Provider views on childhood obesity management in primary care settings: a mixed methods analysis

Abstract

BackgroundPediatric providers are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. The goal of this study was to examine the views of pediatric providers on conducting obesity management in the primary care setting, and identify potential resources and care models that could facilitate delivery of this care.MethodsA mixed methods approach was utilized. Four focus groups were conducted with providers from a large pediatric network in San Diego County. Based on a priori and emerging themes, a questionnaire was developed and administered to the larger group of providers in this network.ResultsBarriers to conducting obesity management fell into four categories: provider-level/individual (e.g., lack of knowledge and confidence), practice-based/systems-level (e.g., lack of time and resources), parent-level (e.g., poor motivation and follow-up), and environmental (e.g., lack of access to resources). Solutions centered around implementing a team approach to care (with case managers and health coaches) and electronic medical record changes to include best practice guidelines, increased ease of documentation, and delivery of standardized handouts/resources. Survey results revealed only 23.8% of providers wanted to conduct behavioral management of obesity. The most requested support was the introduction of a health educator in the office to deliver a brief behavioral intervention.ConclusionWhile providers recognize the importance of addressing weight during a well-child visit, they do not want to conduct obesity management on their own. Future efforts to improve health outcomes for pediatric obesity should consider implementing a collaborative care approach.

Referrals and Management Strategies for Pediatric Obesity—DocStyles Survey 2017

“…While self-efficacy for weight management holds value, evidence suggests non-traditional healthcare providers, such as health coaches (40) might be beneficial in pediatric weight management. In addition, inter-professional collaborations (i.e., between dietitians, exercise therapists, and others) are beneficial for childhood obesity management (17, 23). Family practitioners had lower odds of referral to clinical subspecialists, and to clinic/hospital-based weight management programs, compared to pediatricians.…”

Perception and Management of Obesity Among Pakistani Doctors

“…Another interesting comparison can be drawn from doctors’ confidence levels in conducting health checks on obese patients: while 66% of doctors from our study claimed confidence, only 44% of residents felt qualified to treat such patients in the US [16]. Doctors elsewhere also carried negative opinions about their roles in managing obesity, including their knowledge and confidence levels [17-18].…”

“…The presence of dietitians, psychologists, and physiotherapists was universally stressed [18]. Lack of time was cited as a major barrier to managing obese patients [18-20]. Interestingly, this was also found to be a significant barrier for caretakers in addressing their child’s obesity [21].…”

“…This reinforced our finding that doctors of normal weight were more confident in the management and counseling of adult and childhood obesity, respectively. Doctors were also found to lack confidence in the management of childhood obesity in particular [18]. Parent perception of childhood obesity was also a recurrent topic of discussion.…”

Advanced Practice Nursing student knowledge in obesity management: A mixed methods research study

“…It is imperative to ensure that students are comfortable with obesity management upon graduation (American Nurse Practitioner Foundation, 2013). Thus, providing effective strategies and confidence builders are crucial when training APNs to care for patients who struggle with weight issues (American Nurse Practitioner Foundation, 2013; Rhee, Kessl, Lindback, Littman, & El-Kareh, 2018).…”