1. www.healthinterventions.co. uk Identifying and addressing parental barriers and facilitators to engaging in child weight management programmes. Dr Ellinor Olander Lead, Physical activity and obesity intervention team Applied Research Centre in Health and Lifestyle Interventions Coventry University ellinor.olander@coventry.ac.uk

2. www.healthinterventions.co. uk Background Successful treatments for childhood obesity remain elusive A common challenge to successful obesity treatment is poor attendance Poor attendance rates for family-based interventions are likely to be complex – parental and family characteristics – overweight/obese child characteristics A second related challenge is drop-out

3. www.healthinterventions.co. uk Scoping review January 2012, commissioned to do a scoping review, to identify: – most recent evidence related to parental barriers to engaging in weight management services that target childhood obesity. – most recent evidence related to the National Child Measurement Programme and how the families that have had their child identified as overweight/obese is best supported. – prior learning and best practice in terms of what support and services other PCT’s provide to families whose children has been identified as overweight/obese by the NCMP. Delivered 31 st of March 2012

4. www.healthinterventions.co. uk Methodology Scopus database Children aged 4-11 Qualitative or quantitative papers Parents/children’s views Services in primary care or community settings Excluded weight loss camps Surveyed NOO resources and personal reference library

5. www.healthinterventions.co. uk Why do parents engage in services? The most common reason; improve their child’s self-esteem. Other reasons; wanting help to make necessary weight- related behavioural changes. Parents engaging with services were aware of their child’s weight issue and motivated to tackle it. → Important to consider readiness to change when trying to identify parents that want to engage in a weight management service. The child’s physical health (such as increased risk of diabetes etc) was not commonly mentioned as a reason to seek treatment.

6. www.healthinterventions.co. uk Why do parents drop out of services? Motivational reasons – Child not willing to continue treatment – Parents or child not ready to make the lifestyle change needed Reasons associated with parents’ expectations – Not being able to comply with programme attendance and requirements – Family already satisfied with treatment outcome and not wanting to continue further Physical reasons – Distance to programme – Scheduling conflicts

7. www.healthinterventions.co. uk Why do parents not engage in services? It will take up too much time Venue is inconvenient Things are difficult in the family at the moment (divorce, new baby, moving house) Concern regarding negative effects on child Already involved in other service Health professional said child is of healthy weight Do not need the service as child does not have a weight problem

8. www.healthinterventions.co. uk Parents’ assessment of their child’s weight status… Potential issues with this type of assessment… Examines physical appearance taking into consideration weight for height, type and location of body fat Parents are unsure of whether baby and puppy fat is a concern, others think the child is due a growth spurt soon Compares child’s size to other childrenParents are less likely to identify their child as overweight if they live in a high-obesity region Checks whether child still fits into their clothes/school uniform Clothing sizes today are larger, to take into consideration larger sized children Realises child is unable to do physically activities (such as forward roll/somersault) Overweight and obese children may be less active, thus not providing their parents with an opportunity to realise they are unable to do certain physical activities Asks family, friends and health professionals if their child looks overweight or if they think the child has a weight problem Family and friends are likely to use the same references as parents when assessing children’s weight status. May also not want to upset parents. Health professionals may not be able to identify heavy children

9. www.healthinterventions.co. uk Participating parents and children’s views on weight management services Parents reported + someone outside the family providing a ‘wake up call’ and on-goning support + increase in their child’s self-esteem/confidence (sometimes more important than weight outcomes) – feeling guilty about restricting their child’s food intake Children reported + improve their looks and increase their fitness → help them fit in – How long weight loss took

10. www.healthinterventions.co. uk In summary… To increase service uptake and decrease drop-out: – Help parents realise their child is overweight/obese in a non-judgemental fashion – Ensure services target children’s self-confidence and self- esteem – Sell services accurately so families know what to expect – Create bespoke services that take into considerations each family’s specific needs and circumstances