NHD clinical -
- case study
by Natalie Mohamdee Paediatric Dietitian
Childhood obesity
Obesity in children is becoming more common and is sometimes referred to as ‘a ticking time bomb’ of disease. Over the last two centuries, the rate of childhood obesity has gathered momentum and rates are currently at their highest.
With rising trends in obesity, comes increased cost to the fu- ture generation as well as to the NHS. The estimated cost to the NHS for obesity and related illnesses was £4.2 billion in 2007. This is set to rise to £6.3 billion in 2015 if no action is taken. However, the cost to a person is not monetary, but to long-term health. This growing problem needs to be halted and reversed to ensure a healthy happy future for children. This is where the paediatric dietitian comes in. I currently work with a team that is tackling childhood obe- sity in North Tyneside. We have been running a weight man- agement programme (families attend for 10 weeks) to edu- cate children and their families to become fitter and healthier. During my time working with the team, I have seen that some families have problems that cannot be addressed in the club setting and require some one-to-one work. Here I highlight one such family: Amy and her Mum are a family of two. Amy was 10 years old when they came to see me, weight 70kg (above 99.6th centile), height 149cm (91st to 98th centile), BMI 31.5kg/m2 (above 99.6th centile).
Attendance at club was only 40 percent despite phone calls to remind them of club time/dates and Amy attended the club alone one week as Mum was busy. They live in a neigh- bourhood renewal scheme area, where Mum is unemployed, seeks benefits and Amy gets a taxi to school. Mum had barriers to change and gaps in her knowledge of healthy living. Amy was willing to be involved in all activities despite Mum not always being willing to support her. Amy liked walking/playing, swimming, playing all games and was doing well at school.
Parents are key
Before meeting with Amy and Mum, I had to consider why club hadn’t been a success for this family. Mum is not always keen to be involved in the treatment of Amy. This may be due to her own lack of support, lack of childcare, lack of education in health, denial that her and her child’s weight is a problem, fear of tackling the problem and lack of foresight into how the problem can be addressed. Parents are key to their children’s success. The outcome for the child will be greatly improved if the parents are involved and are motivated to make changes to their lifestyle at home. The family environment can contrib- ute to the development of obesity and parenting styles may influence the development of food preference and the ability to regulate intake. Therefore the involvement of the parents in change at home is essential.
Following these thoughts, I first met with Mum alone. I worked with Mum and I arranged for Amy to be involved in a children’s activity. I met with Mum after she had dropped Amy to the activ- ity. During my first session, the following was covered:
• Consequences of obesity for Mum and Amy to promote willingness to change
NHDmag.com Aug/Sept '10 - issue 57
Natalie Mohamdee is a Paediatric Dietitian working for the Northumbria Healthcare Foundation NHS Trust in a split role. She works both in the clinical setting and in the community tackling childhood obesity.
• The evidence that shows family involvement is key to success
• My weekly involvement and discussion points, allow- ing Mum to alter what is covered in the sessions so she could feel comfortable and could add anything if required
• Offering my support to make sure Mum was aware that I would be there to guide change, but both sides need to give equal effort to get good results
• Discussion of Amy’s height, weight and BMI and show Mum the growth chart. Discuss how Amy can ‘grow’ into her weight and therefore weight maintenance is acceptable, but gradual weight loss is ideal
• Discuss the need for dietary change as well as in- creased physical activity
• Written information given to support everything covered in the session
As it was our first meeting, I proposed a goal (but encour- aged the family to choose their own goals in the future), to do an activity together before the next meeting i.e. exercise DVD, walk in the park, home cooking etc. Amy was to be involved in all future sessions, so the family could work as a team.
After our first meeting, Mum and Amy seemed to have in- creased motivation and I felt that Mum’s attitude had changed and she wanted to use my help in the best way that she could. They had been to the park together twice in the week since we had first met and Amy really liked spending time with her Mum.
Home visit
The family did attend the ‘Eatwell plate’ session during club, but I was unsure how much of the information had been used to change habits at home. I completed a home visit and I did an update session using a large Eatwell plate mat and replica foods to make a game of learning the foods groups.
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