Earlier this year, The Lancet published a six-part series on the obesity epidemic, recommended several changes, including improved training of health care professionals, especially in the areas of counteracting bias and improving care-delivery strategies. It is sad but true that many health professionals have their own issues around weight and obesity, and sometimes patients are the ones who suffer for it.
Efforts toward change are being made. For instance, Elizabeth Harrington reported on a program sponsored by the National Institutes of Health (NIH) that will allow doctors to “virtual role play” and practice creating effective rapport with overweight and obese children. The program’s documentation says:
Even brief advice delivered well can have a meaningful impact, and yet, health care providers indicate that lack of efficacy and skill, impact, patient motivation, and educational materials keep them from routinely addressing obesity prevention and treatment in their practices.
The curriculum was developed by SiMmersion, a company that specializes in communications training. Participating doctors will talk with virtual actors, and little animated characters on the screen will “thumbs-up” them when the conversational flow is going well. There are three different scenarios to role-play: voicing concern about a child’s weight to a parent; speaking with the child about making healthy choices; and scheduling the follow-up appointments.
In January it was announced that, thanks to a government grant amounting to nearly half a million dollars, the program would be tried out by 100 different health care providers in the Minneapolis-Saint Paul region of Minnesota. Apparently it has not gotten off the ground yet, as the SiMmersion website makes no mention. The NIH has already paid the company pretty close to a million dollars each for programs that teach doctors how to talk to alcoholics and prescription drug abusers.
A Childhood Obesity Starter Kit
Elsewhere in the U.S., Healthy Jacksonville’s Childhood Obesity Prevention Coalition is offering a childhood obesity “starter kit” for primary care physicians. Among the several elements is an article from the American Academy of Pediatrics on the pediatrician’s role. It recommends, among other things, that children’s doctors should familiarize themselves with the cultural, socioeconomic, racial and ethnic groups their patients belong to, so they can recognize and empathize with the challenges that each child faces—especially when there are environmental determinants of obesity that can’t be controlled. As they put it:
An interactive, responsive dialog between pediatricians and families and children is important to help families move toward lifestyle change. The AAP Change Talk website, which includes training in motivational interviewing, may be used for primary care providers.
Healthy Jacksonville also offers a comprehensive plan for the management and treatment of overweight or obese children. It urges adopting an “empathic counseling style” to empower the patient and family to make changes in their lifestyles and behaviors. There is an “Encounter Documentation Tool” to record the details of the patient’s history and current condition. It indicates the special things to look for, such as difficulty in breathing, stretch marks, early onset of puberty, knee pain, and other conditions that particularly afflict the obese.
One section offers a brief introduction to motivational interviewing, along with some hints for opening the dialogue. For instance:
Always ask for permission to discuss nutrition, exercise, healthy eating, etc… Use open-ended questions to initiate conversation.
Another suggestion highlights the importance of encouraging patients to set their own goals, because to do otherwise is useless, especially if the clinician takes an aggressive attitude.