The role of nurses in General Practice in preventing children with obesity

Author: 
Associate Professor Elizabeth Denney-Wilson

Written by Associate Professor Elizabeth Denney-Wilson, COMPaRE-PHC Investigator and Associate Professor at Faculty of Health at the University of Technology.

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Children with overweight and obesity are seen frequently in primary care and it is crucial that nurses be able to identify and intervene with parents to prevent ongoing excess weight gain.  Previous studies 1,2  have indicated that with additional training and support nurses can have an impact on unhealthy weight gain in children but little work has been done in Australia to enable them to contribute to obesity prevention efforts.  Our own research suggests that nurses in general practice want to be involved in preventive care and welcome additional training around children with obesity; and that a brief training workshop can facilitate obesity prevention being incorporated into a child health check.

In Australia, general practices are increasingly employing practice nurses (PNs), who are usually Registered Nurses with bachelor degree qualifications.   In 2005, approximately 4,000 PNs were employed in general practices – representing approximately 58% of practices. Data from 2010-11 suggest that over 10,000 nurses are now employed in general practice, with a key responsibility being the prevention of chronic disease and early intervention.  A recent systematic review suggested that within the Australian primary care context, broadening the roles of PNs to include initial screening, follow-up, parental guidance, communication and support represents a promising approach to prevent unhealthy weight gain in children.  Medicare item numbers and block payments to practices have enabled an expansion of the PN role to include preventive care and health checks. One preventive care item, the Healthy Kids Check (HKC) has been available since 2008, and has recently been revised and is available to children aged 3-5.  This health check can be delivered by a doctor or a nurse and includes measurement of height and weight and plotting BMI; however discussion of eating habits or activity is “optional”.  This visit provides an ideal opportunity to promote behaviours that promote healthy weight gain prior to a child starting school.

Two international studies have considered the capacity of the nurses to impact on unhealthy weight gain in children:  nurses who were trained in motivational interviewing in a Swedish study reported it to be a useful technique in the management of overweight in children 5.  A pilot study of a nurse-led intervention in the United States found that a brief intervention to increase the proportion of children with BMI measured and receiving counselling around dietary and activity habits was effective in changing parental intention regarding feeding practices. 

It is not clear whether a brief intervention by PNs can influence parental knowledge and actions around behaviours that may contribute to unhealthy weight gain.  However the frequency of visits by children to primary care and therefore the capacity of PNs to deliver brief interventions frequently may be important.  Findings from research conducted in primary care in adult patients suggest that brief interventions by nurses and GPs can be effective in changing behavioural risk factors, and the COMPaRE research program will tap into the increasing role of the PN to prevent and manage obesity.