Health Professionals in management of Adolescent and Child Obesity

Introduction

Obesity is becoming a complex problem that is leaving health scientists to lag behind in dealing with it. Although analysts agree that genetic factors may be responsible, a combination of metabolic, hormonal and behavioral factors may be contributing a lot. According to Harvard School of Public Health (2013), it has become difficult for doctors to figure out why individuals may be accumulating a lot of fats. Although nations have establishes that the rate of this condition in their country is relatively increasing, the US prevalence one has dramatically become the highest. As analysts note, the American obesity prevalence has increased dramatically over the last forty years by 50%. This has also been accompanied by related diseases such as heart, diabetes and hypertension diseases as the closest consequence of the condition. However, there have also been increases in depression, fatty liver diseases, arthritis, cancer and erectile dysfunction. All said, overweight conditions and obesity has accounted for nearly 10% of all causes of deaths as they drain American society an amount of $223 billion a year (MSN. (2013).

To combat this problem, it is essential that the American society have health professionals with right skills, training and attitudes with no barriers to perform their roles as they engage various stakeholders such as parents and their families in tackling this issue. This is because they are needed to give accurate information and guidance to them so that an adolescent or a child’s health improves. Therefore, the high prevalence rate that is increasing, calls for both short term and long-term actions. In this case, the nation and the community are called upon to invest in the clinical services that involve assessing, treating and preventing the disease. Although issues about obesity have been talked very much, little attention has been given to the health care professionals that are involved (National Institute of Health (US), 2013; Perrin et al., 2005). Therefore, this study will assert itself on why the community needs health care professionals that are well skilled, trained and have the right attitudes towards the child and adolescent. The study will also look at barriers that may make the work of these professional to be difficult so that appropriate measures in training can be taken to overcome them and meet the needs of American child.

Purpose of the Study

1. This study seeks to identify the preferred skills and level of training that various health professionals should have.
2. It also seeks to look at various attitudes the health practitioners should embody to manage their work properly.
3. The article will identify various barriers the practitioners might meet in their professional course and try to illustrate how they can be broken.
4. Additionally, the report will advance various sources of information that can be useful to the health practitioners.
5. Lastly, the study will examine whether there are differences in groups of professionals as regarding barriers, attitudes, training and skills. If they existed, the study will dig further to realize whether this comes because of health practitioners’ own weight status, gender and year of practice.

Literature Review

Importance of Training And Training In Preventing Obesity

According to CDC (2013), the role of training is essential for anyone who wants to work in health industry. The practitioner then will appreciate the role of health literacy and enable him dispatch his services successfully. Training will also enhance someone to communicate effectively with patients. When they communicate very well with their clients, it is evident that barriers with their patients will be reduced. For instance, poor communication that might have hindered the patient from not properly taking medicine will obviously be overcome(Boozeman, 2013).

According to European Respiratory Roadmap (2013), currently the world is changing very fast in technology and therefore for anyone to interact with him or her, he must keep pace with the new technology. Moreover, as the demands of health care systems are increasing so, too the training should also increase to cope up with the pace. In fact, customers already have the information about the quality of medication they should expect, which puts the health practitioner at a critical position to learn more (European Respiratory Roadmap 2013; Perrin, et al.2005).

According to the Royal College of Physicians (2010), as a nutrition and dietetic professional, his role will include caring for patients, promoting and supporting self-care and self-reliance. This demands that he understands fundamentals of nutrition and Diatec science and psychological, environmental, social, physical activities that underpin clinical practices and especially obesity. As the number of obese people in United States keeps on rising, medical practitioners should be available to keep pace with the increasing demand for medication. For instance nearly in every formal profession, there are obese people and the number is projected to increase. As the problem of those with this condition keep on increasing, the community will have to identify individuals from these groups that will be skilled to start the first level of management (New South Wales Government, 2013). Putting in mind that the program will need to treat the already suffering people from the condition and incorporate any program that will be needed to address the issue, the professionals will need skills to do this. Importantly, health care professionals are regarded by the public as holding very authoritative information that relate with health, nutrition and food and therefore patient’s self-care in general (New South Wales Government, 2013). This calls for them to keep on updating themselves with contemporary information on healthy lives and healthy weight so that there is consistency in their key messages about food and proposed physical activities. By doing this, he will be in a position whereby he can motivate individuals and their families to reverse their obese and overweight behaviors. This will also require that he understands the factors influencing changes in food eating habits so that when proposing any move that could make them shift their habit it should be sustainable for health gains (Boozeman, 2013).

