A recent review of paediatric obesity treatment guidelines emphasises the importance of multicomponent family-based treatment tailored to individual needs as the cornerstone of management.(1) The updated holistic approach to paediatric obesity management is underpinned by a more developed understanding of obesity as fat mass dysregulation that negatively impairs health and quality of life. In this view, obesity can cause multisystem problems and be a gateway to a range of other chronic health complications. Thus, treatment is not a simple matter of just “eat less, move more”. Appropriately addressing the causes, consequences and preventing further complications of obesity needs to be the focus within paediatric obesity services as per best practice and international guidelines.(1)

An evaluation of 12 years of patient-level outcomes in the first and, until recently, only dedicated specialist service for child and adolescent obesity in Ireland, found that the younger the age of the children treated and the longer the duration of treatment provided, the greater the significance in BMI-SDS difference between baseline and discharge.(2). Such findings highlight the timely need for intervention but also the complex and chronic nature of obesity, which warrants ongoing support and professional input following the chronic disease model of care. Additionally, because there are so many complex interactions of obesity, from psychological to familial to functional, all paediatric health and social care professionals are stakeholders.

On the 2021 World Obesity Day (4th March), the Health Service Executive (HSE) in Ireland launched the new Model of Care for the Management of Overweight and Obesity for children and adults.(3). This was a vital first step in recognising the need for services at all levels of care to support the effective treatment of obesity nationally and across the entire lifespan.

Prioritising specialised multidisciplinary-led obesity management services for children and adolescents in Ireland, as outlined in the model of care, is a much welcome development and aligns with the Model of Care for Paediatric Healthcare Services in Ireland. However, there is growing evidence worldwide on numerous barriers for individuals and families trying to access obesity care. Developing national and local clinical guidelines and clear patient pathways is an established need for implementing the model of care and the delivery of its services.(3).

The HRB Child and Adolescent Obesity LANDSCAPE Project was instigated as an applied partnership award between the Royal College of Surgeons in Ireland (RCSI), Children’s Health Ireland (CHI) at Temple Street Children’s Hospital and the HSE Health and Wellbeing Division.(4) LANDSCAPE is the acronym for ‘Planning Designated Services for Child and Adolescent Obesity with Professionals and Experts by Experience’.

The aim of The LANDSCAPE Project is to map currently available services and practices in Ireland to caring for children and adolescents with overweight, obesity and their complications. Data was generated by conducting online surveys, focus groups and interviews with health professionals, health managers, those with the lived experience (teenagers and parents) and other key stakeholders, including policymakers. The views captured are helping to develop an understanding of how services and practices may differ across the country and in various settings in Ireland. They are also providing valuable insight on the potential barriers and enablers for the provision of child and adolescent obesity treatment services in Ireland and are helping to identify the support needed.

There were 184 healthcare professionals (HPs) who completed the online anonymous cross-sectional survey, including nurses (18%), physicians (14%), health and social care professionals (HSCPs) (60%) and other HPs (8%). Some key results are illustrated in the tables and figures below. You can read the free full paper online. (5)

Primary barriers were voiced by HPs about providing healthcare for children and adolescents with obesity. These included:

• No pathway in place in primary care

• Currently not a service priority in many settings

• Low self-efficacy (see Table 3 below)

• Not enough public awareness about causes, consequences and appropriate treatment of childhood obesity

• Multifaceted approach needed, but medical intervention is only considered as a minor part; advocacy needed for societal change for both the prevention and management of child and adolescent obesity

Overall, a multitude of barriers and facilitators to providing paediatric obesity care were indicated from the HP survey.(5) The next step in the LANDSCAPE project uses qualitative methods to gain detailed insight into which barriers and facilitators necessitate being prioritised, and how they could be viably addressed within the existing health system in Ireland.

Twenty-two semi-structured focus groups were conducted with 90 HPs who provide care to children in Ireland and 16 clinical leaders/managers. The Nominal Group Technique (NGT) was used to encourage brainstorming and equal contribution amongst the group, to identify problems, facilitate discussion and generate solutions from the participants’ perspectives.

Key priorities identified included the need to:

• develop a care pathway including signposting and referrals;

• enable access to training for HCPs;

• provide better resourcing for HCPs and families;

• provide greater contact time with routine growth monitoring;

• enable a reduction in waiting times and ensure patients with obesity are not deprioritised compared with other conditions.

Five overarching themes were developed from the data, including a need for:

1. Resources

2. Diverse understanding and perceptions

3. A pathway of care

4. Optimal communication

5. An awareness of politics

154 respondents started the survey, and of these, 29% (N=44) completed the survey. Full survey analysis is currently ongoing.

Initial insights reveal that participants report family doctors/GPs, hospital doctors and public health nurses were the main initiators of conversations regarding child growth or weight. Parents shared their dissatisfaction with healthcare professional encounters regarding paediatric obesity, particularly regarding perceived suboptimal provision of written and online resources, information on their child’s growth and information concerning the need for onward referral to other services.

The survey also reported notable bottlenecks in referral pathways and challenges in accessing services once referred, particularly long waiting times. This is interesting to compare with the LANDSCAPE HP survey findings, which showed that:

• Only 42 of 85 HPs accepted referrals and reported the waiting time for giving an appointment ranged from 0-24+ months (28.2% 0-6 months, 8.2% 6-12 months, 3.5% 12-18 months, 2.4% 18-24 months and 7.1% >24 months).

• 7.1% of HPs did not know the average waiting time for an appointment for obesity treatment.

Data captured from the interviews with parents and adolescents are currently undergoing analysis. Findings from each of these work packages in the LANDSCAPE Project will be used to create a framework of recommendations for future service delivery for child and adolescent obesity. Ultimately, this work has provided an opportunity to those most affected by childhood obesity to voice their opinions and contribute to the development of integrated end-to-end equitable care as promised ‘for the first time in the history of the state’ in the HSE Model of Care. (3)

If you are interested in this area, the following may be of value:

• The Association for the Study of Obesity UK (ASO-UK): https://aso.org.uk/. The ASO-UK Congress on Obesity (UKCO) 2025 is taking place in Aberdeen, Scotland on 10-11 September 2025. https://aso.org.uk/events/uk-congress-on-obesity-ukco-2025/.

• The European Association for the Study of Obesity (EASO): https://easo.org/. Become a member of the EASO-Early Career Network (free to join): https://easo.org/easo-early-career-network/. Their Early Career Network Obesity Masterclasses 2025 are taking place in Cascais, Portugal in November 2025. This training and education opportunity is open to early-career professionals working in the area of obesity. https://easo.org/easo-early-career-network/ecn-masterclass/

• The British Dietetic Association (BDA) Obesity Specialist group: www.bda.uk.com/specialist-groups-and-branches/obesity-specialist-group.html