Overweight children in rural Norway - public health nurses' possibilities and limitations within national guidelines.

INTRODUCTION: Globally, overweight and obesity are more prevalent in rural areas than in urban areas. The purpose of this study was to determine to what extent public health nurses in rural areas in Norway feel equipped to tackle the overweight and obesity epidemic within two sets of national guidelines: The National Guidelines for the Standardized Measurement of Height and Weight and The National Guidelines for the Prevention, Identification, and Treatment of Overweight and Obesity in Children and Adolescents. These guidelines are inspired by New Public Management (NPM) logic, which emphasises more market orientation within the public sector to obtain a more cost-effective supply of public goods. The focus is on the weighing of schoolchildren, available resources, inter-agency cooperation and the rural context. METHODS: The data were collected using a structured questionnaire among 40 public health nurses working with children in rural areas, as well as qualitative interviews with 25 informants involved in the prevention and treatment of overweight and obesity among rural children. RESULTS: The study shows that rural public health nurses worry about the lack of resources for follow-up with children with a body mass index greater than what is characterised as 'normal'. The public health nurses suggested better cooperation between different stakeholders to work around the lack of resources and at the same time be able to see the whole picture, considering that overweight and obesity are complex problems connected to different challenges. They believed that it is an advantage to see the individuals in their local surroundings, to know their family history, their leisure activities and so on. This might be easier in rural areas than in urban areas, as these areas are often more transparent. CONCLUSION: There was consensus among the public health nurses involved in this study that national guidelines for treating overweight and obesity in children with the principles of NPM, and simplifying and standardising services, adds challenges instead of solutions. Such practices also hinder the use of experience-based knowledge about both the individual and the local context. There is a need for more flexible guidelines that can easily be adapted to the local (rural) context.

Overweight and obesity among children in rural areas: The importance of culture.

AIMS: This paper focuses on how social inequality is associated with overweight and obesity in children. There is a lack of research with a focus on an important distinction in social inequality, namely geography. The aim of this study was to reduce this knowledge gap by looking closely at the links between rurality and overweight. METHODS: The findings in this paper are based on in-depth interviews with school nurses and teachers in rural Norway. The focus was on their experiences with and knowledge about overweight and obesity numbers in rural versus urban areas. RESULTS: We used Bourdieu's terminology to address the challenges related to urban-rural differences, and found that cultural factors connected to tradition, identity and courtesy play an important role in the rural overweight and obesity discourse. CONCLUSIONS: Actors and 'experts' working with overweight and obesity and national guidelines need to understand rural contexts and customs and address problems of the countryside on rural, not exclusively urban, premises. Different contexts imply different needs when it comes to reducing the inequalities between rural and urban areas regarding overweight and obesity.