Screening and Counseling for Childhood Obesity: Results from a National Survey

The Journal of the American Board of Family Medicine

Tracy S. Sesselberg²  Karen G. O'Connor³  Mark S. Johnson¹  Jonathan D. Klein³ 

[1] Department of Family Medicine, University of Medicine and Dentistry, New Jersey Medical School, Newark (MSJ);Division of Adolescent Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY (TSS);Department of Research, American Academy of Pediatrics, Elk Grove Village, IL (KGO, JDK)

关键词: Obesity;    Pediatrics;    Child;    Prevention;    Screening;    Counseling;   

DOI  :  10.3122/jabfm.2010.03.090070

学科分类：过敏症与临床免疫学

来源: The American Board of Family Medicine

【 摘 要 】

Purpose: To examine family physicians’ beliefs and practices about using body mass index (BMI) percentiles to screen for childhood overweight and obesity.

Methods: Surveys about management of childhood overweight were mailed to 1800 American Academy of Family Physician members in 2006.

Results: 729 surveys were returned; 445 were eligible. Most (71%) members were familiar with BMI guidelines; 41% were familiar with American Academy of Family Physician recommendations about overweight. Most (78%) had tools available to calculate BMI; fewer have enough time for overweight screening (55%), and only 45% reported computing BMI percentile at most or every well visit for children older than 2. Having an electronic health record increased BMI screening rates. Family physicians felt prepared to discuss weight, but only 43% believed their counseling was effective and many (55%) lack community or referral services. Most (72%) wanted simple diet and exercise recommendations for patients. Reimbursement for weight-related services is insufficient: 86% say that patients cannot pay for services not covered by insurance. Factor analysis identified clinician self-efficacy, resources, and reimbursement as factors related to calculating BMI percentiles.

Conclusions: BMI is underutilized by family physicians. Most believe they should try to prevent overweight and have tools to use BMI, but clinicians have few resources available for treatment, have low self-efficacy, and report inadequate reimbursement.

• Obesity
• Pediatrics
• Child
• Prevention
• Screening
• Counseling

Childhood overweight (and obesity) has been recognized as a significant health problem in the United States. The prevalence of overweight among children has increased significantly for the past 20 years: 17% of children aged 2 to 19 are now considered to be overweight.¹ Overweight children are at significant risk for many medical conditions, including cardiovascular disease, type 2 diabetes, and psychosocial issues such as lowered self-esteem and depression.^2–4 An American Academy of Family Physicians (AAFP) 2004 policy statement urged that obesity be considered a chronic disease and treated as such and that diagnosis and treatment be reimbursable.⁵ Continuing Medical Education (CME) training about healthy lifestyles is available on the AAFP website, as are links to CME for the Endocrine Society's guidelines for pediatric obesity,^6,7 which were sent to AAFP members in September 2008.

Prevention and early identification are key to decreasing the prevalence of overweight. In 2000, the Centers for Disease Control recommended using age- and gender-adjusted body mass index (BMI; kg/m²) to screen for overweight children ages 2 to 19 years old.^8,9 Monitoring for upward crossing of BMI percentiles may identify children at risk of becoming overweight sooner than traditional plotting of weight for age. In 2003, the American Academy of Pediatrics released a policy statement recommending that providers “calculate and plot BMI (percentiles) once a year in all children and adolescents” as well as to “[u]se change in BMI to identify rate of excessive weight gain relative to linear growth.”¹⁰ The rate at which BMI percentile is measured in practice since publication of the newest guidelines is unknown, and little research has been done on BMI use among family physicians. Although the recommendation to use BMI to screen for overweight was introduced as early as 1998,^11,12 subsequent studies have demonstrated that providers who care for children have not fully adopted BMI in the evaluation of overweight children. Barlow et al¹³ reported in 2002 that only 19% of pediatricians used BMI. Among North Carolina pediatricians, only 11% “always” use BMI and 31% “never” use BMI.¹⁴ Some believe that they can easily recognize the child or adolescent who is overweight.¹⁵ More recently, a study in 2 family medicine practices found that 63% of adult patients had BMI calculated during a well visit. Height and weight were calculated for 95% of the children, but none had BMI calculated; the authors recommended that family physicians use BMI for age for children and adolescents.¹⁶ Clinicians rarely document overweight, although they perceive high BMI more seriously than weight and height measures.¹⁴ When documentation occurs, screening, counseling, and referral rates increase.^16,17 Another recent study found that pediatricians identified training, time, and resources as barriers to BMI use.¹⁸ Among family physicians, use of an electronic health record (EHR) significantly increased the use of BMI and increased documentation and treatment of obese (but not overweight) adults.¹⁹ Few strategies have been found to be effective for treatment of childhood overweight and obesity, although a recent Cochrane Review²⁰ concluded that family-based lifestyle interventions can be effective. We conducted this study to obtain baseline data on the prevalence of BMI percentile use in family practice and to determine what modifiable factors may predict or prevent BMI percentile use.

【 授权许可】

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