Preventing Childhood Obesity - Evidence Policy and Practice.pdf

Chapter 12
short - and long - term outcomes as regards weight
regulation in the children. 53,54
Further supporting the involvement of parents in
obesity interventions, there is a growing body of evidence
from studies on child nutrition and growth
detailing the impact that parent choices and behaviors
can have on child nutrition and physical activity
habits. 50
A recent meta - analysis, however, has found conflicting
evidence regarding the benefits of parental
involvement in obesity interventions. When interventions
of all age groups were considered together, there
was no significant difference comparing those with
and without parental involvement. 55
What b arriers m ay e xist to p arental
i nvolvement in p rimary c are i nterventions?
In primary care, an effective universal approach will
rely on the motivation of the health care provider.
Although perhaps not the view of most primary care
providers, several UK based qualitative studies have
demonstrated that primary health care professionals,
including GPs and practice nurses, felt that obesity
prevention was an inappropriate use of their time and
was a problem of the family and child. 5,7,48
A more targeted approach, however, perhaps aimed
at secondary prevention of obesity in already overweight
children, starts to rely more on parental
involvement for successful initiation and implementation.
It is the parent who might initiate contact with
primary care services in this situation, even if initially
prompted through BMI measurement in other settings
such as schools. Evidence suggests that an
important barrier in this scenario is parents ’ inability
to recognize overweight or obesity in their children,
or see it as a problem. 56,57 Health professionals (pediatricians,
nurse practitioners and dieticians) felt that
lack of parental involvement was a major barrier. 8
Parenting styles are discussed in some obesity intervention
reviews, 58 focusing on the authoritative
parenting style as having been shown to be the most
successful in effecting behavioral change in relation to
smoking behaviors, and also in increasing physical
activity in adolescent girls. 59,60 Some behavior change
research has also focused on the parents, rather than
the children ’ s, stage of readiness to accomplish lifestyle
changes, 61 particularly given that parents can
influence the outcome of obesity interventions in different
ways, according to their child ’ s developmental
stage, though parental involvement seems to have
most impact in younger children. 55
How a re p rimary c are i nterventions
i nvolving p arents?
We see several levels of parental involvement in child
obesity interventions. The parent may simply be
required to offer a supportive role at home, for
example, getting children to activities; or they they
may receive education during clinic attendance, participate
in education sessions without the specific aim
of getting them to to adopt a behavioralist role, or
receive information packs. 38,39,41 The parent may be
trained in behavioral techniques and required to take
a very active role in the intervention. The parent may
be a subject themselves in family intervention programs
where nutrition and activity behaviors or
parent BMI may be a trial outcome.
Conclusions
The role of primary care will be expected to increase
in the coming years as the incidence and prevalence
of overweight and obesity in children prevails, and
programs are introduced that highlight the issue for
parents, schools and the health care system.
Most effective obesity prevention programs have
been carried out through comprehensive approaches
that include a combination of dietary and behavioral
modification, physical activity and parental involvement.
They have mostly been based in preschool,
school, community, family or tertiary care settings. It
is clear that virtually no evidence of effectiveness and
cost – effectiveness exists about interventions tackling
overweight and obesity in primary care. The continued
identification of effective prevention and weight
reduction strategies for children, and the clarification
of the role of primary care in this, must be research
priorities.
It is clear that there are many barriers for GPs,
nurses and other primary care professionals in
addressing childhood overweight and obesity, many
of which relate to lack of time, resources, appropriate
skills and training. However, the challenges of translating
evidence - based guidelines into health systems
practice must also be addressed. 62 The evidence base
for future obesity prevention interventions can be
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