Approximately 3 in 10 children aged 2–15 years are overweight or obese. This is concerning because weight problems in childhood often continue into adulthood. NICE guidance states that healthcare professionals should ‘aim to create a supportive environment that helps a child who is overweight or who has obesity, and their family, make lifestyle changes’.
Determine the prevalence of obesity amongst paediatric outpatients
Audit practice against NICE guidance
Collect qualitative data on clinician attitudes towards obesity
Methods This prospective audit assessed the weight, BMI, ethnicity and outcome of patients presenting to the paediatric outpatients department (POD) over a 10 week period. Patients were audited from all clinical specialities using the POD.
Overweight and obese children were identified as having a weight above the 91st and 98th centiles respectively and underweight children a BMI below the 0.4th centile on the appropriate RCPCH Body Mass Index (BMI) charts and growth charts. The only exclusion criteria were children under 2 and over 16 years of age. Qualitative data was collected via structured interviews with clinicians working in the POD.
Results 569 children were audited of which 407 met the inclusion criteria. The cohort’s demographics were as expected for the area. The prevalence of overweight and obese children from this cohort was 14% and 11% respectively. Of those identified as either overweight or obese only 2% and 34% respectively were offered an intervention. Interventions included; advice, investigations, or referral. Interestingly all underweight children were investigated and given follow up support. Qualitative data from structured interviews demonstrated that clinicians were aware of obesity as a health issue but failed to act for a variety of reasons including a lack of time and for fear of damaging the doctor-patient relationship.
Analysis Clinicians are not complying with NICE guidelines for a range of reasons including; time constraints, a lack of training and concerns over damaging the doctor-patient relationship. We are currently training an obesity nurse specialist to support clinicians during outpatient clinics and to offer additional training and educational support with a view to changing clinician attitudes towards obesity.
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