Pediatricians' weight assessment and obesity management practices

Jeannie S Huang, Michael Donohue, Golnaz Golnari, Susan Fernandez, Edward Walker-Gallego, Kate Galvan, Christina Briones, Jennifer Tamai, Karen Becerra, Jeannie S Huang, Michael Donohue, Golnaz Golnari, Susan Fernandez, Edward Walker-Gallego, Kate Galvan, Christina Briones, Jennifer Tamai, Karen Becerra

Abstract

Background: Clinician adherence to obesity screening guidelines from United States health agencies remains suboptimal. This study explored how personal and career demographics influence pediatricians' weight assessment and management practices.

Methods: A web-based survey was distributed to U.S. pediatricians. Respondents were asked to identify the weight status of photographed children and about their weight assessment and management practices. Associations between career and personal demographic variables and pediatricians' weight perceptions, weight assessment and management practices were evaluated using univariate and multivariate modeling.

Results: 3,633 pediatric medical providers correctly identified the weight status of children at a median rate of 58%. The majority of pediatric clinicians were white, female, and of normal weight status with more than 10 years clinical experience. Experienced pediatric medical providers were less likely than younger colleagues to correctly identify the weight status of pictured children and were also less likely to know and use BMI criteria for assessing weight status. General pediatricians were more likely than subspecialty practitioners to provide diverse interventions for weight management. Non-white and Hispanic general practitioners were more likely than counterparts to consider cultural approaches to weight management.

Conclusion: Pediatricians' perceptions of children's weight and their weight assessment and management practices are influenced by career and personal characteristics. Objective criteria and clinical guidelines should be uniformly applied by pediatricians to screen for and manage pediatric obesity.

