Table 4.
Summary of responses to question set 4: what approaches work best to initiate weight-related conversations? (n = 20 primary care physicians, 2018)
| Overarching theme | Sub-theme | Illustrative quotes |
|---|---|---|
| Collaboration | Obtain patient and parent perspective (n= 13; 65%) | [By] engaging the child in the conversation, getting them involved, [and] getting ideas from the kid. Kids are great at coming up with ideas of things that they can do or things that they can change. Oftentimes the kids that are in school, they’ve heard this stuff at school too, and so they’ll be able to say, ‘Oh, I shouldn’t drink Kool-Aid’. And it’s just like with adults. You hear one or two things and say, ‘Yeah, that’s a great one. Why don’t you work on that? Why don’t you work on not drinking Kool-Aid and drinking more water?’ (Interview 5) |
| Goal setting (n = 9; 45%) | I’ll try and shift their focus from appearance or a weight number and use my smart goal, ‘So why don’t we set a smart goal around [being] healthy rather than less belly fat? Why don’t we have it be [where] she plays at the gym or outside’. [We] set a behavioural goal so that their goals become focused on something else. (Interview 15) | |
| Capitalize on previous success (n = 6; 30%) | I try and acknowledge any work that they’ve done to date. That’s big too. If they say, ‘Yeah, we kind of switched to putting dinner with vegetables every night’, and I see that the weight gain has decelerated a little bit, even if it’s still going up, I try and acknowledge that piece and give them credit for what they’re doing already. (Interview 15) | |
| Health-focused approach | Frame discussions around health behaviours and lifestyle (n = 16; 80%) | Focusing on positive things [families] can do as opposed to negative things they can [avoid]. [For example], eating together as a family, focusing on how can you increase your fruits and vegetables, or how can you increase your activity, as opposed to how can you decrease calories. (Interview 2) |
| Have conversations with patients and families early (n = 6; 30%) | I’ve actually found that parents are really receptive to when I bring up weight stuff, you know, and I’ll tell them, ‘I wish that my parents helped me out with this when I was younger’. And usually the parents are kind of in the same boat. (Interview 15) | |
| Empathy | Demonstrate care and compassion (n = 7; 35%) | [My] overall answer is to be compassionate and take people where they’re at is helpful for me so that I don’t feel like I need to alter an approach. (Interview 9) |
| Ask permission to bring up weight (n = 5; 25%) | I would say, ‘Do I have your permission to talk about strategies of diet and exercise which can help the child become healthier?’ And then if they would say yes, I would continue. If they would say no, I wouldn’t. (Interview 19) | |
| Objectivity | Present and discuss growth charts (n = 16; 80%) | A lot of times with a visual representation, like showing growth charts, that’s commonly what I do, [and] talk about what the growth chart represents, what the average weight for a particular age is, and then compare that to where their child is. (Interview 19) |
| Explain your rationale behind health-concern (n = 9; 45%) | If they don’t bring it up, I have to sell the idea first, sell the idea that we are concerned, and this is the reason why we are concerned. (Interview 6) |