CHILDHOOD OBESITY PRACTICES OF US PEDIATRICIANS IN 2006 Jonathan D. Klein, Tracy S. Sesselberg, Karen O'Connor, Stephen Cook, Mark Johnson, Reginald Washington, Nancy Krebs, Charles Homer.. Pediatrics, University of Rochester, Rochester, NY; American Academy of Pediatrics, Elk Grove Village, IL; Family Medicine, UMDNJ-New Jersey Medical School, NJ; University of Colorado, Denver; NICHQ, Cambridge, MA.  Presented at the 2007 Pediatric Academic Societies' Annual Meeting.

Background: Guidelines recommend BMI screening and counseling about diet and excercise, however little is known about pediatricians' current practices with overweight children.

Objective: To assess how pediatricians address overweight children and identify barriers to BMI screening and counseling.

Design/Methods: A 2006 Periodic Survey of 1622 AAP members; 63% response rate; analysis limited to practicing MDs providing health supervision (n=677). Attitudes and practices were examined using frequencies and logistic regression.

Results: Pediatricians (99%) report measuring height and weight at well visits. Half (52%) assess BMI for children >2 yrs of age, primarily with BMI wheels or calculators. Most think parents want them to discuss overweight (59%). Most also discuss physical activity (86%) and fruits and vegetables (89%) with all patients at well visits; fewer discuss sugar-sweetened beverages (65%), snacks (55%), fast food (44%) or the food pyramid (31%). Most pediatricians feel somewhat (60%) or very (29%) prepared to counsel on overweight, and 92% are comfortable doing so. However, only 38% think counseling is effective, 21% say time constraints impede BMI screening, and <20% use decision tools to help manage overweight. Many are unfamiliar with billing codes for overweight (62%) and do not think either reimbursement (56%) or time to counsel (67%) is sufficient. Only 14% can bill overweight separately from well visits, and most (69%) say weight management programs are not covered by insurance. Half (53%) say they lack adequate referral resources. In logistic models, BMI use at most/all visits was not associated with clinician age, gender, or practice area. Clinicians in large practices (OR=1.85; 95% CI 1.19-2.87) and medical schools, hospitals, or clinics were more likely to be using BMI (OR= 2.25; 95% CI 1.28-3.97).

Conclusions: Weighing children is common, but BMI use is not. Most pediatricians do not feel well prepared to address overweight, and many want counseling tools, better reimbursement and more nutrition/activity referral resources. Different care settings may require different strategies to improve childhood obesity care.