References

    1. Ogden CL, Flegal KM, Carroll MD, Johnson CL. Prevalence and trends in overweight among US children and adolescents, 1999–2000. Jama. 2002;288:1728–1732. doi: 10.1001/jama.288.14.1728.
    1. Global Strategy on Diet, Physical Activity and Health: Obesity and Overweight
    1. Sinha R, Fisch G, Teague B, Tamborlane WV, Banyas B, Allen K, Savoye M, Rieger V, Taksali S, Barbetta G, et al. Prevalence of impaired glucose tolerance among children and adolescents with marked obesity. N Engl J Med. 2002;346:802–810. doi: 10.1056/NEJMoa012578.
    1. Mallory GB, Jr, Fiser DH, Jackson R. Sleep-associated breathing disorders in morbidly obese children and adolescents. J Pediatr. 1989;115:892–897. doi: 10.1016/S0022-3476(89)80738-3.
    1. Lavine JE, Schwimmer JB. Pediatric initiatives within the Nonalcoholic Steatohepatitis-Clinical Research Network (NASH CNR) J Pediatr Gastroenterol Nutr. 2003;37:220–221. doi: 10.1097/00005176-200309000-00002.
    1. Sorof J, Daniels S. Obesity hypertension in children: a problem of epidemic proportions. Hypertension. 2002;40:441–447. doi: 10.1161/01.HYP.0000032940.33466.12.
    1. Schwimmer JB, Burwinkle TM, Varni JW. Health-related quality of life of severely obese children and adolescents. Jama. 2003;289:1813–1819. doi: 10.1001/jama.289.14.1813.
    1. Barlow SE, Dietz WH. Obesity evaluation and treatment: Expert Committee recommendations. The Maternal and Child Health Bureau, Health Resources and Services Administration and the Department of Health and Human Services. Pediatrics. 1998;102:E29. doi: 10.1542/peds.102.3.e29.
    1. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120:S164–192. doi: 10.1542/peds.2007-2329C.
    1. Expert Committee Recommendations on the Assessment, Prevention, and Treatment of Child and Adolescent Overweight and Obesity
    1. Riley MR, Bass NM, Rosenthal P, Merriman RB. Underdiagnosis of pediatric obesity and underscreening for fatty liver disease and metabolic syndrome by pediatricians and pediatric subspecialists. J Pediatr. 2005;147:839–842. doi: 10.1016/j.jpeds.2005.07.020.
    1. O'Brien SH, Holubkov R, Reis EC. Identification, evaluation, and management of obesity in an academic primary care center. Pediatrics. 2004;114:e154–159. doi: 10.1542/peds.114.2.e154.
    1. Mabry IR, Clark SJ, Kemper A, Fraser K, Kileny S, Cabana MD. Variation in establishing a diagnosis of obesity in children. Clin Pediatr (Phila) 2005;44:221–227.
    1. Dorsey KB, Wells C, Krumholz HM, Concato JC. Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice. Arch Pediatr Adolesc Med. 2005;159:632–638. doi: 10.1001/archpedi.159.7.632.
    1. Dilley KJ, Martin LA, Sullivan C, Seshadri R, Binns HJ. Identification of overweight status is associated with higher rates of screening for comorbidities of overweight in pediatric primary care practice. Pediatrics. 2007;119:e148–155. doi: 10.1542/peds.2005-2867.
    1. Cook S, Weitzman M, Auinger P, Barlow SE. Screening and counseling associated with obesity diagnosis in a national survey of ambulatory pediatric visits. Pediatrics. 2005;116:112–116. doi: 10.1542/peds.2004-1517.
    1. Barlow SE, Bobra SR, Elliott MB, Brownson RC, Haire-Joshu D. Recognition of childhood overweight during health supervision visits: Does BMI help pediatricians? Obesity (Silver Spring) 2007;15:225–232. doi: 10.1038/oby.2007.535.
    1. Klein JD, Sesselberg TS, O'Connor K, Cook S, Johnson M, Washington R, Krebs N, Homer C. Childhood obesity practices of US pediatricians in 2006. Pediatric Academic Societies: 2007; Toronto, Canada. 2007.
    1. Kuczmarski RJ, Ogden CL, Guo SS, Grummer-Strawn LM, Flegal KM, Mei Z, Wei R, Curtin LR, Roche AF, Johnson CL. 2000 CDC Growth Charts for the United States: methods and development. Vital and health statistics. 2002. pp. 1–190.
    1. Kuczmarski RJ, Flegal KM. Criteria for definition of overweight in transition: background and recommendations for the United States. Am J Clin Nutr. 2000;72:1074–1081.
    1. Zeger SL, Liang KY. Longitudinal data analysis for discrete and continuous outcomes. Biometrics. 1986;42:121–130. doi: 10.2307/2531248.
    1. R Development Core Team . R: A language and environment for statistical computing. Vienna, Austria: R Foundation for Statistical Computing; 2006.
    1. Carey VJ. gee: Generalized Estimation Equation Solver. R package version 413-10. 2002.
    1. Eysenbach G. Improving the quality of Web surveys: the Checklist for Reporting Results of Internet E-Surveys (CHERRIES) Journal of medical Internet research. 2004;6:e34. doi: 10.2196/jmir.6.3.e34.
    1. Huang JS, Becerra K, Oda T, Walker E, Xu R, Donohue M, Chen I, Curbelo V, Breslow A. Parental ability to discriminate the weight status of children: results of a survey. Pediatrics. 2007;120:e112–119. doi: 10.1542/peds.2006-2143.
    1. Dorsey KB, Wells C, Krumholz HM, Concato J. Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice. Arch Pediatr Adolesc Med. 2005;159:632–638. doi: 10.1001/archpedi.159.7.632.
    1. Reilly JM. Are obese physicians effective at providing healthy lifestyle counseling? American family physician. 2007;75:738. 741.
    1. McAdams MA, Van Dam RM, Hu FB. Comparison of self-reported and measured BMI as correlates of disease markers in US adults. Obesity (Silver Spring) 2007;15:188–196. doi: 10.1038/oby.2007.504.
    1. Klag MJ, He J, Mead LA, Ford DE, Pearson TA, Levine DM. Validity of physicians' self-reports of cardiovascular disease risk factors. Ann Epidemiol. 1993;3:442–447.

Source: PubMed

Patrocinadores y Colaboradores

Condiciones médicas

Intervenciones de drogas

3
Suscribir