Expert Case Review

CHILDREN’S WEIGHT MANAGEMENT

Olivia is a 15-year-old girl referred to the Tier 3 Child Weight Management Service in March 2020 by a consultant paediatrician. Initial contact was made with Olivia and her family in April 2020 and the intervention began in May 2020.

Olivia15 Years Old

Background

 

When referred to the service Olivia’s medical conditions included; chronic headache disorder, irregular periods, hypermetropia, polycystic ovary syndrome, temporomandibular joint pain dysfunction syndrome, gastro-oesophageal reflux disease, idiopathic intracranial hypertension and  morbid obesity (101.7kg, BMI of 39.2kg/m2 (SDS>+3.33). Due to these she was not attending school and had not done so since Easter 2019.

 

Olivia had always wanted to lose weight and been trying to do so for five years since the age of nine when she was first referred to a weight management service.   She had tried many techniques but had little success in achieving any weight loss. During the initial assessment her mother described the negative experiences that the family had encountered in the past due to Olivia’s weight. This included health professionals accusing her of lying about her food intake and level of exercise which resulted in her becoming very defensive about her weight.

 

Olivia felt pressured by professionals to lose weight and do more exercise and although she was doing her best to do this; she felt professionals did not believe her.  This led to negative self-thoughts and an increasing lack of self-confidence. Olivia frequently discussed being overweight as having a negative impact upon her everyday life.  As a result of her experiences her relationship with food had become obsessive and unbalanced.

Intervention

 

Olivia joined a Zoom group with 5 other families with children aged 13years and older. She engaged well with the group and attended 11 out of 12 of the core sessions and 4 out of 4 sessions in the maintenance phase.  These sessions covered a range of topics including food labels, a balanced diet, physical activity and sleep.  Olivia and her mum reported that although they were familiar with some of the topics discussed, they liked how these were approached differently from their previous experience.

 

In Onelife Suffolk sessions they commented on being supported to make realistic changes that fitted within their current lifestyle and not being told what to do, as they had been in the past.  They found the content on other factors such as sleep and the wider influences and pressures that can make lifestyle changes challenging very helpful, making them feel that not everything was their fault.  Olivia openly discussed her battles due to her medical conditions with the other members of the group. The family enjoyed attending the group and Olivia found it helpful to talk to other young people in similar situations to herself. This differed from previous weight management programmes which were like a doctor’s appointment with no opportunity for support from her peers. Olivia explained how this group had given them the opportunity to share experiences and her and her mum felt listened to by the practitioners who always had time to support them.

 

Additional dietetic support over 3-hour long sessions were also provided where more specialist dietary advice was provided. Involvement with the service dietitian and her communication with medical professionals also improved the clinical support and assessments provided by medical professionals outside of the service.  Understanding more about how medical conditions such as Polycystic Ovary Syndrome can present challenges for weight loss improved Olivia’s knowledge and helped to increase her confidence.

Suddenly I didn’t feel so alone and other people were having the same battles as I was having. As a parent I had no support in trying to implement these changes and it is all about my child. The group allowed us to share ideas which makes it feel like I am not dealing with it by myself

Olivia's Mother

Outcomes

 

During lockdown the pressures eased, Olivia started receiving education from school and she had the time to catch up with schoolwork and feel more up to date, she is now attending school every day. Olivia’s wellbeing score as measured by the Good Childhood Index have improved.

 

Olivia has dramatically improved her eating habits and changed the way she thinks of foods as good and bad and obsessive and focus on calorie counting. Olivia has become more and more positive throughout the group as for the first time was being reassured what she is doing it right.

 

Within 6 months on the programme Olivia has lost 5.5 kg, reducing her BMI to 36.73kg/m2  (SDS =+3.33) Olivia has reduced her dress size from 22 to size 18 and her family are starting to notice a change in body shape.

 

The family feel that OneLife Suffolk was a huge factor for this change as it was the first time someone took the time to listen to them and ‘’not just bark information at them’’.  Olivia and her family feel they are now on a new road, and the weight she has lost has made her determined to continue and increased the confidence she has in herself to do so.  Olivia is now working towards her long-term goal of feeling good and confident in her prom dress for her prom in June.