Healthy kids for professionals (part 1): Raising the issue

ABIGAIL MCCARTHY:

Good evening and welcome to the raising the issue webinar, this is one of a series of three webinars provided by the NSW Ministry of Health dealing with childhood overweight and obesity.

Before we begin, I would like to acknowledge and pay my respects to the traditional custodians of the land on which this meeting takes place, and also pay my respects to elders past and present.

I will now hand over to our facilitators.

GEORGIA RIGAS:

Good evening everyone and welcome to this evening’s twilight seminar on raising the issue. My name is Dr Georgia Rigas and I am the Chair of the RACGPs Obesity Management Network. With me this evening, I have my fellow colleague Dr Shirley Alexander.

SHIRELY ALEXANDER:

Thanks for that introduction, Georgia.

Tonight we are going to talk about childhood obesity because it has been recognised as a major problem, so much so that it is one of the 12 premier’s priorities, and it is the only childhood priority.

The NSW Ministry of health have been doing a lot of initiatives, including working with clinical services. We have a working group every fortnight on a Tuesday involving a number of clinicians from a number of LHDs (Local Health Districts) who are either in the process of thinking about, or setting up a new clinical service, or already have a new clinical service in progress. They are also working with schools, education, and the food and built up environment to look and see what changes can be made to prevent childhood obesity from getting worse, and also in other childhood settings like childcare centres etc.

There is a lot of activity going on in terms of looking at preventing childhood obesity and looking at it from many different angles because it is a complex problem and it is not just one single, simple solution and lots of things happening in this space, which is very exciting. Obviously, one of the main things is in the primary care sector, general practitioners can make a huge difference as they [general practitioners] are often the first point of contact for families and children with obesity in terms of the health care services.

GEROGIA RIGAS: General practitioners play a crucial role in both the identification and management of children who are above a healthy weight. We are trusted members of the health community, often knowing both children, adolescents and their families for many years. We offer a continuity of care and understand how critically important this is. Often we are the only point of contact that children and adolescents have with the health care system. We know the volume of patients that we see on a day-to-day basis, therefore we are well placed to potentially screen and treat such children at risk of overweight and its repercussions. Finally, as Shirley will attest, as general practitioners we are very well equipped in managing chronic health conditions, we have a multidisciplinary team at our disposal and have years of experience in managing such health conditions.

The leaning objectives for this webinar are as follows:

1. Refer to recent evidence in childhood overweight and obesity
2. Assess a child’s weight status as a part of routine growth assessment
3. Document a child’s weight status on a BMI-for-age chart (hard copy, online calculator and in your clinical software)
4. Discuss the issue of healthy growth for age with children and families

Before we proceed any further, I think it is important that we firstly understand and utilise the correct terminology. I think it is important also for us to be aware that the language we are about to explore has been tested with families and their children.

A healthy weight is defined as being between the 5^th and just under the 85^th centile; below a healthy weight is defined as being under the 5^th centile; above a healthy weight is defined as 85^th centile to just under the 95^th centile; and finally, well above a healthy weight is defined as the 95 centile and above.

Let us not forget that these growth for age charts are used as a screening tool, as a guide of the health risk, they are not meant to be used as labels. The idea behind them is to assist health professionals and parents to see an improvement in the health of the child or adolescent.

SHIRLEY ALEXANDER:

Just to give a little bit of background of what’s happening in terms of the prevalence of childhood obesity and overweight, and there is some data to indicate that there might be a levelling off, or plateauing of prevalence of childhood overweight and obesity, which is good news, it means there are some differences being made. However there still is a prevalence of one in four children of school age in Australia have overweight or obesity, so there is still lots of things to do.

Slightly more worrying though is that although overweight and obesity in total might be plateauing a little bit or reducing the trend, the more worrying thing is that those with sever obesity are actually increasing in number. There are certain areas in certain communities and pockets/cohorts of children that have higher prevalence than even the national prevalence rates, particularly as can be seen in our next slide looking at prevalence rates.

