Support family, quality of life and play when treating obesity in children and adolescents
Future clinical guidelines for treating obesity in children and teenagers should reflect contemporary research addressing quality of life, behaviour change and family-oriented treatments that support nutrition and play.
That’s according to a new study led by RSCI University of Medicine and Health Sciences, which highlights the need for clinical guidelines to incorporate new evidence about treatments – such as exercise therapy, sleep therapy, medications and surgery – and ways to address family poverty, deprivation, access to healthy food and safe places to play.
The research, published in the journal Frontiers in Nutrition examined the main recommendations from nine international guidelines for treating obesity in children and adolescents and is available as a free full text here
The current clinical guidelines for treating obesity in children and teenagers provide recommendations relating to evidence-based approaches to treating obesity in the early years of life.
The researchers say that further information and guidance is needed around how health professionals are trained to assess and treat child and adolescent obesity, optimal ways to address obesity-related stigma and bias, the use of clinical staging for obesity severity and how treatment success should be defined.
They also say that the existing guidelines lack recommendations related to managing limitations in physical fitness or to the transition of adolescents with obesity into adult healthcare services.
“Obesity is a chronic disease that is negatively affecting the physical and mental health of increasing numbers of children worldwide, and rates of obesity are increasing particularly quickly among young people from low-income households,”Dr Louise Tully, RCSI School of Physiotherapy
“We need to prioritise access to quality care for children who have health complications related to obesity in order to improve their quality of life and slow down or reverse breathing difficulties, joint pain, non-alcoholic fatty liver disease and early type 2 diabetes. Clinical guidelines exist to guide general practitioners (GPs) and other health and social care professionals on how to help children and their families, but to date no-one had looked at these guidelines in a systematic way.”
“For the first time in Ireland we are seeing direct investment in healthcare services for child and adolescent obesity through the HSE’s Obesity National Clinical Programme.Senior author on the study and Principal Investigator of the RCSI Obesity Research and Care Group, Dr Grace O’Malley highlights the timeliness of this work.
Our clinical guideline work will support health professionals and policy makers, ensuring the design and implementation of obesity services are guided by scientific evidence. Our work also identified clear gaps within existing clinical guidelines for childhood obesity and will help researchers to develop future studies with significant impact for children, families and the health system.”
The researchers systematically reviewed and analysed nine high-quality guidelines. They compared similarities and differences between these guidelines and recommendations, and identified gaps in the current evidence.
“We found that family-orientated treatments are recommended as the first steps of treatment for childhood obesity and that different approaches are needed as the child develops into an adolescent. Unfortunately, very little research to date has focused on the importance of adolescent health and the transition services required for adolescents moving from paediatric healthcare into adult healthcare,”
says Dr O’Malley, who holds a joint position at RCSI and Children’s Health Ireland Child and Adolescent Obesity Service.
“Treatment should address a number of different factors in the child’s life to support high-quality nutrition, child development, play, sleep and family dynamics while being delivered by a range of health professionals with training in obesity care.”
The study also identified that a greater emphasis is needed regarding managing complications of obesity, improving quality of life and addressing the practical or social barriers to care, such as food insecurity, limited cooking skills, inadequate housing, and access to safe, fun and age-appropriate active play.
‘Guidelines for Treating Child and Adolescent Obesity: A Systematic Review’ is published as an open access article in Frontiers in Nutrition.
This work will be shared through open access platforms, health professional networks, scientific associations, patient advocacy groups and with health policy makers in Ireland and across the world through our collaborators and stakeholders in obesity research, clinical practice, media and advocacy.
The study was a collaboration between RCSI University of Medicine and Health Sciences, Children’s Health Ireland, University College Dublin, St Vincent’s University Hospital, Dublin, St Columcille’s Hospital Weight Management Service, Loughlinstown, University of Limerick and University Hospital Limerick. The research received funding from the Department of Health – Sláintecare Integration Fund, the Health Research Board, and the HSE Health and Wellbeing Division.
