmosphere
• - Monitored weight
• - Individual sessions and group work
• - Duration of programme
• - Coordinate with school efforts
• - Child group discussion sessions
• - Against school involvement
• Treatment expectations and achieved outcomes
• - Positive physical and psychosocial outcomes
  not just weight loss
• - Positive outcomes of physical activity
• - Parental weight loss goal
• - Health improvement

11
Results
12
Results
13
Results Key Themes Importance of Social Support

• Children and parents suggested a consistent
  support network incorporating the core family,
  similar others (i.e. other overweight children
  and their parents) and health professionals is
  key,
• I were looking forward to child 3 getting
  interaction with children that are (pause) that
  look the same as child 3. (Parent 3)
• Children and health professionals suggest parents
  need to be healthy role models
• Parents see their role provision of emotional
  and tangible support empowering children
  behaviour change,
• I see it as being my role to carry on
  facilitating this so with the food and taking her
  to activity cause child 6 is young and I wouldn't
  see it as appropriate to take that over. (Parent
  6)

14
Results Key Theme Readiness/Motivation to Change

• A number of children suggested they were not
  motivated to change,
• I, I didnt know I was coming my mum jus
  brought me I didnt really wanna come. (Child
  8)
• Health professionals suggested treatment
  programmes need to assess stage of change,
• I think certainly you need someone (pause)
  someone to assess their readiness to change cause
  if their not ready to change then you might as
  well not bother and its better saving your money
  and I think thats the real reason you need
  psychology. (Stakeholder 7)

15
Results Key Theme Challenges to maintenance

• Bullying key barrier to adherence in children
• your just gonna think well I'm trying my best
  but they just keep on bullying me so then you'd
  just think what's the point in trying to lose
  more weight cause they won't stop (Child 4)
• Motivation as a key issue to sustain changes post
  treatment
• If you are doing it cos you've got to then once
  it's over you'll just give up on it. (Parent 1)
• Lack of Support from other family members key
  barrier adhering to behaviour change
• you know it's so easy you know if you've got a
  mum who buys these multiple packs of chocolate
  bars and sticks one in your lunchbox every day
  you know the other kids in the house can eat
  those things and not put on weight it's very,
  very easy in our society to over eat
  (Stakeholder 3)

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Discussion/Implications for Research

• Research to identify cost effective, innovative
  strategies should be considered (e.g. home based
  support, self help groups, buddy systems) to
  provide continued support.
• Research needed to identify optimal family
  approach
• Research to investigate effective maintenance
  strategies in childhood obesity context limited
  evidence to date.
• Further qualitative research needed with drop out
  families represent alternative perspective
• Further research needed to investigate potential
  value of tailoring treatment according to
• Families readiness/ motivation to change
• Age
• Degree of obesity
• Ethnicity

17
Discussion/Implications for Practice

• Multi component lifestyle treatment should
  incorporate physical activity, nutrition and
  psychological element.
• Treatment programs should engage the whole
  family.
• Encourage parents they need to be healthy role
  models
• Need more programmes in non medical settings
• Computer/internet mediated support potential
  strategy to maintain support similar to recent
  review findings. (Whiteley et al., 2008)
• Encourage continued group support (e.g. self
  support groups)

18
Implications for Practice

• Potential Maintenance strategies to enhance
  treatment sustainability include
• Social facilitation techniques
• Extended behavioral skills training (Wilfley et
  al., 2007)
• Potential maintenance strategies shown promise in
  adult weight loss settings include
• Extended professional contact,
• Problem solving techniques
• Physical exercise
• Extended peer support (Wing et al., 2006)
• Relapse prevention techniques show promise in
  addiction field (e.g. ID high risk situations,
  develop coping strategies, enhancing self
  efficacy, cognitive restructuring)

19
Acknowledgements

• I would like to thank the MEND central team
  and program leaders at Hillsborough leisure
  centre for allowing me to be involved with the
  programme and access participants for the study.
  I would also like to thank the children, parents
  and health professionals who gave up their own
  time to be involved in the study and without
  whom, the study would not have been possible.

20
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