As National Institute of Health (US)(2013) puts it, it is expected, professionals in this field will be interacting with various stakeholders that include primary care and health professionals, public health and strategic planners; it is important that they develop advisory skills. At organizational level, a health care professional is encouraged to contribute to initiate programs that are aimed at maintaining healthy weight and treatment of children and adolescent problems (New South Wales Government, 2013). This aspect can be included in their training program. By the training, the health care professionals will have to appreciate the need to cut the rising costs of treating obesity that hurts the economy. Therefore they will be aware that preventing and managing effectively excessive fats of the body will promote the long-term goal of cost saving. Additionally, by training, it will enable a health officer acknowledge his own effects of maintaining healthy weight or increasing the weight when meeting patients. They will also need to be educated so that they discuss issues that are related to sensitive social changes like religion and so forth.

On Attitudes

Studies have shown that skills alone cannot lead a health practitioner to change behaviors of the patient. This implies that the health care practitioner should espouse good attitudes towards the clients so that he becomes more assertive in supporting patients and their families in changing behaviors. Since attitudes come from one’s financial, social and cultural situations, it may be difficult to change. However when the health officer manages to change his behaviors he will have a big impact on obesity. Therefore, good attitudes will always be needful in motivating the client (National Institute of Health (US), 2013). . Barriers to Health Practitioners Meeting the Needs of Customers

Mauro et al.(2008) note that individuals gain weight during certain seasons, which may be hard to determine how such individuals may be assisted. Nevertheless, it is hard for these people to believe in the actual effects of such overweight. However, for those who are aware about themselves, they would prefer short remedies such as surgery and drug use to cut their fat. The recent escalation in heavy weight and obesity has resulted from the complex social life style. For instance due to hard ship, individuals are expected to remain for a long time in their offices to sustain themselves. In this regard, there have been changes in eating habits where they have been eating fast foods that have a lot of fats while at the same time having little time to do exercises (Perrin, et al., 2005).

Ignorance or poor understanding about obesity hazards have made combating this condition very hard. For instance, while many people are aware about healthy eating habits and living, they are in most cases, unaware how these are applicable in the normal life. As sometimes, some eating habits may be temporary, the public would like to run have some cosmetic gains. The other barrier to combating the problem is some people’s cultural set up. Since culture dictates nearly every aspect of one’s life, it will be hard for the client to accept. In certain cultural embeddings, obesity is believed to be healthier status, which could be a barrier to prevention programs change (Clinical Trials. gov., 2012). According to Whitaker, the fight against the condition is multifaceted, and it is hard to ensure that every stakeholder participates optimally to ensure goals are met. For instance, the school and home may provide meals that are full of fats (News Centre, 2010). Additionally adults, apart from their own problems, need to be emotionally engaged. There are also negative perceptions and attitudes towards the doctors and other anti-obesity campaigners. Some members of the public believe that the campaign may be stigmatizing their physical status; mocking them because they are overweight (Puhl, Peterson and Luedicke, 2012).

Research questions

In order to meet the Objective of this study, researchers sought to answer the following questions:

• What are common attitudes manifested by health practitioners and the community at large towards dealing with adolescent and child obesity?
• What are the perceived barriers that are manifested in the treatment of overweight adolescents and children?
• What level of training and skills is appropriate for the management of the condition?
• What are the relationship between the differences in attitudes, skill levels and barriers and the three professional groups in fighting the conditions?

Methods of Data Collection

The study employed survey questionnaires, with sample size being determined according to the rules of Hill (1998). The questionnaires were then mailed to every member of a randomly selected sample of 1652 people from the American Dietetic Association, 1088 people from the National American of Pediatrics and the remaining 879 members from the National Association of Pediatric Nurse Practitioners. The response rates were as follows 27%, 19% and 33% respectively. In designing of the survey questionnaire, the information in it was derived from the literature review, clinicians dealing with youth obesity and other experts representing various disciplines of obesity. Measurement

On attitudes, practitioners were given eight attitudinal statements to answer. The responses were rated as ‘most of the time’, ‘often’, ‘sometimes’, ‘rarely’ or ‘never’. On barriers, the respondents were presented with nine barriers and asked how each response contributed to the effectiveness of the treatment. Their responses were rated as same as those on attitude scales. On the perceived needed skills, respondents were asked to answer 7 areas where their responses were rated on a 3point Linkert scale that has ‘low’, ‘moderate’, and ‘high’ proficiency levels. The survey also espoused two questions that are frequently asked in the assessment and treatment of obesity. Nevertheless, respondents were also asked about demographic characteristics in their areas of practice.

