Tackling childhood and adolescent obesity in Malta: attitudes, barriers, and skills of medical paediatric staff

Aims Malta leads most childhood obesity statistics. This study aimed to assess paediatric staff9s attitudes towards managing overweight and obese children, explore barriers they experienced when looking after these children and determine perceived levels of skill and interest in training in childhood obesity management. Methods A questionnaire was distributed to all registered Maltese paediatricians (n=42) and paediatric specialist trainees (n=13), in both public and private sectors in Malta. The questionnaire explored attitudes, barriers, perceived level of skill and interest in training in childhood obesity management. Participants were asked to return the questionnaire anonymously in a sealed envelope. Results were analysed with Microsoft Excel 2007 and an online statistical tool. Ethics approval was obtained. Results 52 participants responded to the questionnaire (94.5%). Most had considerable experience in paediatrics (1-10 years, 28.8%; 11-20 years, 36.5%; 21 or more years, 34.6%). The overwhelming majority (>94%) believe paediatricians play an important role in childhood obesity and recognise obesity is a serious health problem in Malta, affecting children9s quality of life and psychological wellbeing. The commonest barriers in obesity management were: lack of patient motivation (96.2%), lack of support services (84.6%) and lack of parental involvement (82.7%). Doctors with 20 years or less of experience felt more competent and comfortable managing childhood obesity than their more experienced counterparts. Overall, less than half of respondents felt either competent (49%) or comfortable (47.1%) managing overweight children. Perceived competencies were poorest for behavioural management, family therapy, and parenting guidance. A third to half of respondents reported a high interest in obesity management skills training. 67.5% of respondents stated that they use past experience as their source of information to manage overweight children, topping professional guidelines (37.3%), speciality training (31.4%), and medical school teaching (12%). Conclusion This study is the only attempt to assess Maltese paediatricians9 experiences when caring for overweight children. The study identified a need to improve training programmes for Maltes paediatricians and trainees, while setting up a multidisciplinary service for overweight children would facilitate the management of childhood obesity.