Food insecurity is a serious health concern among children in the United States with 15.3 million children living in food insecure households. The American Academy of Pediatrics recommends that pediatricians screen for food insecurity at health maintenance visits as identifying children at risk is a crucial step in the amelioration of food insecurity. Two surveys were administered in a Midwest pediatric clinic. A cross-sectional survey was electronically distributed to pediatric providers to assess perceptions of food insecurity among patients, provider readiness to conduct food security screenings, and barriers to conducting those screenings. A cross-sectional caregiver survey was administered to assess demographics, household food security status, participation in nutrition assistance programs, and barriers to getting enough food to eat. Descriptive statistics and odds ratios were calculated. Eighty-eight percent of physicians believe that food insecurity is a challenge for some of their patients. Only 15 % of providers reported screening for food insecurity, while 80 % were willing to screen. Physicians were most concerned with knowing how to handle a positive screen. Among caregivers, 57 % screened positive for food insecurity. Those experiencing food insecurity were more likely to be non-white, participate in SNAP and to feel discomfort towards the idea of talking to a doctor or nurse about food needs. Caregivers reporting food insecurity were significantly less likely to have a personal vehicle. Effective food insecurity screening requires addressing caregiver and health provider barriers in order to increase the likelihood of identifying households most at risk.

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Keywords Obesity I Overweight I Text messaging I Motivational interviewing I Social media Opinion statement Successful management of pediatric overweight and obesity remains very challenging, particularly in a busy primary care setting. Numerous barriers exist for both patients and providers. Comprehensive counseling directed at improved dietary habits, increased exercise, and decreased screen time is not always practical. It is crucial to elicit a genuine recognition of the child's obesity as a health problem and obtain a sincere, nonjudgmental commitment to change from the patient as well as parents and other household members. Providers may benefit from learning and utilizing motivational interviewing (MI) as a tool to interact with adolescents and families. In addition, the use of ubiquitous venues such as social media and text messaging, as well as newer health apps may increase continuity and engagement with adolescents and families. Taken together, the traditional modalities of diet, exercise, and screen time counseling, combined with MI and new engagement strategies, such as close follow-up via phone, social media or text provide more opportunities for primary care providers to tighten the belt on the obesity epidemic.