Pediatrician Engagement in and Tailoring of Treatment for Childhood Obesity in Primary Care: Results from a U.S. National Survey

Janice L. Liebhart, MS,¹ Sandra G. Hassink, MD, MS, FAAP,¹ Jeanne Lindros, MPH,¹ Megan R. Harrison, MPH, RD,² Alyson B. Goodman, MD, MPH,² Blake Sisk, PhD,³ and Stephen R. Cook, MD, MPH, FAAP^1,4

¹American Academy of Pediatrics (AAP), Institute for Healthy Childhood Weight, Itasca, IL, U.S; ²Division

of Nutrition, Physical Activity & Obesity, Centers for Disease Control and Prevention, Atlanta, GA, U.S.; ³AAP Department of Research, Itasca, IL, U.S.; ⁴University of Rochester Medical Center, Division of General Pediatrics, Rochester, NY, U.S.

Presented at the 2018 Pediatric Academic Societies Annual Meeting.

Background: Primary care pediatricians (PCPs) play a pivotal role in responding to the ongoing childhood obesity epidemic. However, little is known about current practices on obesity treatment.

Objective: To assess PCPs’ perceptions and care related to treatment for children in 3 patient groups: overweight, obesity without complications, or obesity with complications/comorbidities.

Methods: The Periodic Survey, based on a national, random sample of AAP U.S. members, was focused on obesity in 2017 (response rate=50%). Analytic sample included practicing, non-resident pediatricians who provide health supervision (n=557). Questions covered follow-up and referrals for each patient group and perceived comfort and attitudes regarding treatment. McNemar tests compared responses across patient groups for follow-up visits and referrals.

Results: For children with overweight and obesity, PCPs report being more likely to follow up and refer as the child’s BMI/comorbidities increase (Figure 1; p<.001 for all). For example, 45% conduct follow-up visits focused on behaviors identified by families for children with overweight, compared to 77% and 87% for children with obesity without and with complications, respectively. Also, for children with obesity and complications, the vast majority report not only providing follow-up visits, but also referring patients locally for treatment: 93% to a dietitian, 79% to a weight management program in a hospital setting and 69% to a community program.

Although most PCPs report being somewhat or very comfortable monitoring behavior change goals (67%), only a modest majority (54%) report such comfort levels for behavior change techniques like motivational interviewing. Consistent with reports about practice, more than 80% believe that management should vary with severity (Figure 2). However, just 56% agree that there are effective means of treatment. Also, 77% report having insufficient time for relevant counseling, and 52% say that there are not enough resources in their area for referrals.

Conclusion: PCPs report being highly engaged in treatment for children with overweight and obesity and that their management varies with the child’s BMI/comorbidities. However, a perceived lack of time and community resources for treatment by PCPs, coupled with modest perceived levels of success and comfort with counseling suggest that both additional training and organizational/systems-level supports are needed to enhance treatment for childhood obesity.