Fitwits MD : An Office-Based Tool and Games for Conversations about Obesity with 9- to 12-Year-Old Children

McGaffey, Ann; Abatemarco, Diane J.; Jewell, Ilene Katz; Fidler, Susan K.; Hughes, Kristin

doi:10.3122/jabfm.2011.06.100278

Cited by 9 publications

(13 citation statements)

References 7 publications

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“…Two studies described the results of provider education interventions. Clinicians trained on the use of a brief, structured intervention for school-age children involving the use of flash-cards and take-home games reported increased physician comfort and competence discussing obesity issues [52]. Pediatricians and registered dieticians who received training on motivational interviewing techniques reported the need for more role-playing activities and experience asking open-ended questions [53].…”

Section: Review Findingsmentioning

confidence: 99%

Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic- and Community-Based Recommendations and Interventions

et al. 2013

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Although pediatric providers have traditionally assessed and treated childhood obesity and associated health-related conditions in the clinic setting, there is a recognized need to expand the provider role. We reviewed the literature published from 2005 to 2012 to (1) provide examples of the spectrum of roles that primary care providers can play in the successful treatment and prevention of childhood obesity in both clinic and community settings and (2) synthesize the evidence of important characteristics, factors, or strategies in successful community-based models. The review identified 96 articles that provide evidence of how primary care providers can successfully prevent and treat childhood obesity by coordinating efforts within the primary care setting and through linkages to obesity prevention and treatment resources within the community. By aligning the most promising interventions with recommendations published over the past decade by the Institute of Medicine, the American Academy of Pediatrics, and other health organizations, we present nine areas in which providers can promote the prevention and treatment of childhood obesity through efforts in clinical and community settings: weight status assessment and monitoring, healthy lifestyle promotion, treatment, clinician skill development, clinic infrastructure development, community program referrals, community health education, multisector community initiatives, and policy advocacy.

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Section: Review Findingsmentioning

confidence: 99%

Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic- and Community-Based Recommendations and Interventions

et al. 2013

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“…Many resources (28) (29) have been developed to promote conversations, but lack rigorous evaluation of their efficacy and effectiveness. The feasibility of one tool, FitWits MD ™ (30), designed to improve the effectiveness of discussion and family-related barriers to childhood obesity discussions, found 40.7% of physicians used this tool during at least half of their visits, and of those who used FitWits MD ™ 96.2% reported increased comfort, 96.3% enhanced competence, and 77.7% fewer barriers. The discussion of difficult health-related issues could be an opportunity to strengthen the provider-family/patient relationship.…”

Section: Discussionmentioning

confidence: 99%

A Preschool Obesity Treatment Clinical Trial: Reasons Primary Care Providers Declined Referrals

Robson

Bolling²,

McCullough

et al. 2016

The Journal of Pediatrics

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Objective To examine primary care providers’ (PCPs) referral of preschool children with obesity (≥ 95th percentile for body mass index [BMI]) to a weight management intervention when offered through a randomized clinical trial (RCT) and identification of reasons for not referring children. Study design In Phase-I, three experts across obesity, psychology, and nutrition completed an open card sort and classified PCP decline reasons into groups based on similarity of reasons. Categories were then defined and labeled. In Phase-II, two independent sorters placed the decline reasons into one of the categories defined in Phase-I. Results PCPs referred 78% of eligible children to the RCT. Referred children had a significantly higher weight (48.4 vs. 46.1 lbs., p<0.001) and BMI percentile (97.6 vs. 97.0, p<0.001) than children declined for referral. Eleven decline categories were identified in Phase-I. Phrase-II obtained excellent reliability between each independent sorter and the Phase-I categories, and between the two independent sorters (kappas of 0.72–1.0). The most common reason for declining was “Family not a good fit” (23.6%), followed by “doesn’t believe weight is a problem” (13.9%), “family would not be interested” (12%), and “doesn’t believe measurement is accurate” (11.5%). Appropriately, exclusionary criteria of the RCT (11.8%), was also a reason. Conclusion Availability of weight management for preschoolers through RCTs appeared to overcome barriers of resources, time, and credible treatment cited in prior studies. However, concern about the family’s response or interest in a weight management remained barriers as did PCP perceptions about obesity in young children. Trial registration ClinicalTrials.gov: NCT01546727

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“…Maybe one answer to behavior change is to incorporate some flash cards and games, as noted in the research letter by McGaffey et al 10 With a few minutes, physicians (mostly residents) could easily incorporate office-based exercise counseling for 9-to 12-year-old children, and they reported being more comfortable about so doing in the future.…”

Section: Conflict Of Interestmentioning

confidence: 99%

Change, Lack of Change, and Creating Optimal Change Out of Chaos

Bowman¹,

Neale²

2011

The Journal of the American Board of Family Medicine

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Once again, we consider how to effect practice change at the local and national levels. This issue includes several articles that relate to quality improvement. Some physician actions seem resistant to change, as do the underlying social determinants and processes that lead to what are thought to be avoidable hospitalizations, but we also find that concerted effort, along with standardized orders sets and other avenues, can make a difference. Sometimes, however, our attempts at change can lead to more distraction then efficacy. Here we include articles that place the quality issues in context, report interventions, and advance the types of specific knowledge that allow interventional trials. We also have several articles about cancer screening and follow-up, a subset of quality improvement. Quality ImprovementBaird 1 provides us with a fascinating historic and nuanced reflection of how and whether medical homes represent something new or otherwise different from former attempts at reform in family medicine, specifically managed care. In light of previous inflated expectations of the ways in which reforms can change medical care, he says, "no villains allowed."Information chaos is clearly one of the reasons that we struggle to improve quality to a desired level. Beasley and colleagues 2 provide a structure to consider the information chaos, the negative outcomes of the chaos, and some direction for future research. This construct also relates to our tonguein-cheek, yet provocative, selection from Baxley et al.3 who suggests that we sometimes act as if we have attention deficit disorder as we attempt to implement multiple concurrent Plan-Do-StudyAct practice improvement projects. It is a variant of a "quality improvement disorder." Therefore, some remedies are in order. However, the answer is not to just take a pill daily and hope it will go away. Hopefully, we can improve the quality of our quality improvement activities.In one major attempt to improve health care nationally, the Affordable Care Act mandates that the Centers for Medicaid and Medicare Services (CMS) implement a 10% payment increase for primary care. CMS criteria defining primary care are unfortunately currently inadequate to the task because they exclude many family physicians, particularly those in more rural settings or those who provide a broader range of services, as documented by research from the Robert Graham Center. 4 On to specific examples from the articles in this issue. We know that preventable hospitalizations vary by location, but just how easy are these to avert? Sumner et al 5 determined that the differences in preventable hospitalizations between the counties in Kentucky persisted over time. This suggests that underlying problems or processes are not readily changed, and that needed health care improvements will be relatively resistant to transformation.Another specific quality improvement item that seems resistant to change is the ordering of urine cultures for women with urinary tract infection symptoms. Obtaining urine culture...

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Fitwits MD : An Office-Based Tool and Games for Conversations about Obesity with 9- to 12-Year-Old Children

Cited by 9 publications

References 7 publications

Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic- and Community-Based Recommendations and Interventions

Expanding the Role of Primary Care in the Prevention and Treatment of Childhood Obesity: A Review of Clinic- and Community-Based Recommendations and Interventions

A Preschool Obesity Treatment Clinical Trial: Reasons Primary Care Providers Declined Referrals

Change, Lack of Change, and Creating Optimal Change Out of Chaos

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