부산대학교 도서관

The Care of Childhood Obesity (COCO) clinic offers the only Tier 3 paediatric weight management service in the country. The clinic is successful, with two-thirds of patients losing weight, however for the remaining one-third, the current approach does not result in a change in weight. The current care includes a multi-disciplinary approach, with patients having appointments every-other month with a dietitian, clinical nurse specialist, clinical psychologist and social worker, and meeting with a consultant endocrinologist every four months. The aim of this PhD is to use insight from psychology to improve the care of the patients who attend the COCO clinic. To do this, this PhD has taken two approaches. First, I have considered interventions that have shown promising results in non-clinical, psychology laboratory settings and both trialled and reviewed how they have translated into paediatric clinical settings. Secondly, I have approached the problem from a patient-led perspective, conducting patient interviews and using tools from Health Psychology including the COM-B model to begin the co-design of a new intervention. The thesis takes a mixed methods approach, with quantitative research, qualitative research and a systematic review contributing to the conclusions made. We see that interventions designed for adults do not necessarily translate directly to successful interventions in children. Whilst children are able to understand the concepts of portion size, eating speed and calorie dense foods; maintaining engagement with interventions that utilise these concepts to change behaviour is more difficult. Self-determination, the sense that a person can make their own choices and control their own outcomes, without external influence, is a key facet of motivation. From interviews I conducted with patients and their families, it was apparent that the children and adolescents lacked self-determination. Using COM-B and a person-centred approach, I have begun to develop an intervention using Acceptance and Commitment Therapy, that would aim to raise patients' sense of self-determination and improve their outcomes at the clinic. NIHR research for patient benefit funding has been successfully secured, meaning this co-design work will be continued as a post-doctoral project.