RCSI School of Physiotherapy: Obesity Research and Care Group
Following two years of virtual only events, the 29th European Congress on Obesity (ECO) was a blended event with both online and attendance in person options in Maastricht, The Netherlands. The 4-day hybrid event was hosted by The European Association for the Study of Obesity (EASO) in conjunction with the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). The ECO provides a platform for individuals working in the field of obesity and those affected by obesity to convene, share insight, learn together and establish stronger relations across communities, organisations and countries worldwide.
Members of the RCSI Obesity Research and Care Group actively participated throughout the congress presenting the most recent developments in their work and chairing relevant sessions. Principal Investigator Dr. Grace O’Malley and Researcher Niamh Arthurs participated in policy workshops at ECO, contributing to insight and discussion on national plans for obesity and implementation from policy to practice.
Niamh Arthurs presented on behalf of the RCSI Group’s Sláintecare childhood obesity project in a guided poster presentation, that detailed the process involved in developing the online free and CPD accredited childhood obesity training programme for health professionals in Ireland.
Dr. Louise Tully, Post-doctoral Researcher in the RCSI Obesity Research and Care Group delivered an oral presentation on findings from an HRB-sponsored APA project addressing capacity building for childhood obesity management in the Irish health system. She outlined results of a systematic review on clinical practice guidelines for treating child and adolescent obesity. We were very proud of Dr. Tully who won the ‘The EASO Best Thesis Award 2022’ in a highly competitive process (Please read here). Following presentations from the top three scoring theses, Dr. Tully achieved this prestigious award from the EASO Early Career Network (Details here) for her RCSI StAR-funded Ph.D. on the use of digital healthcare for children with obesity. The use of digital healthcare and telemedicine is a topic of importance to health systems globally, particularly since the emergence of the COVID-19 pandemic. Dr. Tully specifically investigated user perspectives on barriers and facilitators for implementing paediatric telehealth, the role of mobile health (mHealth) in paediatric obesity management, healthcare utilisation costs for children with obesity and a cost analysis of delivering mHealth interventions compared to face-to-face care.
Dr. Maeve O’Brien Post-doctoral Researcher from the RCSI Obesity Research and Care Group presented details on the development of a communication toolkit for primary care health professionals working in childhood obesity management. This project is funded by EASO and is a collaboration with the RCSI SIM Centre for Simulation, Education and Research.
All of the conference presentations are published and represent ongoing work from the Group and other collaborators including public patient representatives.
Involving the lived experience was a pivotal feature of each day of the congress. The importance of people-first language was emphasised by delegates choosing to wear a green ribbon stating ‘I’m People First’ on their congress lanyard. In addition, the blinded abstract review process screened for the use of people-first language by submitting authors. Public-patient representatives were welcomed and actively involved in the congress as equal partners including the chairing of sessions, presenting, co-authors on posters and abstracts and as a powerful reminder that obesity affects real life and people.
ECO2022 closed with the announcement that the 30th European Congress on Obesity will be in Dublin from May 17th-20th 2023, Chaired by Dr. Grace O’Malley from RCSI Physiotherapy. Plans and preparations are already in place and after winning this bid as the host country, The Association for the Study of Obesity on the Island of Ireland (ASOI) will ensure ‘céad míle fáilte’ (a hundred thousand welcomes) to all who attend ECO2023.
The LANDSCAPE study team want to hear from healthcare professionals and managers in Ireland who see children and adolescents in their daily practice
The Royal College of Surgeons in Ireland (RCSI University of Medicine and Health Sciences) in collaboration with the Health Service Executive (HSE), are recruiting health professionals and managers from all disciplines, who work in Ireland, to complete an online survey and/or take part in an online focus group on current childhood obesity treatment services in Ireland.
Aims and further details
The aim of this work is to map currently available services and practices in relation to caring for children with obesity and their complications. It is envisaged that this will help develop an understanding of how these services and practices may differ across the country and in various settings in Ireland. It may also provide valuable insight on the potential barriers and enablers for the provision of obesity treatment services in Ireland and identifying the supports needed.
