Development of an evidence-based intervention for the treatment of overweight and obese children in general practice

Abstract

Treatment for overweight and obese children is complex, and intervention in general practice may be an important addition to the portfolio of effective interventions. However, effective strategies for Australian general practice have not been identified. The aim of this project was to develop an evidence-based intervention for the treatment of overweight and obese children which has the potential to be both effective and feasible when delivered in the Australian general practice setting. The first phase of the project was to conduct a systematic review of the evidence for interventions to treat overweight or obese children in either a primary care setting or with the involvement of a primary care health professional. Seventeen studies were identified. Comparison of the twelve studies that reported at least one significant intervention effect, provided evidence that effective interventions involved one or more of the following components: health professional training; dietary, activity or sedentary behaviour change; and affected behaviour change via a combination of counselling, education, written resources, support and motivation. A potential intervention model, named the Healthykids 4 life program, was developed using: the evidence-based components identified by the systematic review, strategies to mitigate known barriers (to increase feasibility), other evidence to fill knowledge gaps, and behaviour change theory. The feasibility of implementing the Healthykids 4 life program was pilot tested in Wagga Wagga, NSW, with eight practice nurses in four general practices. Adoption of the program was high, and participating practice nurses found the stages acceptable and displayed a high level of willingness to deliver the program. However, a combination of intrinsic and extrinsic barriers prevented some practice nurses from delivering two essential components (identification of eligible families and family recruitment). Therefore, effective implementation requires additional support at the practitioner, practice and systems levels. In conclusion, the systematic review provided strong evidence that intervention in general practice has the potential to be effective, when measured using a variety of outcomes. However, until barriers to implementation are addressed, it will not be feasible for practice nurses to implement all essential components of this evidence-based intervention developed to treat overweight or obese children in general practice.