Children from lower socioeconomic backgrounds have a much higher risk of having problems with overweight and obesity; also, children from certain ethnic backgrounds, particularly children from the Middle East have higher risk of obesity. Not only are there pockets from socioeconomic backgrounds and ethnic backgrounds, there are certain ages that have increased risks of having overweight and obesity, or their excess weight gain increasing. Those periods are particularly in the preschool children, the age 0-3, we have seen much higher incidence and prevalence of obesity in recent years, and older adolescents and young adults, they are vulnerable times because the older adolescents are often leaving school, they are going to university or further education and often leaving the home environment where the parents have had more of an influence on them. Their lives are busy, they have discovered socialisation and alcohol and all that sort of stuff, so this is much more of a risky time for weight gain, or excess weight gain during that period of their life.

In terms of what are the underlying causes of obesity, as mentioned it is a complex condition, there is not just one cause, and as you can see from this slide here that is entitled Aetiology, that complex picture is from the Foresight Report, which was a report done in the United Kingdom about 7-10 years ago. It illustrates the complexity and the many inter dependant factors that lead to problems of excess weight gain, which includes things like genetics and epigenetics but as it is highlighted, we all have a genetic predisposition to weight gain, but really at the end of the day it is the environment that makes such a difference.

I once heard that your genetics is like the gun, but your environment is like pulling the trigger, you’ve got to have the environment to express the problem. We really need, particularly in childhood obesity, to focus on our environment and making changes in the environment so that the healthy decisions are the easier decision to make, whereas at the moment it tends to be that the less healthy decisions are the easier decisions to make.

In children, excess weight gain can be associated with medications, in particular steroid usage and occasionally underlying medical conditions; however just to highlight that in childhood obesity, underlying medical conditions and medications is actually a very small percentage of children that have excess weight gain because of that, less than 5 percent. There is also some research into potential viral triggers and what is much more of an upcoming and interesting field is the involvement of endocrine disrupter chemicals in the development of excess weight gain. I think we are going to hear a lot more about that in the future about how some of their toxins, if you like, in our environment might be acting as a trigger to weight gain and a number of children with excess weight gain.

GEORGIA RIGAS:

I have been a GP for 15 years now, both here in Australian and also the UK, and I am sure many of my colleagues tonight who have been in general practice for some time now would concur that most patients will not present because of their obesity, but usually because of something else. Psychosocial issues are definitely, by far the most common reason that children above a healthy weight come to our rooms. We know that weight is the most common reason for children and adolescents being bullied at school, such students have lower self-esteem and body image and higher rates of depression. They do less well in school and often drop out of school a lot earlier than their peers, when they eventually enter the work force, they earn less and therefore the cycle perpetuates.

We also know that children above a healthy weight may present to us as general practitioners as a result of a range of physical issues as we can see very clear in the slide in front of us. These can range from cardio vascular, and it is quite distressing to see the number of children who have hypertension and hyperlipoidemia. Pulmonary presentations, in particular asthma. Endocrine - I can think of at least a couple of parents who have come in saying, ‘I’m struggling to get this brown mark off my child’s neck despite everything that I’ve done’, and on examination we see that it’s acanthosis nigricans, which can be a sign of insulin resistance.

Musculoskeletal presentations are quite common in this age group as well, and it is concerning that these children and adolescents are developing premature wear and tear osteoarthritis because when they are in the adult cohort many of them are told that they are “too young” to be having a knee replacement, and therefore have to bear and grin the arthralgia. Then we have the neurological, and also acknowledge that idiopathic intracranial hypertension does not occur that often, but I must say that I have in my years seen a couple of cases and I will never forget them. Therefore, if you do have a child who is above a healthy weight who presents with a headache, obviously, you will look for the most common pathologies, but I would implore you to have idiopathic intracranial hypertension in your top five differential diagnoses, otherwise we would be missing a very critical diagnosis.

I would now like to spend a little bit more time showing you the healthy kids for professional’s website. This has been specifically designed and created to help support primary health care professionals in assessing, identifying and managing children and adolescents who are above a healthy weight. A number of health care professionals including Shirley and myself were involved in the development of this website; therefore, it has been specifically developed by health care professionals for health care professionals.

