Abstract
In Romania, one in four children has excess weight. Because childhood obesity is a sensitive topic, many healthcare professionals find it difficult to discuss children's excess weight with parents. This study aims to identify barriers and facilitators in childhood obesity-related communication, as perceived by healthcare professionals in Romania. As part of the STOP project, healthcare professionals (family physicians, pediatricians, and dieticians) who treat children with excess weight were invited to a telephone interview. The semi-structured questions were translated from a questionnaire previously used at the Swedish study site of the STOP project. Interviews were transcribed and then used for thematic analysis. Fifteen doctors and three dieticians (16 females and 2 males), with average 18.2 ± 10.1 years of experience, were interviewed. Four main themes were identified. Professionals reported that when children began experiencing obesity-related stigma or comorbidities, this became the tipping point of weight excess, where parents felt motivated to begin treatment. Barriers in communication were part of several layers of distrust, recognized as tension between professionals and caregivers due to conflicting beliefs about excess weight, as well as lack of trust in medical studies. Most respondents felt confident using models of good practice, consisting of a gentle approach and patient-centered care. Nonetheless, professionals noted systemic barriers due to a referral system and allocation of clinical time that hinder obesity treatment. They suggested that lack of specialized centers and inadequate education of healthcare professional conveys the system does not prioritize obesity treatment and prevention. The interviewed Romanian doctors and dieticians identified patient-centered care as key to treating children with obesity and building trust with their caregivers. Howevertheir efforts are hindered by healthcare system barriers, including the lack of specialized centers, training, and a referral system. The findings therefore suggest that, to improve childhood obesity prevention and treatment, systemic barriers should be addressed.Trial Registration: ClinicalTrials.gov, NCT03800823; 11 Jan 2019.
Highlights
Excess weight in children is prevalent worldwide
This study presents the first analysis of barriers and facilitators Romanian healthcare professionals face when communicating with and treating families of children with excess weight
All respondents underlined the need for a systemic approach, with childhood obesity prevention and intervention promoted by government policies, media, kindergartens and schools, family physicians, and general pediatricians. This is the first study in Romania and in Central/Eastern Europe to investigate the barriers and facilitators healthcare professionals face when communicating with and treating families of children with obesity
Summary
Plateauing trends were observed in many high-income countries in Europe, in medium and low-income countries childhood obesity prevalence has increased in the last decade [1]. In Romania, almost one in four children has overweight or obesity, as shown in a pooled analysis of more than 25,000 school age Romanian children [2] and the European Childhood Obesity Surveillance Initiative (COSI) [3]. Childhood obesity is recognized as a significant concern in the 2014–2020 Romanian National Health Strategy (HG, No.1028/18.11.2014) and efforts have been made to implement policies supporting healthy food and activities in the school setting. The Health Ministry’s strategy did not formally name the healthcare professionals who should treat childhood obesity; family physicians, general, and specialist pediatricians (endocrinologists and specialists in diabetes and metabolic diseases), together with dieticians, are key to childhood obesity treatment
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