Identifying and barriers to intervening in childhood obesity in paediatric outpatient nursing settings using a mixed methods study

Abstract Background: Obesity is an increasing problem in England and disproportionately affects those of lower socio-economic status, and there has been a drive for health care professionals at all levels to provide brief advice regarding weight management. There is little evidence on what barriers exist to providing this advice in paediatric settings. Methods: A retrospective review of children’s outpatient clinic notes in a hospital in London, UK during one week was undertaken to collate height and weight measurements and calculate (Body-Mass-Index) BMI centile. Qualitative interviews were conducted with staff to explore attitudes and opportunities to discuss weight Results: Of children included (n=236) Two fifths (41.1%, n=97) had height and weight recorded. BMI centile was calculated for 79.4% of those (n=77). A quarter (26% [95% CI: 13-30%], n=20) were overweight (>91st centile) or obese (>98th centile). Nursing staff reported that the period taking height and weight measurements was not a good opportunity to raise the issue of weight, due to lack of time, lack of knowledge of patient’s medical history and not having BMI centile available. Conclusion: Over one in four children attending the paediatric clinic were overweight or obese. Nursing staff need support and training to feel confident to incorporate discussions around healthy weight into their role and to make the most of opportunities to make every contact count.