I’d like to draw your attention to the top right hand side [of the presentation] where we have a dark blue tab called ‘online learning’, which is something we can do at our own leisure at a time that suits us, to continue our professional development. Adjacent to that is a green tab labelled ‘videos’, and I will shortly be showing you one example of these, there are great videos on there – Go4Fun, healthy shopping and how to do this, and also how to calculate your child’s weight status. These are things that are useful for us as GPs, but also to show our health care practitioners in our practice, but they are also useful to show parents and families when you are consulting with them. Moving along we can also see the light green tab called the ‘FAQ’ tab, for me this is a very important tab because whether you’re a recently graduated GP or a GP of 40 or 50 years, I think we can all polish up our consulting skills and continue to develop in that regard. It has some really good resources on how to raise the issue of a child’s weight with their parent or carer, because we know this has to be done in a very sensitive and non-judgemental manner. How to start a healthy lifestyle discussion so as not to adversely affect the patient doctor relationship that we have worked so hard, over so many years to develop, so I highly recommend these resources. Moving along we have the aqua blue tab titled ‘Resources’, now this is gold! This has so many resources, I can’t read them all out now, but I want you to be aware that there is the ‘8 for healthy weight chart, which you can print out and give to your patients. It has the BMI for age charts for both boys and girls if your IT software does not support the electronic versions. It has posters for the waiting room - that way everyone knows this is routine clinical care. It has the Go4Fun posters and referral form, it has the Get Healthy posters and referral forms, but it also has referral forms for secondary and tertiary services, and these are things that can be downloaded and printed with the click of a button so you can give them to your patients.

This is just one example of the resources that are available to be downloaded and it very systematically and very clearly indicates what we need to be doing for children who are between the 85^th centile and under the 95^th centile, and then on the right, what we need to do for children who are at the 95^th centile and above. I encourage you to join us for the next webinar, during which we will be discussing this flow chart in a lot greater detail.

Now for a little bit of fun, this is to make sure everyone is paying attention and haven’t fallen asleep. Shortly I’m going to show you three photos and I would like you to note on a piece of paper, or on your laptop, what you think the BMI of each child is. Afterwards I’m going to show you all the three pictures and the answers and then we will discuss things further.

Here is child number one. This child is three years and three weeks of age. I’m not sure Shirley can you see ribs there? I think I can see ribs in the photograph. I’d like everyone here who is joining us tonight just to jot down whether they think this child is underweight, a healthy weight, above a health weight, or well above a healthy weight. We are going to move on to the second picture, same thing, I would like you to look at this photograph clearly and closely and determine whether you think they are underweight, a normal weight, above a healthy weight, or well above a healthy weight. Finally the third child, same thing again. Having a look at this child, who if my eyes serve me right is bulging out of their knickers, so maybe a bit heavy on the bottom side, I’m not sure? Do you think this child is underweight, a normal weight, above a healthy weight or well above a healthy weight?

Now that you have jotted down your thoughts on these three children, I’m going to give you the answers and for those of you joining us tonight in the webinar I would like you to message us if you got them all correct. The child on the left has a BMI above the 95^th centile, and therefore this child is well above a healthy weight. In the middle, this child has a BMI at the 10^th centile and therefore they are of a healthy weight. Finally, the third child, we see they have a BMI in the 85^th-95^th centile, which is above a healthy weight. I’ll be curious to see how many people got all three correct, so we are just going to pause and wait for a tick so we can give you ample time to type in, and our moderator will collate the figures. The moral to the story here is – do not judge a book by its cover, we definitely need to measure; we are not good at determining weight status through visual inspection alone.

In 2015, the SPANS report indicated that over 70% of parents correctly classified their children’s weight status. From over 500 parents, only 1.7% of parents of overweight children and 17% of parents of obese children described their children as being overweight. When paediatricians were asked 58% diagnosed correct weight status, which is quite concerning given that they see children every day and it’s their area of specialty. Sorry Shirley, but we did out do you as GPs, but only modestly - 72% of GPs did correctly diagnose the weight status of children. The bottom line is, both parents and clinicians are not good at what I call ‘guestimating’ a child’s weight status, therefore it is imperative that we measure a child’s height and weight at least every three months and utilise these measures to determine the BMI and plot it on the BMI for age chart. Whether it be the paper copy of electronic version.

