Public Health Nurses afraid of misclassifying children as obese, new research shows

Public Health Nurses were afraid of misclassifying children as obese and wary of approaching the issue of excess weight with the child's parents, according to new research.

The study was based on input from nine Public Health Nurses (PHN) in the west and south of the country as well as from parents and children themselves.

As concerns grow about Ireland's rate of childhood obesity, the research - conducted by experts at School of Public Health in University College Cork and the HRB Clinical Research Facility in the city's Mercy Hospital - found that "uncertainty surrounds the most effective way to manage childhood obesity in the community."

Through interviews with the PHNs as well as 10 parents and nine children referred to the childhood obesity programme W82GO-community, it said the retention of participants in the programme was "problematic", which had negative effects for those involved and the health system as a whole.

Children aged between five and seven and who were obese with no apparent clinical problems are eligible for the programme, which aims to improve nutrition, increase physical activity and encourage changes in behaviour over a one year period. It has been running in the west and south since April 2015.

Looking at figures from April 2015 for a period of 12 months, it found that out of 2,000 children measured by PHN, 121 or 6% were in the 98th percentile and potentially eligible for the programme. However, less than half of the families invited for initial assessment presented at the appointments and there was a double-digit drop-out rate even as the programme went into phases two and three.

As for those who underwent interview for the research, it said: "PHN and parents reported a number of fears relating to the referral process. For PHN these fears included misclassifying children as obese and approaching parents about their child's excess weight.

For parents, most were afraid of what the referral meant for the health and wellbeing of their child. This concern ultimately outweighed any fears they had prior to accepting the referral.

If found that PHN felt obesity was "an enormously sensitive issue", with some finding themselves "double- and triple-checking at every stage of the screening process" to ensure no child was misclassified.

One said: "I would say I checked them half a dozen times before I sent out the letter because your worst nightmare would be to send out a letter when they weren't right."

Others were fearful of upsetting parents, with one PHN stating: "It was so bad sometimes That I used to bless myself before I went on the phone."

All PHN said training was needed on how to communicate to parents that their child is overweight while parents said there needed to be a better way of explaining Body Mass Index.

PHN also referred to instances of parental denial while parents said they could receive "conflicting messages" regarding their child's weight from family, friends and figures of authority. Some were concerned about their child being bullied.

However, the families who completed the programme said they found it very beneficial and the report made a number of recommendations including that appropriate resources be allocated to support practical training and education.

The report, entitled 'Understanding engagement in a family-focused, multicomponent, childhood weight management programme delivered in the community setting' is available here.

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