Physician practices related to use of BMI-for-age and counseling for childhood obesity prevention: A cross-sectional study

Abstract

BackgroundScreening for obesity and providing appropriate obesity-related counseling in the clinical setting are important strategies to prevent and control childhood obesity. The purpose of this study is to document pediatricians (PEDs) and general practitioners (GPs) with pediatric patients use of BMI-for-age to screen for obesity, confidence in explaining BMI, access to referral clinics, and characteristics associated with screening and counseling to children and their caregivers.MethodsThe authors used 2008 DocStyles survey data to examine these practices at every well child visit for children aged two years and older. Counseling topics included: physical activity, TV viewing time, energy dense foods, fruits and vegetables, and sugar-sweetened beverages. Chi-square tests were used to examine differences in proportions and logistic regression to identify characteristics associated with screening and counseling.ResultsThe final analytic sample included 250 PEDs and 621 GPs. Prevalence of using BMI-for-age to screen for obesity at every well child visit was higher for PEDs than GPs (50% vs. 22%, χ2 = 67.0, p ≤ 0.01); more PEDs reported being very/somewhat confident in explaining BMI (94% vs. GPs, 87%, p < 0.01); more PEDs reported access to a pediatric obesity specialty clinic for referral (PEDs = 65% vs. GPs = 42%, χ2 = 37.5, p ≤ 0.0001).In general, PEDs reported higher counseling prevalence than GPs. There were significant differences in the following topics: TV viewing (PEDs, 79% vs. GPs, 61%, χ2 = 19.1, p ≤ 0.0001); fruit and vegetable consumption (PEDs, 87% vs. GPs, 78%, χ2 = 6.4, p ≤ 0.01). The only characteristics associated with use of BMI for GPs were being female (OR = 2.3, 95% CI = 1.5-3.5) and serving mostly non-white patients (OR = 1.8, 95% CI = 1.1-2.9); there were no significant associations for PEDs.ConclusionsThe findings for use of BMI-for-age, counseling habits, and access to a pediatric obesity specialty clinic leave room for improvement. More research is needed to better understand why BMI-for-age is not being used to screen at every well child visit, which may increase the likelihood overweight and obese patients receive counseling and referrals for additional services. The authors also suggest more communication between PEDs and GPs through professional organizations to increase awareness of existing resources, and to enhance access and referral to pediatric obesity specialty clinics.

Characteristics of US Health Care Providers Who Counsel Adolescents on Sports and Energy Drink Consumption

“…The finding that pediatricians typically exhibited the highest rates of SED counseling is congruent with previous studies, which have also have found that pediatricians more frequently assessed weight status and provided behavioral counseling than family/general practitioners [19, 20]. Nurse practitioners were more likely to provide SED counseling than FGPs and internists in this study.…”

Sugar-Sweetened Beverages and Children's Health

“…Another way researchers and public health advocates have sought to reach children and families with messages about SSBs is through pediatricians (14,36,147). Because many children regularly visit their primary care provider throughout childhood, starting shortly after birth, this channel may be a good way to provide information and education to families about obesity prevention and treatment strategies (147).…”

Overview of the key current population-level strategies used to prevent obesity

“…However, this same study found that fewer than half of over weight patients and one-third of obese patients had been told by their phys i cians about their weight status. Other research in pedi at ric settings has found that only 50% of pedi at ri cians and 22% of general prac ti tion ers used BMI-for-age to screen for obesity at every well-child visit (Wethington et al , 2011).…”