Shouldn't we talk more about childhood obesity?

Sarah Redsell

As our Professor of Public Health, Dr Sarah Redsell has an academic and clinical background in nursing and public health, together with research skills in health psychology.

Sarah’s research has primarily focused on communicating aspects of health and wellbeing with parents of infants and children, including developing and testing interventions for health professionals and service users. Her work has also explored barriers to immunisation and identifying and preventing obesity during infancy.

Childhood obesity is a significant public health issue. In 2012, 22% of children aged 4-5 years and 33% of 10-11 year olds in the UK were overweight. Yet the risk factors for childhood obesity can be identified during infancy (under one year) or even earlier. If we can recognise the infants most at risk of childhood obesity, we can target resources at them and their parents.

It’s important to raise parents’ awareness about obesity risk factors, such as infant feeding practices – it’s not just what you eat but also about eating patterns. Along with researchers at the Universities of Lincoln and Nottingham, I undertook a study in 2009 that revealed some parents would want to know if their baby had a greater risk of obesity. However, healthcare practitioners (GPs, practice nurses and health visitors) said they were reticent about giving information about obesity as they did not want to stigmatise parents. These healthcare practitioners knew they needed to be sensitive and non-judgemental in their discussions with parents about obesity, but some felt they lacked the skills to do this effectively. They were concerned about getting it right and did not want to unnecessarily worry or upset parents.

Overcoming healthcare practitioners’ concerns that raising the topic of infant obesity might jeopardise their relationship with parents is crucial to prevention. The research team I was part of realised that guidance was needed to improve healthcare practitioners’ confidence in recognising infants at risk of developing childhood obesity and to help them work with parents on strategies for change. Consequently, we undertook two further research projects. In 2011, the team developed a questionnaire to identify childhood obesity risk during infancy. This questionnaire is now called the Infant Risk of Obesity Checklist (IROC). A year later, we undertook a review of all the papers published worldwide that described and tested interventions that could be used to prevent obesity in children under two years of age. This work led to the creation of a guideline for health visitors to help them with obesity prevention during infancy. This guideline is available to health professionals via the Institute of Health Visiting website www.ihv.org.uk.

The next project started in September and the team consists of researchers from Anglia Ruskin, Cambridge, Lincoln and Nottingham universities, and healthcare practitioners. It is funded by a Medical Research Council grant. The first stage will be to create a computer-based programme for health visitors that will include the Infant Risk of Obesity Checklist. The programme will be called the ProActive Assessment of Obesity Risk during Infancy (ProAsk). The second stage involves health visitors using the programme with parents to raise awareness about future obesity risk. The team hopes ProAsk will guide discussions between health visitors and parents about possible strategies for prevention. At the end of the second stage of the project, parents and health visitors will be asked their views about the ProAsk programme and how it worked in practice.

Research matters

What inspired you?

I worked as a health visitor in Nottingham in the early 1990s before entering academia. About six years ago I stumbled across a paper that proposed that obesity risk could be identified very early in a baby’s life. As a researcher, I wanted to explore what models we could use that could communicate this risk, while not alienating parents. It’s about balancing this need for information with the possible stigma of labelling an infant as ‘obese’.

Any surprises?

Our earlier work discovered that health visitors felt they weren’t allowed to tell parents how to feed appropriately with formula milk. They said they weren’t really supposed to talk about anything other than ‘breast is best’. We feel that parents who formula feed need help too.

Why does this research matter?

We want to understand if knowing your baby is at greater risk of being an overweight child is important to parents. If so, it is vital that parents are empowered to make informed decisions about the way they feed and soothe their babies, supported by a healthcare practitioner who can communicate the evidence in a sensitive way.

Research funding

Medical Research Council

Amount of funding awarded: £151,576

Duration of the funding: 1 September 2014 -28 February 2016

Reading matter

Development of an algorithm to estimate overweight risk in childhood from predictors during infancy.

Pediatrics, Published on-line 15th July 2013, e414-e421 (doi: 10.1542/peds.2012_3858)

Weng SF, Redsell, SA, Nathan, D Swift, JA, Yang, M, Glazebrook, C.