Dr. Geoff Ball
Childhood obesity affects 20 to 30 per cent of young Canadians and many of these children face serious health problems into adulthood, including diabetes and heart disease.
To help address the problem, pediatric clinics like the Pediatric Centre for Weight and Health (PCWH) at the Stollery Children's Hospital offer individualized, interdisciplinary health services to help children and their families learn about proper nutrition, physical activity and other healthy habits. Families connect with dietitians, mental-health professionals, pediatricians and other health-care professionals to develop a plan that caters to their individual habits, needs and abilities.
But how effective are these services?
Principal investigator Geoff Ball, associate professor of pediatrics with the Faculty of Medicine & Dentistry, and lead author Jillian Avis, graduate student, led a team of experts to find the answer. Information was gathered over a four-year period and included 165 patients referred to the PCWH by their physicians. Follow-up assessments were held three, seven and 11 months following initial assessment. The team examined three components of the program: how children's weight changed over time, what services in the program were utilized and whether the child became disengaged with the program. The study was published December 2013 in Paediatrics and Child Health, the official journal of the Canadian Paediatrics Society.
Children who participated for the full length of the program showed positive results. Assessments during the third and fifth months revealed that 55 per cent of participants either maintained or decreased their weight. That number increased to 75 per cent at the final assessment in the 11th month.
According to Ball, disengagement is a big challenge for pediatric obesity clinics. PCWH is no exception: by the final assessment, 73 per cent of the original patient sample had discontinued care.
"When families discontinue care, we usually don't get a specific explanation or reason why," Ball said. "However, motivation to change is key. A lot of the families who attend when they are ready, willing and able can make healthy changes."
Some of the barriers families experience may include economic stress, family problems or priorities that simply aren't focused on health. Ball emphasized that misconceptions about the services may also prompt disengagement, but, he says, rather than offer a strict diet and exercise program, families are more likely to receive coaching and support to make healthy habits.
Travel may present a challenge to some families, particularly those living in rural areas. To help accommodate this hurdle, some clinics are working to provide evening or weekend appointments, video conferencing and virtual support. PCWH is also working with the Stollery Children's Hospital Foundation to provide public transit passes for families to attend clinic appointments and recreation facilities in the city.
"One of the biggest challenges to overcome is conceptualizing obesity as a chronic illness," Ball said. "It is incredibly difficult for families to make healthy changes to diet and exercise when they're bombarded by conflicting messages and environmental cues that tell us to eat whatever we like and be as sedentary as possible. There's a lot of mental power and social support needed to overcome those choices on a day-to-day basis."
Ball says that the most important part is raising awareness with the parents about the impact the home environment has on their children's health, but strategies have to be personalized to each family to make them meaningful. For example, health professionals may recommend removing televisions and game consoles from children's bedrooms but that might be a non-priority for some families. In such cases, health professionals can focus on other areas for change.
While the positive results for patients who remained engaged with the program is encouraging, adjustments must be made to decrease the risk of disengagement.
"We want to empower parents to be the best that they can be. We want to address any barriers they have and help them access resources and information," Ball said. "It's about how we can help the families and what kinds of things they already have in place so we can build on their strengths."