Ok great, we have measured these but it does not just stop there. We also need to show and discuss these findings with the parental caregiver and provide better advice on a healthier lifestyle. This is an example of one of the many resources that are available on the Healthy ids for professional’s website. It shows one how to accurately measure the length of a child if they are not walking yet, and similarly, how to accurately measure the height of a child once they are upright and mobilising.

I am just going to stop for a moment and reflect, and I ask you to do the same thing. I want you to think about your current practice - which team members are there, how the waiting room is set up, if you have scales, where they are, If you have a stadiometer, where is it? If you don’t, but you’re going to put one up, where would you put it up? Then ask yourself, who should be doing these measurements, should it be the nurse? Should it be the GP? Should it be both? I’d like a response from the audience, so we are going to pause for just for a short period of time and I would like you to type in some responses and let us know what you are doing, and what is working for you. Our moderator will be look at the results and reporting to us.

We are going to change gears now and show you a short animation, a resource that is readily available on the Healthy kids for professional’s website. It’s entitled ‘How to calculate weight status and monitor growth over time’.

ANIMATION:

This short animation explains how to calculate a child’s weight status and monitor growth over time.

Girls and boys grow at different rates; it is important that you use the right chart for boys or girls aged 2-18 years. Today we will track John Smith’s weight status. John is 4 years old – let’s draw a line from 4 years old, now let’s find John’s BMI, which is 16.6, Johns weigh status is in the green band, which is the healthy weight range.

Let’s see how John is going at his next check-up 6 months later, his weight status is now in the yellow band, which is above a healthy weight.

John is now five, John is still in the yellow band, let’s plot John’s weight status now that he is five and a half years old - John’s weight status is now in the red zone, which is well above a healthy weight. This child’s weight status is on the upward trajectory. It is important to discuss this trajectory with the child and family.

GEORGIA RIGAS:

Ok, we have measure the height and we have measured the weight, now we need to actually put the data together and make some sense of it. Whether you do the electronic version or the paper version, once you have identified which zone the child is in, then we need to discuss it with the parents.

Let’s go through the colour zones first, from the bottom going up. We have in the light orange colour, children who are under a healthy weight. In the green shaded area we have children who are a healthy weight. In the yellow, we have children who are above a healthy weight range, then in the red/pink colour, children who are well above a healthy weight range.

We need to be realistic as to what our objectives are. When we are showing parents where their child on these BMI for age percentile charts, we are by no means aiming to get a child that is in the red down to the green. Our first goal is to make sure this child or adolescent does not continue to gain weight, the second part is to try to turn things around. As you would have noticed thus far, both Shirley and I have not used the word obesity or morbid obesity, or anything like that at all. This is important because we know that these words are quite emotive and stigmatising and for many adults, discriminatory, and therefore serve no purpose when we are talking to children and adolescents and their families. What we always need to be cognisant of is the fact that we are looking at kid’s health and making sure that they are growing appropriately. The weight is just one of many means of monitoring this.

We would now like to cover some common misconception and to dispel them. Misconception number 1 – Children will grow out of puppy fat. As you might remember earlier, we discussed about weight gain over the life course and that there are some somewhat predictable high-risk times when children and adolescents will gain weight. We also know that two thirds of children who are above a healthy weight will become adults who are above a healthy weight. Disturbingly four fifths of children who are well above a healthy weight will become adults who are above a healthy weight, and so I think the statistics speak for themselves and therefore, I hope I have convinced you that misconception number one is a definite no no.

SHIRELY ALEXANDER:

I am going to briefly talk on the fact that parents don’t want to talk about it,

childhood obesity and obesity in general is a very sensitive topic, it’s very emotive, people stigmatise and blame and so there is a feeling that parents actually don’t want to talk about what the weight of their child is. But in fact, most parents actually when they come to see a paediatrician, at least from my perspective, they really want to know how their child is growing and developing. It’s all part in part, it’s one of the main difference between paediatric medicine and adult medicine is looking at the growth of the child and the development of the child. I think we shouldn’t not talk about it because we perceive, or we think parents don’t want to talk about it when actually they do want to talk about it and there is research around that fact that in fact, parents would rather that you highlighted if there was a health issue, even if it is also a weight issue, or around weight.