Data Analysis

The data collected was performed using the SAS statistical package. Each professional group had its own frequency distribution variables treated separately. To analyze the variances of the groups the χ2 measure was used which enabled to determine the relationship among various interest levels by the variables analyzed from each professional groups.

Results

Attitudes

Majority of the respondents in all of the professional groups agreed with feelings that childhood obesity was a problem that needed urgent treatment. The 75%- 93% felt that it was a very risky condition that needed urgent address. Participants represented by 76%-89% responded by taking it as a chronic disease that was becoming very risky. 83%-93% of them believed that it will deteriorate the future quality of life .However, less than 10% of the respondents felt that adolescent children would in future outgrow to be obese. 50% of the participants indicated that adolescents and children were more amenable to health facilities to treatment than their counterparts were. Differences at significance levels were clearly indicated in Registered Dietitian (RDs) group than in Registered Nurse Practitioners (RNPs). For RDs, they were less likely to agree with statements about the need for treatment measures and health outcomes of the obesity.

Findings

While answering questions on the most frequent barriers, all respondents took it generally as lack of parental involvement, low parental motivation and lack of support services from other stakeholders in the community. More than half of RNPs and pediatricians and a third of RDs, found treatment futility as the main barrier of most of the time. On clinical side, time was said to be the major barrier for about 60% of clinicians. Generally, RNPs or pediatricians identified more barriers to the problems than RDs.

Interest in Training and Skill Level

In this domain, most respondents perceived themselves as proficiently low in techniques that enhance parental guidance, strategies for behavioral management and addressing family conflicts. RDs did not cite themselves very much as being low proficient in behavioral management, but did it more in identifying family conflicts guiding parents in parenting techniques. However all groups expressed high interest and optimism to add some training in all areas of skills. Over half of the participants expressed that they were in dire need of training in parenting techniques and behavioral management

.Information Sources

On disseminating information that was relevant for their treatment, across all professional bodies, everybody preferred professional guidelines, at more than 95%, which was followed closely by both national and local meetings at 95%. Telephone conferences at 28% were the least preferred method.

Discussion

In any American community, the urgent discussion in addressing health issues should be geared towards the epidemic of obesity. Revelation from Literature review and research findings indicates that to reverse the current rising prevalence of child obesity, it will have to be a multifaceted intervention. All stakeholders including schools, health care settings, communities and the environment would have a very critical role to play to prevent and treat the condition. Pediatric practitioners consider adolescent and child obesity as a concern whose intervention is of much importance. However, as discussed, there are various barriers to implement these. Practitioners lack counseling related skills that are needed to manage obesity effectively. The barriers therefore should form the directions that the next training curricula should encompass. Prominently, the barriers advanced were patients’ lack of motivation, support services and low or lack of family involvement. Other studies have also noted that among the key barriers is the financial funding of the program. They assert that not unless insurance companies change their policies, for the managed care programs, the degree of obesity is likely to increase (Perrin et al., 2005). When the practitioners espouse high degree of motivation, they will enhance self-amanagement behaviors such as changed eating habits and readiness to do exercise. The techniques the health practitioners should have are the behavioral self-management, motivational interviewing, brief negotiation, tailored messages, motivational interviewing, change counseling and so forth. However, as a matter of increasing efficiency in the above techniques, subsequent researches will have to be done.

As already noted, in general, the Registered Dietitians have shown some differences in the whole approach as regards to skills and training, barriers and attitudes. They seemed more optimistic by going with current treatments than proposing the need of new treatments. For them, they perceived fewer treatment barriers and were confident in their skills of assessing body weight and behavioral management

.Conclusion and Recommendations

The discussion has shown that majority of practitioners view the issue of child obesity as a problem whose effective treatment is very much important. However, they have also advanced some barriers to the effective treatment and prevention of the issue. The barriers therefore has formed a very important inquiry into the kind of curriculum that can be designed in training so that to overcome them. However as the study has shown, although the participants noted their training needs as being the weakest point in patients behavioral management, they have expressed optimism in training to be perfect. Some of the barriers, apart from being directly related to the health practitioners themselves, they are multifaceted. Therefore, this will call for family, national and local community authorities to get involved in solving the problem. This also calls for the current instructional heads of curricula to consider incorporating the needed components to meet these objectives.

Although the results in this study have tried to identify issues that the community need to address as concerns the child’s health care, especially in obesity, the low response rate experienced could lower its validity and therefore may limit its generalizations. As seen, those individuals who were not influenced with additional training or positive attitudes towards the issue of preventing child obesity did not respond adequately. Extensive length of the questionnaire might also have contributed to the low response rate. Therefore, additional researches need to care about these areas.