Survey of Physician Attitudes and Practices Related to Pediatric Obesity

Jelalian, Elissa; Boergers, Julie; Alday, C. Sloan; Frank, Rachel

doi:10.1177/000992280304200307

Cited by 150 publications

(161 citation statements)

References 30 publications

(5 reference statements)

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“…11,12 Nearly 80% of pediatricians report frustration with modifying children's obesity, however. 13 Patient motivation is associated with program adherence and predicts weight reduction. 14 Including brief motivational techniques such as motivational interviewing (MI) in weight control interventions increases effectiveness.…”

Section: What This Study Addsmentioning

confidence: 99%

Motivational Interviewing With Parents for Obesity: An RCT

et al. 2015

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BACKGROUND AND OBJECTIVE: Motivational interviewing (MI) has been shown to be an effective strategy for targeting obesity in adolescents, and parental involvement is associated with increased effectiveness. The aim of this study was to evaluate and compare the role of parental involvement in MI interventions for obese adolescents.METHODS: A total of 357 Iranian adolescents (aged 14-18 years) were randomized to receive an MI intervention or an MI intervention with parental involvement (MI + PI) or assessments only (passive control). Data regarding anthropometric, biochemical, psychosocial, and behavioral measures were collected at baseline and 12 months later. A series of intention-totreat, 2-way repeated-measures analysis of covariance were performed to examine group differences in change in outcomes measures over the 12-month follow-up period.RESULTS: Results revealed significant effects on most of the outcome parameters for MI + PI (eg, mean 6 SD BMI z score: 2.58 6 0.61) compared with the passive control group (2.76 6 0.70; post hoc test, P = .02), as well as an additional superiority of MI + PI compared with MI only (2.81 6 0.76; post hoc test, P = .05). This pattern was also shown for most of the anthropometric, biochemical, psychometric, and behavioral outcome variables.CONCLUSIONS: MI with parental involvement is an effective strategy in changing obesity-related outcomes and has additional effects beyond MI with adolescents only. These findings might be important when administering MI interventions in school settings. WHAT'S KNOWN ON THIS SUBJECT:Motivational interviewing (MI) has been found to increase the effectiveness of weight loss programs in obese children and adolescents. Although parental involvement seems to be linked to its effectiveness, strong conclusions cannot be drawn. WHAT THIS STUDY ADDS:The present study found that MI with parental involvement is an effective strategy in changing obesity-related outcomes and has additional effects beyond MI with adolescents only. These findings are important when administering MI interventions in school settings.

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Section: What This Study Addsmentioning

confidence: 99%

Motivational Interviewing With Parents for Obesity: An RCT

et al. 2015

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“…12,14 The present study found evidence of this concern and view, not only among GPs but also among practice nurses, school nurses, and health visitors. In addition, researchers have identified GPs feeling professionally unprepared to manage childhood obesity, 10,12 and perceiving their efforts as ineffective.…”

Section: Comparison With Existing Literaturementioning

confidence: 99%

“…9 Researchers have assessed primary care practitioners' views and experiences of treating childhood obesity. [10][11][12][13][14][15] However, to date, only two studies have employed qualitative research methods that enabled practitioners' views and experiences to be explored in detail. 14,15 In addition, the research undertaken so far in this area has been limited to assessing the views of GPs and practice nurses, and was carried out before the publication of the obesity care pathway and the NICE guidance.…”

Section: Introductionmentioning

confidence: 99%

Practitioners' views on managing childhood obesity in primary care: a qualitative study