There has been some studies in the United Kingdom, Ireland, and Europe that have specifically looked at that and that in fact, most parents would prefer that you do raise the issue and talk to them about it. Obviously, part of these webinars is about how to raise that issue in a way that is not stigmatising, not blaming, and is sensitive so that the parents feel comfortable talking about it.

Another common misconception is - we can’t to do anything about it, so why bother? Again, there is plenty of evidence out there in systematic reviews and randomised control trials that in fact, we can make a difference with family focused interventions, looking at long-term behavioural changes around activity, nutrition, and screen time. Research doesn’t often go beyond 2 years, so there is that need for longer-term outcomes and research. There certainly is plenty of research to indicate that not doing anything means that the trajectory of the obesity continues to be exponential, whereas making some intervention makes a difference, even if it just slowing the trajectory of weight gain it is a positive thing. I would really encourage you to think more positively in the fact that intervening, even just talking about it in itself makes a difference. There was a recent paper from the UK in the BMJ (I think) that was a 30-second intervention. It did happen to be in adults so we are not sure if it translates for children, but the intervention was basically saying to the adult – did you ever realise your weight is above a healthy weight. Would you like to do something about it? If so, our nurse can sign you up to a specific program to help you with that to get healthier. The outcomes were really quite amazing after just doing that introductory 30 second ‘would you like to do something about it’. The intervention group got signed up and they lost 3 kilograms in a year on average, and the control group, which the GP just mentioned that ‘you might want to do something about it to get a bit healthier’, and not specifically signing them up, that group lost 1 kilogram on average over a year. [This shows] there really is plenty of evidence to suggest that doing something at least, is better than doing nothing.

To highlight this from a paediatric perspective, we have a case study. We have a 5-year-old girl who has a BMI of 35, which is obviously way above a healthy range for a child, it is actually in the grade 2 obesity range for adults and this girl is only 5 years old. Her mum was a single mother who also had excess weight issues, she had some depression and it was felt that the mum was not able to cope so the child went into the care of the grandparents. She came to our clinic, which was a multidisciplinary family centred approach, so having input from multiple health professionals including dietician, doctor, nurse, physiotherapist and psychologist. As you can see from the growth charts on this slide, it made a huge difference just being able to have that family centred approach, having adults that were actively engaged and supporting changes made on a family wide basis, and for this young girl this made a huge difference for her. When she first started coming she wasn’t particularly happy, and then towards the end of coming to the clinic, she would skip in and looked like a totally different child. She was going to school regularly, whereas before she was missing out on school and getting behind, now she was really catching up and doing very well in school. It was a pure delight to see.

One of the other misconceptions is that people are very concerned about talking about weight, because they think it might induce an eating disorder. There is absolutely no evidence what so ever to suggest that talking about weight per se causes and eating disorder. Obviously, it goes without saying, that whenever you are talking about weight or bringing up that issue with people, in particular with young teenagers and young adolescents is to do it sensitively, and in a way that is non-stigmatising, non-blaming, sensitive and empathetic. The way that we approach it will make a huge difference as to the way the young person engages in support from the medical perspective.

GEORGIA RIGAS:

Now for some fun!

Scripted scenario number 1

I would like to present Sam, who is a 7-year-old boy who came to my practice with a hand injury. His BMI for age places him in the well above a healthy weight range, the general practitioner talks to Sam’s father.

GP:

I have noticed that Sam is a big boy for his age – does he eat a lot of junk food at home?

FATHER:

My family are all big. If we stop him from playing his X-Box and eating his snacks, he gets cranky. He only eats because he is hungry. Are you telling us we are bad parents?

GP:

No, but I think you need to cut out all the junk food and soft drinks at home and he needs to start exercising every day.

FATHER:

Like to see you try to get him to do exercise! We aren’t getting rid of the coke and potato chips or else what would I eat? No way!

GP:

I am writing a referral to see a dietician. I want you to see them as soon as possible.

