Successful HSU pilot project addresses childhood obesity in a structured way

In recent months, the Health Institution of South Iceland (HSU) has been working on a development and research project to establish a so-called lifestyle clinic for children at local health centers in its district. The project, titled Kraftmiklir krakkar, aims to address childhood obesity systematically. The project has been highly successful, and both children and parents report great satisfaction with the results.

The lifestyle clinic is a pioneering initiative and serves as a potential model nationwide. HSU specialists hope that a handbook and standardized procedures can be developed, allowing similar clinics to be offered at other healthcare institutions and health centers across the country. Childhood obesity is a significant challenge: it is estimated that nearly 8% of Icelandic children aged 6–18 are obese. With around 58,000 children in this age group, that equates to approximately 4,500 children.

50 children participating

The methodology involved screening children in grades 1, 4, and 7 across South Iceland, carried out by school nurses according to national child health protocols. Children diagnosed with obesity, along with their parents, were invited to participate in the study. This consisted of six consultations over six months — four to five with a nurse and one to two with a doctor. Approximately 50 children and their parents from across the district participated.

Rising rates of childhood obesity

The project was initiated in response to the rapid increase in childhood obesity both globally and in Iceland. Today, nearly 8% of Icelandic schoolchildren are obese, with about 10% in rural areas compared to 6% in the capital area — and the rates are rising everywhere. Despite clinical guidelines for obesity treatment, no multidisciplinary services are available locally in rural areas. The only structured option in Iceland so far has been the Health School at the National Children’s Hospital in Reykjavík.

Strong team of specialists

The project is led by Vignir Sigurðsson, pediatric specialist at HSU, who completed his PhD in pediatrics at the University of Gothenburg in 2021, focusing on inflammatory bowel disease in children. Vignir has extensive experience in pediatric gastroenterology and nutrition. Supporting him is a strong team of healthcare professionals, led by nurses Bjarnheiður Böðvarsdóttir and Þorbjörg Anna Steinarsdóttir, along with residents Íris Óskarsdóttir and Eyrún Anna Stefánsdóttir.

• Bjarnheiður recently completed her master’s thesis on the feasibility of establishing such a lifestyle clinic, supervised by Vignir and Árún Kristín Sigurðardóttir, professor of nursing at the University of Akureyri.

• Þorbjörg Anna’s master’s thesis focuses primarily on the impact of this six-month intervention on children’s lifestyle habits.

• Íris and Eyrún Anna, residents in family medicine, are studying the medical aspects: evaluating metabolic syndrome in children and identifying whether underlying undiagnosed diseases (e.g., hypothyroidism, sleep apnea, gastrointestinal disorders) may be contributing to obesity.

Serious health concerns

“We focus on four key areas: sleep and screen time, nutrition, physical activity, and mental well-being. The situation is serious, and the growing number of children struggling with obesity is alarming. In my practice, I already treat very young patients, even as young as ten or eleven years old, with fatty liver disease or pre-diabetes requiring medication,” says Vignir.

Findings from Bjarnheiður’s master’s research show that the treatment is feasible and practical, with strong demand for the service and all necessary resources available. Remote consultations also proved effective. Parents and children expressed high satisfaction, and their expectations were met.

Satisfaction among children and parents

“The project has been successful, well-received, and has met the expectations of both participants and their parents. I sense that the results and benefits are tangible. Both children and parents are eager to learn about lifestyle changes that can improve health. It is risky to measure success solely by weight and BMI over six months. The real goal is to achieve long-term changes in lifestyle, habits, sleep, nutrition, and well-being,” says Vignir.

Accessible local healthcare solutions

“The aim is to address the problem with accessible, practical, and structured services at local health centers. This involves a six-month intervention program, lifestyle education, and mapping of both physical and mental health. Over this period, we assess the seriousness of each child’s obesity and place it in context with their social situation. This gives us a clear picture of the way forward,” Vignir explains.

Afterwards, children may continue with follow-up by school nurses and regular check-ins, or move to extended treatment at the local health center. This represents the first level of care and prevention. If necessary, they may then be referred to pediatric specialists or the Health School at Landspítali National University Hospital, which represents second and third levels of care.

A model for other health centers

According to Vignir, the hope is to create a handbook with standardized procedures so that lifestyle clinics like Kraftmiklir krakkar can be established across the country. Discussions with the Ministry of Health are already underway. Vignir emphasizes that the project is not particularly resource-intensive but rather relies on improved organization and streamlined workflows. Most of the necessary resources are already available within HSU.

Clear results from master’s research

An abstract from Bjarnheiður’s thesis states:
“In recent years, a research project has been underway at HSU to examine the feasibility of establishing lifestyle treatment for children with obesity and their parents at local health centers. The study assessed demand, adherence, and the feasibility of in-person versus remote consultations. The aim was also to describe the lifestyle factors of these children — such as sleep, diet, exercise, and well-being — as well as parental background. In addition, the study explored parents’ and children’s experiences and satisfaction with the treatment.”

In summary, the findings show that the treatment proved both feasible and practical, demand was high, remote consultations worked well, and parents and children were satisfied with the process and outcomes.

Next steps

HSU has decided to continue the Kraftmiklir krakkar lifestyle clinic as part of routine school health services and follow-up for children in need. This winter, the research team will travel to Uppsala, Sweden, for a European childhood obesity conference. There, Íris and Eyrún will present their first results on the prevalence of obesity-related conditions in children. Þorbjörg plans to defend her master’s thesis on treatment outcomes early next year. Following that, work will begin on publishing a handbook and workflow guide to help other health centers in Iceland establish Kraftmiklir krakkar lifestyle clinics.