How can families set priorities in pediatric weight management?

Today’s post comes from Maryam Kebbe. Maryam is a PhD Student, Department of Pediatrics, Faculty of Medicine & Dentistry, University of Alberta


The Canadian Obesity Network lends access to a wide variety of clinical tools and resources, including Conversation Cards© (CCs). Developed in 2012 via a process of knowledge synthesis and qualitative data, this tool comprises a deck of 44 cards. Each card contains an individual statement pertaining to a challenge or enabler faced in weight management. The cards are organized across six categorical suits:

  1. Communication
  2. Interpersonal relationships
  3. Nutrition
  4. Parenting
  5. Physical activity
  6. Weight management

Prior to families’ initial clinical appointment, CCs are presented by clinic or research staff as an icebreaker activity. Families are instructed to select their top priorities as reflected by the cards, and document them on a one-page chart note. This page is then inserted into children’s medical records and serves as a resource for clinicians to identify families’ preferred areas of change.

Recently, we published a retrospective medical record review on CCs in the Journal of Nutrition Education and Behavior in pediatric weight management since the time of their integration at the Pediatric Centre for Weight and Health (Edmonton, AB); press release and podcast can be accessed here for more information. Through this study, we aimed to describe families’ selections of CCs and examine CC-related differences based on families’ characteristics.

We retrieved a total of 146 children’s medical records. This represented around 50% of the families who visited the clinic during 2012 – 2016, indicating that CCs can be integrated in this setting. Families were not restricted by the number of cards that they could select; on average, families selected 10 ± 6 cards, with a relatively equal proportion of cards selected across suits. We found that cards indicating less healthy eating behaviors (p = 0.001) and physical activity (p = 0.002) were chosen more for teens (vs children) and that goal-setting was perceived to be a motivator across several sociodemographic characteristics, including having a higher level of education and a lower household income (p < 0.05).

The top 5 most frequently selected CCs included:

  1. “I am ready to make healthy changes” (n=73; 50%)
  2. “I think it’s good for my child to be involved in discussions” (n=61; 42%)
  3. “It is important for my child to share his/her thoughts” (n=59; 40%)
  4. “I would like to learn how to make healthy foods fun” (n=57; 39%)
  5. “I would like a specially-trained fitness instructor to work with my child” (n= 56; 38%)

These card selections spanned families’ motivation, patient engagement, and healthy behaviors. The fact that not all families were universally motivated to participate in care highlights the importance of incorporating effective strategies (e.g., goal-setting, motivational interviewing) to help more families reach that stage.

Families presenting to multidisciplinary pediatric weight management reported a variety of issues that can make it easier or more difficult to make healthy changes. Our study suggests that CCs can be used by families to set priorities that clinicians can subsequently help attend to on an individualized level.

Allana

I have a PhD in population health from the University of Ottawa looking at why children are sedentary, the difference between types of sedentary behaviour (as you’d expect screen time is much worse than reading a book!) and what we can do about it in Canada, and around the world. I completed my master’s at Queen’s University in kinesiology and epidemiology, and graduated from Acadia University with a double major in biology and kinesiology. I am also a Certified Exercise Physiologist with the Canadian Society for Exercise Physiology, a Clinical Exercise Specialist with the American College of Sports Medicine and a Physical Activity in Public Health Specialist with the American College of Sports Medicine/National Physical Activity Society. I love to be active, especially when I get to be outside and especially when I get to explore a new city!