Spotlight on EASO Paediatric COMs: Heilsuskolinn – The Health School, Landspitali University Hospital, Iceland with Dr Tryggvi Helgason

Spotlight on EASO Paediatric COMs: Heilsuskolinn – The Health School, Landspitali University Hospital, Iceland with Dr Tryggvi Helgason

Meet Dr. Tryggvi Helgason, the lead of Heilsuskolinn - The Health School based at Landspitali University Hospital. This multidisciplinary team of 8 people includes expertise from paediatrics, psychology, nursing, sport science and teaching, social work and nutrition.

Thank you for speaking with us, Dr. Helgason. It is exciting to hear about your COM! Please describe your COM’s patient care philosophy and approach.

We are a multidisciplinary team helping the families of children who have obesity and an inherent tendency to increase their weight faster than other children. Our goal is to coach children and their families into having a lifestyle that makes it possible to live in an obesogenic environment with this tendency. We see our treatment as long-term, aiming at reducing the number of children reaching adulthood with obesity. For those who still live with obesity into adulthood despite treatment, we aim to support them to have a better lifestyle. Our main methods are cognitive behavioural treatment, motivational interviewing, and group approaches. Our most valuable asset in therapy is our bond with the patient. Respect for the patient and family is central, and patient-first language is a logical part of that. Medical treatment is an increasing part of our approach; this is because the numbers of pharmacotherapy options increase and our knowledge about the negative effects of untreated obesity increases.

Excellent, thank you. What specific obesity treatments and services does your multidisciplinary COM offer?

Our therapy revolves around cognitive behavioural modification treatment and motivational interviewing. We evaluate all aspects of obesity; of course, nutrition and exercise are central, but sleep, mental well-being, family organisation, and school support are almost universally addressed as well. Increasingly we are seeing problems in other systems in the body than adipose tissue only, with glucose and liver at the forefront. This has led to increased medical treatment with both metformin and GLP1-drugs. Training, physiotherapy, deeper psychology treatment, and other therapies are supplied outside our COM. We have not referred any children to metabolic surgery. It is a possibility in Iceland, but this surgery is most often only offered after patients have reached 18 years of age. We follow children from the first visit (usually from around 12 years of age, but ranging between 2-18 years) until 18 years old. Sometimes, especially for children living in the countryside, long-term follow-up is organised with the local GPs. When children turn 18 years old, they are followed by their GP, except for the children with the highest grades of obesity, who are sometimes referred directly to the tertiary adults clinic for ongoing support and care.

It is great to have insight into your COM services. Please could you tell us about the main challenges your COM currently faces?

The primary challenge our COMs faces is a long waitlist for patients. This originates from the growing prevalence of childhood obesity and the low availability of treatment options. In Iceland, the prevalence of obesity has surged rapidly, rising from 5% to 7.3% in the last six years. This increase intensifies the demand for our services but also highlights the increasing need for advocacy and awareness campaigns directed at government and healthcare officials to instigate change. Furthermore, the prevalence of obesity is more pronounced in rural areas, where treatment options are currently limited. Anticipating the incorporation of additional treatment options, we foresee a heightened demand for our consultancy services, especially regarding the implementation of these new treatment modalities within local health centers.

Thank you Tryggvi. Finally, what are the main goals and plans for your COM during the next 3-5 years?

We aim to double the size of our staff team, which will in turn help increase our treatment capacity by around 50%. This means we can also support local health care center in treatment of childhood obesity. The heads of our department fully support this, and the organisation of funding to support this expansion is underway.