Table 2 Overview of the themes and subthemes identified in the interviews

Absence of physical or mental complaints

Frequency of consultation

e.g. low consultation rate

‘Well, the problem is … I don’t see children with overweight weekly. It isn’t something we see very frequently... […] Very young children we see more often and children aged 4 to 12 years we see less. So, it is possible we’re not able to recognize it. (#9)’

Internal barriers of the GP

Sensitivity of the topic

e.g. fear for patient reaction/ disturbance doctor-patient relation, self-esteem of the child, resistance in the parent

‘It is a very sensitive topic and of course they have heard this before either during bullying or by an aunt saying: ‘you’re getting a little fat’. You know what it’s like with family and their opinions. So, it is already hard for them … that is a barrier to me. I don’t want the child to get hurt. It probably already is? (#6)’

Motivation of the GP

e.g. negative experience in the past

‘I can imagine when you put a lot of effort in it and it often doesn’t succeed, you might think the next time ‘let it be’. […] And if parents say: ‘we will co-operate’ and you notice change: Yes, then you’re successful. I think it is your experience as well that makes it difficult. Most of the time I think ‘they have to make the effort’ and that is true of course, but apparently, I’m not able to motivate them enough. (#4)’

Knowledge and skills of the GP

‘This is a sort of grey area for us. (#11)’

Doctor-patient relation

e.g. absence of doctor-patient relation

‘If you want to discuss it or confront people, it’s important to have a good doctor-patient relation. […] I think it’s the strength of a general practitioner seeing and knowing a patient for a longer time, which makes it easier to anticipate and help to adjust in certain areas. (#8)’

Child’s family background

Child

e.g. culture, socio-economic status

‘Cultural differences might play a role in this. In some cultures, they see overweight as a sign of welfare. For example, it is more common in Antillean or Surinamese children. (#9)’

Parents

e.g. parents with overweight

‘Yes that [overweight in parents] has definitely an effect. It’s a sensitive topic. Something has been said and done about it a 100.000 times already of course […] Parents often have a wrong diet or are sedentary or have a predisposition for overweight. So, yes that is definitely a barrier. (#6)’

Logistics

Time and prioritizing

e.g. lack of time

‘Due to lack of time, it’s often not discussed […] and lack of time sounds like it’s an external factor, but I think it’s more prioritizing. One prioritizes this in a way that makes it part of the grey area of your time. (#10)’