Primary Care Providers' Knowledge, Practices, and Perceived Barriers to the Treatment and Prevention of Childhood Obesity

Abstract

This study evaluated primary care providers' (PCPs, pediatricians, and nurse practitioners) knowledge, current practices, and perceived barriers to childhood obesity prevention and treatment, with an emphasis on first-year wellchild care visits. A questionnaire was distributed to 192 PCPs in the primary care network at The Children's Hospital of Philadelphia (CHOP) addressing (i) knowledge of obesity and American Academy of Pediatrics (AAP) guidelines, (ii) anticipatory guidance practices at well visits regarding nutrition and exercise, and (iii) perceived barriers to childhood obesity treatment and prevention. Eighty pediatricians and seven nurse practitioners responded, and a minority correctly identified the definition (26%) and prevalence (9%) of childhood overweight and AAP guidelines for exercise (39%) and juice consumption (44%). Most PCPs (81%) spent 11-20 min per well visit during the first 2 years, and 79% discussed diet, nutrition, and exercise for ≥3 min. Although >95% of PCPs discussed juice, fruits and vegetables, sippy cups, and finger foods during the first year, over 35% never discussed fast food, TV, or candy, and 55% never discussed exercise. Few rated current resources as adequate to treat or prevent childhood obesity. Over 90% rated the following barriers for obesity prevention and treatment as important or very important: parent is not motivated, child is not motivated, parents are overweight, families often have fast food, watch too much TV, and do not get enough exercise. In conclusion, there is much room to improve PCPs' knowledge of obesity and AAP guidelines. Although PCPs rate fast-food consumption, TV viewing, and lack of exercise as important treatment barriers, many never discussed these topics during the first year.

Health profiles of overweight and obese youth attending general practice

“…Literature shows that general practitioners (GPs) acknowledge their potential role in the management of childhood obesity, but the majority of GPs do not address weight in regular consultations 6. Barriers include the limited evidence base for effective management7 and perceptions held by primary care providers that parents and children lack the motivation to change 8. Notwithstanding these issues, with young people attending primary care at least annually there are many opportunities for detection of weight issues and preventive health advice 9…”

Primary Care Providers' Self-Efficacy and Outcome Expectations for Childhood Obesity Counseling

“…16,17 Competing priorities in a busy clinical practice in addition to perceived barriers, such as lack of time, practice, and community level resources, and reimbursement may make it less likely for providers to spend time discussing obesity. 5,18,19 Previous studies have explored practice characteristics (number of staff, location, and access to educational material and community resources) and preventive service delivery, not including obesity. 20,21 Practice characteristics vary greatly, but these characteristics may impact the provider's ability to provide preventive services, such as obesity-related counseling.…”

Evaluating Parents and Adult Caregivers as “Agents of Change” for Treating Obese Children: Evidence for Parent Behavior Change Strategies and Research Gaps

“…Another report of 87 primary care pediatricians and nurse practitioners found that only 26% knew the definition of childhood obesity and 9% knew its prevalence, whereas only 39% and 44% knew the American Academy of Pediatrics' guidelines for exercise and juice consumption, respectively. 10 More than 35% of the respondents never discussed fast food, television, or candy and 55% never discussed exercise at well child visits in the first year of life. The management of obesity in primary care settings is an emerging area of healthcare research, [11][12][13] and greater information dissemination on core behavior change strategies by health professionals is needed.…”