Weight and its relationship to adolescent perceptions of their providers (WRAP): A qualitative and quantitative assessment of teen weight-related preferences and concerns

Abstract

Purpose-To examine the relationship of body weight to satisfaction with care in adolescents, and to obtain qualitative data on preferences for general and weight-related medical care in normal weight and overweight adolescents. Methods-TheWeight and its Relationship to Adolescent Perceptions of their Providers survey, a 4-page questionnaire containing previously validated satisfaction scales and open-ended qualitative questions regarding health care preferences, was administered to 62 severely overweight (body mass index [BMI] 38.9 ± 8.4 kg/m 2 ) and 29 normal weight (BMI 22.5 ± 4.0 kg/m 2 ) adolescents (age 13.9 ± 1.7 years; 57% female; 50% Caucasian, 47% African-American, 3% Hispanic).Results-The affective subscale of the medical satisfaction scale was negatively correlated with BMI standard deviation score (r = −.22, p < .05). Multiple regression models predicting affective satisfaction with medical care included BMI standard deviation score; however, continuity with provider appeared to be the strongest independent predictor of affective satisfaction. Fifty-five percent of participants identified their mother as the person they felt most comfortable talking with about weight, although 68% believed their provider knew the most about healthy eating. "Overweight" was identified by 47% of participants as the preferred term for heavy teens. Seventynine percent of overweight adolescents stated their health care provider discussed their weight with them; however, only 41% of overweight adolescents desired to discuss their weight. Compared to normal-weight adolescents, overweight teens were more likely to report that their provider raised topics of weight (p < .001), diet (p < .01), and exercise (p < .01) at their last physical, and were more likely to report that they would have liked their provider to discuss diet and exercise (both p < .05). Ten percent of overweight teens expressed concerns regarding the public location of their provider's office scale.Conclusions-Satisfaction with affective aspects of the provider-patient relationship is negatively correlated with BMI standard deviation score. Length of experience with one's provider is also a strong predictor of teen satisfaction with their medical care. Teens prefer the term "overweight" for those with high body weight. Sensitivity to confidentiality, privacy, and embarrassment regarding physical examination and weight are important for teen satisfaction. Overweight adults report feeling stigmatized, stereotyped [6], and treated disrespectfully [7] within their communities and by medical professionals. Health care providers, nurses, and medical students have been reported to perceive obese adult patients as lazy and lacking selfcontrol [8,9] and to believe they are less likely to comply with prescribed treatment regimens than patients of normal weight [10,11]. Based upon these findings, it is perhaps not surprising that many overweight adults report that physicians do not understand the extent to which overweight causes difficulty in their lives [12]...

How Pediatricians Can Improve Diet and Activity for Overweight Preschoolers: A Qualitative Study of Parental Attitudes

“…Contrary to studies on adults and adolescents who did not like the term obese when receiving messages about their own weight, 27,28 parents of preschoolers preferred the direct terminology of overweight or obese . In fact, parents reported that colloquial terms would be offensive coming from a pediatrician if they were meant to convey concern about weight.…”

Expert Committee Recommendations Regarding the Prevention, Assessment, and Treatment of Child and Adolescent Overweight and Obesity: Summary Report

“…Adult patients have identified "fatness," "excess fat," and "obesity" as derogatory terms, 25 and obese adolescents prefer the term "overweight." 26 Younger children and their families may respond similarly, and clinicians should discuss the problem with individual families by using more-neutral terms, such as "weight," "excess weight," and "BMI." Therefore, the expert committee recommends the use of the clinical terms overweight and obesity for documentation and risk assessment but the use of different terms in the clinician's office, to avoid an inference of judgment or repugnance.…”

Lack of Recognition, Diagnosis, and Treatment of Overweight/Obesity in Children Hospitalized for Asthma

“…Provider and patient sensitivity and bias have been shown to influence provider diagnosis and treatment of overweight and obesity. 21,46,47 In our study, to avoid possible provider or patient sensitivity to the word obesity, any term indicating overweight or obesity was accepted for diagnosis, and accuracy of the term according to BMI percentile was not studied. It is interesting that a study of hospitalized children by Bradford et al 48 showed that parents underestimate their child' s weight status, but almost all parents in the study expected that providers would monitor BMI during admission and inform them of the results.…”