General Practitioners practice nurses and parents' perspectives on childhood overweight management - a qualitative study.

European Journal of General Practice 2024, VOL. 30, NO. 1, 2402259 https://doi.org/10.1080/13814788.2024.2402259 Research Article General Practitioners practice nurses and parents’ perspectives on childhood overweight management – a qualitative study Maxime Adriana Maria van der Veldena, Hevy Hassana, Dieuwke Schiphofa, Madelon van Tilborg-den Boefta, Sylvia Buisa, Wilma Jansenb,c, Patrick Jan Eugène Bindelsa and Marienke van Middelkoopa Department of General Practice, Erasmus MC Medical University Center Rotterdam, The Netherlands; bDepartment of Public Health, Erasmus MC Medical University Center Rotterdam, The Netherlands; cDepartment of Social Development, City of Rotterdam, The Netherlands a KEY MESSAGES • General practitioners recognise that they can play an important role in the management of overweight and obesity in children. • Parents are open for weight-related conversations if general practitioners are non-judgemental and have an open attitude. • General practitioners need supportive tools to identify, address and refer children with overweight and obesity. ARTICLE HISTORY ABSTRACT Background: Overweight and obesity in children is a major health problem. General practice might be a promising setting for identifying and for the first steps in the management of overweight and obesity in children. Objective: To explore opinions, needs and preferences about the role of general practice in the management of overweight and obesity in children from the perspectives of Dutch general practitioners (GPs), practice nurses (PNs) and parents of children with and without overweight. Methods: A qualitative study using semi-structured focus group interviews. GPs and PNs were recruited from general practices from the region South-Western. Parents were mainly recruited via social media and primary schools. Twenty-five GPs, seven PNs and 18 parents were interviewed. All interviews were audio recorded, transcribed and thematically analysed. Results: GPs, PNs and parents agreed that it is the task of the GP to identify, address and refer children with overweight and obesity. However, GPs find it difficult to start this conversation due to time constraints; fear for the reaction of parents and children; lack of clarity about treatment and referral options. Parents indicated they are open to a conversation if the GP is non-judgmental, honest and respectful. PNs saw no role in managing overweight and obesity in children. Conclusion: Although GPs experience several barriers, GPs, PNs and parents all agreed that GPs should play a role in identifying, addressing and referring children with overweight and obesity. Supportive tools are required for GPs in order to play this role. Introduction Childhood overweight and obesity are an increasing health problem worldwide [1,2]. In the Netherlands, 11.5% of the children aged four to 12 years have overweight [3,4]. Children with overweight have an increased risk to develop health problems like high cholesterol and hypertension [5,6]. In addition, these children are more likely to become overweight adults with an increased risk to Received 12 February 2024 Revised 3 June 2024 Accepted 4 September 2024 KEYWORDS Children; overweight; obesity; screening; qualitative research develop diseases such as cardiovascular diseases, type 2 diabetes and diverse types of cancer [7]. Next to that, children with overweight experience more psychosocial problems compared to children with a normal body weight, such as low self-esteem, depression and they are more often victims of bullying [8]. Hence, it is imperative to identify, address and treat overweight and obesity in children as early as possible [9,10]. CONTACT Maxime Adriana Maria van der Velden Medical Centre, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Department of General Practice, Erasmus MC University © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 M. A. M. VAN DER VELDEN ET AL. In the Netherlands, the general practitioner (GP) is the first point of care for health complaints. Most children visit their GP at least once during each life year [5,11]. This makes general practice a promising setting to identify and address overweight and obesity in children [9,11,12]. The Dutch Obesity guideline for GPs states that obesity in children should always be addressed, no matter the reason of consultation and recommends measuring bodyweight and height of children suspected to have overweight or obesity [13–15]. However, it appears that most Dutch GPs do not adhere to these guidelines, since only 24% of them determine the Body Mass Index (BMI) of children who seem to be overweight and the number of GPs who refer these children is even lower [1,3,13,16]. This is likely related to barriers experienced by GPs in clinical practice, such as sensitivity of the topic, lack of time and fear of disturbing the doctor-patient relationship [7,9,10,13,17]. Moreover, current guidelines do not seem to offer enough support to identify and discuss overweight and obesity in children in general practice [14]. It is therefore especially important to get a better understanding of the opinions and needs of GPs in managing overweight and obesity in children. Next to GPs, also practice nurses (PNs) working in general practice could be involved in the management of overweight and obesity in children. Based on previous literature, a cooperation between GPs and PNs might be possible by expanding overweight management tasks to PNs [9,17,18]. However, little is known about their willingness and needs to play a role in this management. Furthermore, in order to manage overweight and obesity in children in general practice, it is crucial to explore the expectations and preferences of parents regarding the role of general practices in tackling overweight and obesity in children. Therefore, the primary aim of this study was to gather insights into the opinions, needs and preferences regarding the role of general practice in the management of overweight and obesity in children from the perspectives of GPs, PNs and parents. Methods Study design A qualitative study was set up to investigate opinions, needs and preferences about the role of general practice in the management of overweight and obesity in children. This was done from three perspectives: GPs, PNs and parents of children with and without overweight or obesity. Semi-structured focus-group interviews were conducted using an interview guide [Appendix 1A1-3, supplementary material]. The topics and o (...truncated)