Turner¹,

Shield²,

Salisbury³

2009

Br J Gen Pract

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BackgroundIn 2006 the Department of Health and the National Institute for Health and Clinical Excellence (NICE) published guidance on the management of childhood obesity, for use by primary care practitioners. Little is known, however, about practitioners' views and experiences of managing childhood obesity in primary care. AimTo explore practitioners' views of primary care as a setting in which to treat childhood obesity. Design of studyQualitative interview study. SettingPrimary care and other community settings based in Bristol, England. MethodInterviews explored practitioners' views and experiences of managing childhood obesity and their knowledge of the recent guidance provided by the Department of Health and NICE. Interviews were audiotaped and transcribed verbatim. Analysis was thematic and comparisons made both within and across the interviews. ResultsThirty practitioners were interviewed: 12 GPs, 10 practice nurses, four school nurses, and four health visitors. Participants varied in their views about whether primary care is an appropriate treatment setting for childhood obesity. However, all described factors that limited the extent to which they could intervene effectively: a lack of expertise, resources, and contact with primary school children; the causes of childhood obesity; and the need to work with parents. It was also apparent that very few participants had knowledge of the recent guidance. ConclusionPractitioners do not currently view primary care as an effective treatment setting for childhood obesity and it is unlikely that the guidance from the Department of Health and NICE will have a meaningful impact on their management of this condition.

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“…To date, there have been a few qualitative studies examining barriers to weight loss from the perspectives of health professionals (9)(10)(11) , parents (4,12,13) and children (13,14) . A survey of American health professionals identified lack of parental involvement, lack of patient motivation and lack of support services as key barriers to the management of childhood obesity (9) .…”

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confidence: 99%

Lessons learned from a family-focused weight management intervention for obese and overweight children

Twiddy

Wilson

Bryant

et al. 2012

Public Health Nutr.

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Objective: Treatment for childhood obesity is characterised by high attrition rates and failure to achieve weight maintenance. It is therefore important to develop more effective programmes. The aim of the present qualitative study was to explore the views of parents, children and health trainers to identify issues which can inform the development of more effective programmes. Design: A qualitative study combining in-depth interviews and focus groups. Participants were selected purposively from current and past attendees. Setting: WATCH-IT, a UK-based community child weight management programme. Subjects: Twenty-three families who had previously attended (or were currently attending) WATCH-IT were interviewed. Focus groups with ten trainers explored their views of the intervention. Results: Parents and children had different goals for involvement, with parents focusing on psychological benefits, while children concentrated on goals relating to weight loss and physical fitness. Parents were found to struggle to provide consistent support to their children and this was exacerbated by family dynamics. The child's commitment to lose weight, support from their family and a good relationship between the child and their trainer were viewed as important keys to successful weight management. Conclusions: The study will guide the design of existing and future programmes by providing insights into issues that challenge successful engagement. It highlights the possible value of exploring the therapeutic relationship between trainers and participants. Keywords Obesity management Children InterventionChildhood obesity is rising almost universally (1,2) . Given the significant long-term health consequences of childhood obesity it is important to consider how best to manage children who are already overweight or obese. The most recent Cochrane review of interventions for childhood obesity examined the results of sixty-four randomised controlled trials and concluded that programmes that involved the whole family and included aspects around nutrition, behaviour modification and physical activity were more effective than those targeting the obese child alone (3) . Although lifestyle interventions can reduce the level of obesity in children and adolescents, attrition rates for interventions were often high (3) . Evidence also suggests that, while children might lose weight following a lifestyle intervention, they often remain in the obese category (4) . It is therefore important to understand those factors associated with success on weight management programmes.Psychological theory can be used to understand how the beliefs of young people, family members and health trainers may influence young people's weight management behaviours. Bandura's Social Cognitive Theory (5) (SCT) proposes that behaviour is a function of aspects of the person and the environment, and that the primary drivers of behaviour change include skills (e.g. ability to exercise more or control calorie intake), self-efficacy (belief in one's ability to perf...

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Survey of Physician Attitudes and Practices Related to Pediatric Obesity

Cited by 150 publications

References 30 publications

Motivational Interviewing With Parents for Obesity: An RCT

Motivational Interviewing With Parents for Obesity: An RCT

Practitioners' views on managing childhood obesity in primary care: a qualitative study

Lessons learned from a family-focused weight management intervention for obese and overweight children

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