FATHER:

I’m not going to see any diet person!

GP:

[Writes the referral anyway]

SHIRLEY ALEXANDER:

So that is an example of what I think, and I’m sure Georgia agrees, that was not the preferred way to do things, or outcome. Think about what did the GP do well. How did Sam’s father react to the discussion about Sam’s weight? What was the outcome, and suggestions or comments for improvement.

From my perspective, I think the father felt like he was being targeted, as a bad parent. We probably didn’t get across the message that there are so many different aspects that could be looked at for the whole family and doing it in a more empathetic way and asking what the father understands about the situation, what he might be able to do about it, or what he would be willing to do about it and work towards getting him engaged to seek further help. Basically you want to get the families on board, to work with them, and at the end of the day, to do that, you’ve got to come across as being empathetic, you’ve got to be understanding of their situation, you’ve got to see it from their perspective and work together. You are much more likely to be successful if you can develop a plan that they are going to be willing to follow through on, and as I said, explore some of the reasons that might be acting as barriers for these families to be able to make some changes. At the end of the day you need to be up front and tell them it’s going to take some work, it’s going to be a bit hard, it’s not going to happen instantaneously, you will have some setbacks, but really, at the end of the day what we are looking at is helping the families to develop strategies to overcome some of the things they see as barriers. These barriers might be some of the misconceptions that we have already talked about, there might be some cultural beliefs that we need to explore, some financial issues that we need to look into, and there also might be some other priorities for the family - there might be another individual in the family who is more acutely unwell. We have had families where the child might have some sever illness that they have to address at the moment, and sometimes looking at strategies for weight management just adds another stress into their life and is setting them up for failure rather than setting them up for success. That is what we want to do, we really want the latter, we want to set them up for success by helping them make some small decisions one-step at a time, and embed those changes so they become longer-term habits. We are looking for little wins along the way, and also explaining to them that they are not on their own, we are here to help them and there is a suite of health professionals that are able to support them on their journey to health and wellness.

GEORGIA RIGAS:

Shirley and I are now going to present scripted scenario number 2, and we will be curious to see what you think about this dialogue.

GP:

We measure all children’s weight and height as a part of our routine care to check their growth and development. When Sam arrived we recorded his weight adjusted for height and noted that he is above a healthy weight range. I would like to show you Sam’s height and weight chart compared to other children his age.

FATHER:

My family are all big. We can’t stop him from playing his X-Box; he gets cranky. He only eats because he is hungry. Are you telling us we are bad parents?

GP:

I know it can be difficult to manage kids his age and I am not blaming you. What I would like to do is offer you a few changes to consider that will help stop Sam gaining weight, so he can live a healthy life and avoid the health risks that overweight can cause.

FATHER:

So do I have to see some diet person and then she will fix it?

GP:

As I’m sure you are aware, there are more factors than what we eat and drink – you said it’s hard to get him off the X-Box. What I would like to suggest is we look at a few family lifestyle changes first. These are things you can do which apply to your whole family. Once you get the hang of these, we can involve other health professionals if we need to, but let’s start small and make changes that the whole family can keep doing.

FATHER:

So all of us have to change?

GP:

Yes, the whole family has to make some changes – these are some healthy lifestyle messages that you can consider. Sometimes families find these a little challenging to do but if you keep up with them, you will have better control over yours and your family’s weight and health. (Hands them 8 for a healthy weight diagram).

FATHER:

I guess we could try some of these.

GEORGIA RIGAS:

The 8 for healthy weight diagram is one of the resources available on the healthy kids for professionals website and I’m honoured to be sitting here with Shirley who was one of the main people involved in developing this resource some years ago. It is very easy to understand and relate the key messages to families, even those that may have English as their second language. Beginning from the top and working our way around in a clockwise fashion.

Firstly, in the dark blue circle, drink water instead of juice, soft drinks and cordial, we know that water is always best. Next, in the light green circle, we have at least five serves of vegetables and two serves of fruit per day.

In the orange circle we have start each day with a healthy breakfast, it’s alarming the number of children who turn up to school without having had breakfast!

Fourthly, in the purple circle – know your portions and serving sizes and this is quite important, as we have seen over the decades portions have increased.

