School nurses’ experiences and challenges of working with childhood obesity in Northern Sweden: A qualitative descriptive study

Helene Johansson,Jennifer Gothilander

doi:10.1177/20571585211044698

Helene Johansson, Jennifer Gothilander

Open Access

https://doi.org/10.1177/20571585211044698

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Abstract

Childhood obesity is increasing in Sweden. All children are offered regularly spread health visits to a school nurse. As health visits include a measure of height and weight and a health dialogue, school nurses can discover, disclose, and treat a child's weight gain. The aim of this study was to describe school nurses’ experiences and challenges in working with childhood obesity. This qualitative study collected data through focus-group discussion and semi-structured interviews with ten female school nurses from six municipalities. Data were analysed inductively using manifest qualitative content analysis. The study was reported using the COREQ guidelines. Stigmatization and lack of resources are major challenges for school nurses working with childhood obesity, and they experience frustration, powerlessness and feel that they provide unequal treatment. The present study concludes that obesity stigmatization is a widespread challenge for school nurses. They cannot alone generate all the resources needed or conquer all challenges. Evidence-based guidelines, increased knowledge, time for reflections and peer support could potentially empower school nurses, reduce frustration, and improve the quality of and equality in childhood obesity treatment.

Highlights

Obesity is a disease defined as ‘abnormal or excessive fat accumulation that presents a risk to health’ and childhood obesity is associated with an increased risk of mortality in early adulthood.[1,2] It is a strong predictor of obesity, diabetes, cardiovascular disease, and musculoskeletal pain in adulthood.[1,3] In Sweden, the proportion of 11–15-year-olds who are overweight or obese is 9–20%; a figure which has doubled since the 1990s.4 The prevalence of overweight and obesity in children aged 6–9 years has been reported to be 24%.5The World Health Organization classifies obesity as a preventable disease.[6]
Two major challenges were identified as the categories Access to and use of impactful resources and Stigmatization in addition to the two categories Frustration and powerlessness and Unequal treatment describing experiences of school nurses’ work with childhood obesity
The main findings are that obesity stigmatization, along with the absence of useful resources such as collaboration, time, and guidelines, are major challenges

Summary

Introduction

Obesity is a disease defined as ‘abnormal or excessive fat accumulation that presents a risk to health’ and childhood obesity is associated with an increased risk of mortality in early adulthood.[1,2] It is a strong predictor of obesity, diabetes, cardiovascular disease, and musculoskeletal pain in adulthood.[1,3] In Sweden, the proportion of 11–15-year-olds who are overweight or obese is 9–20%; a figure which has doubled since the 1990s.4. The World Health Organization classifies obesity as a preventable disease.[6] Systematic reviews of lifestyle treatment for childhood obesity conclude that a multi-component lifestyle treatment could have a small, short-term effect in decreasing body mass index (BMI) in children aged 6–11 years, but the evidence is of low or very low quality.[7] For children aged 12–

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