Obesity Prevention, Screening, and Treatment: Practices of Pediatric Providers Since the 2007 Expert Committee Recommendations

Abstract

This study surveyed pediatric primary care providers at a major academic center regarding their attitudes and practices of obesity screening, prevention, and treatment. The authors compared the care providers' reported practices to the 2007 American Medical Association and Centers for Disease Control and Prevention Expert Committee Recommendations to evaluate their adherence to the guidelines and differences based on level of training and specialty. Of 96 providers surveyed, less than half used the currently recommended criteria for identifying children who are overweight (24.7%) and obese (34.4%), with attendings more likely to use the correct criteria than residents (P< .05). Although most providers felt comfortable counseling patients and families about the prevention of overweight and obesity, the majority felt their counseling was not effective. There was considerable variability in reported practices of lab screening and referral patterns of overweight and obese children. More efforts are needed to standardize providers' approach to overweight and obese children.

Fitwits TM Leads to Improved Parental Recognition of Childhood Obesity and Plans to Encourage Change

“…9,20,21,[45][46][47][48][49] Our study measured communication between physicians, preadolescents, and parents, starting with an ordinary well-child office visit and mediated by a childfriendly tool, to test correct understanding of BMI-a known gap in parent-child readiness to pursue health-attaining behavioral goals. This wellchild visit tested the Fitwits office tool for joint discussions among physicians, parents, and 9-to 12-year-olds about their understanding and identification of BMI category (underweight, healthy weight, overweight, or obese).…”

Children's Report of Lifestyle Counseling Differs by BMI Status

“…Despite recommendations to assess children's weight status annually by calculating BMI percentiles, 2,23 in several recent surveys of physician practices, at least one-half of physicians did not calculate BMI percentiles. [24][25][26][27][28] Instead, physicians were more likely to plot children's height and weight on a growth chart and visually assess patients for weight concerns. Given the high prevalence of childhood overweight and obesity in the United States, it may be that the appearance of an overweight or obese child has become normalized, and by relying on visual assessment, clinicians are not diagnosing all overweight and obese children.…”

Temporal Trends in the Diagnosis and Management of Childhood Obesity/Overweight in Primary Care

“…2,4,9 Factors responsible for low rates of obesity diagnosis may include a lack of familiarity with the revised definitions of childhood overweight and obesity, insufficient time available for appropriate counseling and the contention that counseling may have modest impact as suggested by recent nationally representative surveys of the American Academy of Pediatrics and American Academy of Family Physicians. [10][11][12][13][14] In 2007, recommendations were made to classify children with BMI ≥95th percentile for their age and gender as "obese" rather than "overweight" and those with a BMI between the 85th and 94th percentile as "overweight" rather than "at risk for overweight." 15 Specific recommendations were also made regarding lifestyle counseling and laboratory screening for obesity-related comorbidities.…”