In the dark blue again, we have choose healthier snacks and fewer of the, what we call, discretional or sometimes foods. Sorry Shirley, but I had to remove the word ‘treat’ because I don’t think these are really treat foods, and I’m sure you agree, we have now moved on and agreed we should be using words such as ‘discretional’ or ‘sometimes foods’ rather than “treat foods”.

Moving along, we are in the green circle. Limit screen time, children who are between the ages of 2-5 years of age should have up to one hour of screen time per day as a maximum. Children who are six years and older, a maximum of two hours screen time a day – this includes i-pads, i-pods, i-phones and smartphones, television and computer games, and we need to be strict about it because there is constantly new emerging data about the adverse outcomes associated with prolonged screen time in children.

The seventh one - Be active for at least one hour a day, every day. I’m sure that if children were spending less time with their screen time, they would easily be able to meet that criteria and have been active for one hour a day.

Finally, get enough sleep. Under the age of 12, they need to have at least 10-12 hours of sleep, and over the age of 12 about eight-10 hours so that they can function appropriately the next day, but also so they continue to grow and develop appropriately. This is an excellent resource, even for people who may not be able to read, the pictures speak for themselves. 

ABIGAIL MCCARTHY:

We will now move on to scripted scenario number three.

FATHER:

Not interested, thanks. I am too busy and my wife won’t have anything to do with diet food.

GP:

That’s fine, the time may not be right for the family to make changes now. I would like you to take the fact sheet with you, and this copy of Sam’s BMI-for-age chart. Please come back and talk to me if you have any questions.

FATHER:

Sure, that sounds like a good idea.

GP:

[Sets up patient recall in clinical software and documents interaction in patient notes]

GEORGIA RIGAS:

Recall is important because we know that overweight and obesity is a chronic health condition. Sam’s father may not interested in discussing things at this point in time, but you have kept the door open so that down the track it can be re visited opportunistically.

SHIRLEY ALEXANDER:

We have covered in this webinar how to raise the issue and some of the misconceptions about the barriers to raising the issue. In our next webinar, we are going to go over how, once we have raised the issue, we can then move forward to look at what is needing to be done in terms of helping families take that next step to having a healthier lifestyle.

We do know that there is not too much out in the community in terms of intervention programs, however, we do have in New South Wales Go4Fun, which is a free community based childhood obesity treatment program, which we know is being underutilised. It has been shown to be effective and it’s run in various locations by various LHDs (Local Health Districts). I suggest you go onto the website to find out where the nearest one is in your community, but basically, it consists of once a week sessions for both the child and the parents, it is two hours per sessions over a 10-week program delivered over the school term. It is multi component, so again, looking at helping the families from many different angles, there is a dietary component, which is often aimed more at the adults, there is also some structured exercise and physical activity, which the children often do while their parents are receiving education around diet and nutrition. There is a behavioural component and as I said, the parents are heavily involved because research shows that the more involvement that the adults have with the child and making family wide changes, the more likely you are to be successful. The program, as I said, is in New South Wales, it is for children aged 7-13 years old above a healthy weight, so there are some limitations there, there is nothing for below seven or above 13 and as I said, the parent or carer has to be available to attend the sessions. As mentioned before, the intervention has been shown to be successful with BMI reduction outcomes of 0.5 kilograms per meter squared and those that attend showed a reduction in waist circumference, which again, abdominal obesity is highly associated with cardio metabolic risk factors. Those children that attend Go4Fun tend to increase their physical activity per week by over three hours, and reduce the sedentary behaviours by the same amount, self-esteem improvements are also positive for those participants in this program. Additionally, as part of the education they [Go4Fun] encourage increase in vegetable intake in particular and ensuring the right amount of fruit intake – the outcomes from the studies show that statistically there has been significant improvements in fruit and vegetable intake.

ABIGAIL MCCARTHY:

Thank you for joining us for the Healthy Kids for Professionals webinar, as indicated on the screen, please feel free to contact either of our facilitator at the email addresses provided. We hope to see you at the next two webinars in this series of three regarding childhood overweight and obesity. Thank you.