The online survey takes approximately 15-25 minutes to complete, depending on the level to which the health professional or healthcare manager cares for children and adolescents with obesity in their daily practice, either for weight management specifically or for treatment of other conditions. Survey participants will also have the opportunity to add any information that they feel is important and the opportunity to express an interest in participating in a focus group which is also part of this project. Please see further details on the LANDSCAPE focus groups via the participant information sheet available here.
Please access the survey here
For the next part of this study, we will later be undertaking focus groups with healthcare professionals also. You can register your interest for the online focus groups here. These are open to all health professionals and managers, including those who complete the survey or not.
All views and participation will be greatly appreciated. Participants can choose to take part in both the survey and focus group or just one of these options.
This work and its analysis will be completely anonymous.
Obesity in children
Nearly 20% of children in Ireland are living with overweight or obesity1 with 7% estimated to have obesity2 and 1.5% estimated to have severe obesity3. When children develop obesity they can have difficulties with their physical and mental health including: high blood pressure; painful joints; breathing difficulties; anxiety and early development of other diseases.
International health research4 and clinical guidelines5 recommend that children with obesity are offered treatment early in their life in an effort to reduce health complications and the risk of future disease. Evidence based treatment should be available to children in their community and in children’s hospitals depending on the severity of their obesity.
In Ireland we do not know whether children with obesity can get treatment and if they can, where treatment is offered, what it involves and how children and their parents feel about the treatment they receive. We also do not know what health professionals believe is important for their local context in order to offer quality treatment for childhood obesity.
Previous related work
In 2020 the Obesity Research and Care Group at RCSI conducted the Sláintecare needs assessment survey among healthcare professionals in Ireland which related to the provision of health professional training and education for childhood obesity. The Childhood Obesity LANDSCAPE Project follows on from that work with the aim of furthering knowledge on factors that can facilitate or hamper the provision and access to treatment services for children and adolescents with obesity. Completing this survey and taking part in this focus group will enable our research group to delve deeper into the experiences and insights of health professionals and healthcare managers so that services can be improved in an informed and collaborative manner.
The Childhood Obesity LANDSCAPE Project has been funded by the Health Research Board of Ireland’s Applied Partnership Award and the Health Service Executive. Dr Grace O’Malley, RCSI is the principal investigator, and Sarah O’Brien, HSE is the lead knowledge user.
For further information in relation to this survey, please see the Survey Participant Information Sheet available here
For further information in relation to this focus group, please complete the Focus Group Expression of Interest Form available here and the Focus Group Participant Information Sheet available here. If you leave your contact information and consent to being invited, you will be provided with more information about this part of the project in due course.
1Mitchell L, Bel-Serrat S, Stanley I, Hegarty T, McCann L, Mehegan J, Murrin C, Heinen M, Kelleher C. (2020). The Childhood Obesity Surveillance Initiative (COSI) in the Republic of Ireland – Findings from 2018 and 2019.
2Layte R, McCrory C. Growing Up in Ireland – National Longitudinal Study of Children: Overweight and Obesity Among 9-Year-Olds. Dublin, Stationery Office; November 2011.
3Bel Serrat S, Heinen MM, O’Malley G, Mehegan J, Murrin C, Kelleher CK. Trends in the prevalence of childhood obesity and morbid obesity in the Republic of Ireland – The Childhood Obesity Surveillance Initiative in 2008, 2010, 2012 and 2015. Obesity Facts 2018;11(Suppl 1):43. DOI:10.1159/000497797.
4Ells, L.J., Rees, K., Brown, T. et al. Interventions for treating children and adolescents with overweight and obesity: an overview of Cochrane reviews. Int J Obes 2018;42, 1823–1833. https://doi.org/10.1038/s41366-018-0230-y.
5National Clinical Guideline Centre (UK). Obesity: Identification, Assessment and Management of Overweight and Obesity in Children, Young People and Adults. NICE clinical guidance 189. London: National Institute for Health and Care Excellence (UK); November 2014.