Gamifying education and behavioural change to reduce childhood obesity

Bianca Parau, Paediatric Dietitian at Chelsea and Westminster Hospital, shares her experiences and insights of managing childhood obesity, and provides an overview of her Horizon Fellowship project – a multidisciplinary behavioural change digital curriculum to empower children and their families.

Oh I love my job as a Paediatric Dietitian and don’t tell anyone, but with the ability to manipulate nutrition, I often see it as one of my super powers! 

Like Spiderman with his webs, Batman with his utility belt and Wonder Woman with her superhuman strength, for the past 17 years I’ve honed my dietetic super powers to help children and young people navigate their diets; to live healthier lives, as ultimately our health is our wealth. 

One size doesn’t fit all when it comes to food

Eating and food is emotive and not just for sustenance. As humans, we also associate food with cultural, religious and celebratory occasions, but food can also be our medicine – as it plays an important role in disease prevention and management.  If I use coeliac disease as an example, the condition does not require any pharmacological treatment, a gluten free diet is the only remedy. 

Similarly with any pharmacological treatments, when it comes to food as a medicine, there isn’t a one size fits all approach – we need to have a deeper understanding of an individual’s circumstances as well as their likes and dislikes to tailor our approach to have the maximum benefit and to enable the individual to ultimately a live a longer, healthier and happier life. 

Unfortunately, there are not enough dietetic super powers to go around – with both skills shortages and recruitment difficulties within allied health professionals (AHPs), one of the questions that I frequently ask myself is; how do we go about maximising our impact on the growing population’s rising healthcare needs with our limited resources? 

A paradigm shift is clearly needed, we have to move away from the traditional approaches to more sustainable, accessible and inclusive models of care.  Although we have adapted in various areas within Paediatric Dietetics post covid, this is a drop in the bucket and more needs to be done.

My lightbulb moment

As part of my current clinical role, I analyse our referrals and waiting lists to identify pinch points in our service, and earlier this year I had a lightbulb moment; I found our kryptonite, or at least one deposit of it!

Although I was aware of the increase in overweight referrals over the past two years, it was only when I covered the weight management clinic on a rainy Monday afternoon for a colleague, that I realised a few things:

  1. Our current treatment models to tackle childhood obesity are not working and we are not having any impact – we currently see patients for 30-minute appointments every six to nine months due to capacity issues. 
  2. Staff morale tends to be low when they cover this clinic – most likely due to the poor outcomes and our reduced impact (I also noted that staff members returning from this clinic alway dip into the snack jar in our office… and yes as dietitian’s we always have an emergency stash of treats for exactly these occasions).

I do not believe in coincidences in life, so shortly after my aha moment, the Horizon Fellowship opportunity came along, and I knew I had to apply.  Something had to be done to limit the effect of the “Kryptonite” on our small team.

I also wanted to broaden my knowledge around digital healthcare and to be able to apply this in combination with my clinical skills to transform more aspects of paediatric dietetic care, but the main driving force was absolutely to look at how we can improve both patient and staff outcomes for the overweight clinic.  A win-win situation!

The National Child Measurement Program in the UK identified that 20% of children are overweight or obese when they begin school with one in three classified as overweight or obese by the time they leave primary school.  Unfortunately, managing overweight and obesity has no quick fix, but it is also not an acute problem, or solely a dietetic problem to solve. 

Despite the fact that there are various different models and approaches out there trying to combat the obesity epidemic; awareness of these is often limited, and access can be tricky –  similar to the postcode lottery and these models also have varying success.

In our situation, due to limited resources in primary care, access difficulties and outdated treatment pathways, many of these patients are being referred to their local acute hospital’s dietetic department (us!) which is not having the desired impact on our patients or my team’s waists for that matter! 

When patients attend a hospital appointment, one of their expectations is to receive treatment, but in managing obesity, the burden of responsibility lies heavily on the patient (and parent) to apply the advice on a daily basis and to change their behaviour.

My Horizon Fellowship project

Through my Horizon Fellowship project, I am looking at a multidisciplinary behavioural change digital curriculum for overweight children and young people. The programme will be adapted for various age groups in paediatrics to empower not only the overweight child, but also their family.  This will be achieved through gamifying education and behavioural change to set them up for success and improve the quality of life of so many families.

Eight months in, and I can truly say the Horizon Fellowship has already exceeded my expectations.  It has provided me with magnificent opportunities to explore how AHP services can adapt and also collaborate, to address pressure points whilst achieving sustainable NHS long term goals such as:

  1. Improving health and longevity of our current and future population
  2. Lessening the burden on the NHS and its limited resources

The support and mentorship I’ve received has been invaluable and the networking opportunities are priceless!  If anyone is reading this and have doubts about applying for a fellowship, take the plunge, you will not regret it. 

So, what is my vision for the future? As obesity is reversible and best of all preventable, I am optimistic that through extensive collaboration (with other superpowers in this field) and modernisation of our treatment pathways, we can break the obesity cycle and shape the health span and longevity of future generations, whilst also reducing the burden on acute services and healthcare.

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