Academic journal article Childhood Obesity

Weight Management-Related Assessment and Counseling by Primary Care Providers in an Area of High Childhood Obesity Prevalence: Current Practices and Areas of Opportunity

Academic journal article Childhood Obesity

Weight Management-Related Assessment and Counseling by Primary Care Providers in an Area of High Childhood Obesity Prevalence: Current Practices and Areas of Opportunity

Article excerpt

[Author Affiliation]

Jennifer M. Nelson. 1 Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA.

Miriam B. Vos. 1 Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA. 2 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 3 Nutrition and Health Sciences Program, Graduate School of Biological and Biomedical Sciences, Emory University, Atlanta, GA.

Stephanie M. Walsh. 1 Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA. 2 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA.

Lauren A. O'Brien. 1 Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA.

Jean A. Welsh. 1 Wellness Department, Children's Healthcare of Atlanta, Atlanta, GA. 2 Department of Pediatrics, Emory University School of Medicine, Atlanta, GA. 3 Nutrition and Health Sciences Program, Graduate School of Biological and Biomedical Sciences, Emory University, Atlanta, GA.

Address correspondence to: Jean A. Welsh, PhD, RN, Wellness Department, Children's Healthcare of Atlanta, 1760 Haygood Drive, Atlanta, GA 30329, E-mail: jwelsh1@emory.edu

Introduction

Childhood obesity in the United States has increased dramatically since the 1970s.1 There has also been an increase in the comorbidities associated with childhood obesity, including hypertension, dyslipidemia, type 2 diabetes, asthma, obstructive sleep apnea, and nonalcoholic fatty liver disease.2 Psychosocial health issues, including depression, low self-esteem, and decreased quality of life, are also more likely to occur among obese children.3 As such, obesity and its associated comorbidities have led to projections for a reduced lifespan.4

There are significant geographic differences in the prevalence of childhood obesity. The southeastern region of the United States, including Georgia, has a higher prevalence of childhood overweight and obesity, when compared with other regions. Over one third (35.0%) of Georgia's 10- to 17-year-olds are overweight or obese, compared to 31.3% nationally.5 It is estimated that only 20% of Georgia's school-aged children are able to pass a basic fitness test.6 Significant work is needed to improve the diet and activity patterns of Georgia's children.

Pediatric primary care providers (PCPs) are positioned to play an important role in promoting the behavior changes necessary to decrease the prevalence of childhood obesity and its associated comorbidities. Most parents view pediatricians as a valued advisor concerning their child's weight.7 Pediatricians, however, often refrain from weight-management-related counseling because they perceive their efforts as futile, they perceive a lack of interest by families, or they lack effective counseling skills.8-10 Less is known about the perceptions and practices of mid-level providers, specifically nurse practitioners/physician assistants (NP/PAs), who play an increasingly important role in the provision of well-child care.11

With growing concern about the prevalence of childhood obesity in Georgia, Children's Healthcare of Atlanta developed the Strong4Life Provider Training program in 2011 to support and improve the healthy weight-management-related counseling efforts of pediatric PCPs. This study was conducted to assess the baseline perceptions and practices of Georgia's pediatric PCPs regarding lifestyle and weight-related counseling done during well-child visits and determine the extent to which these perceptions and practices vary by provider type.

Methods

Sample and Survey Instrument

Multiple 2-hour Strong4Life trainings were held at central locations, physician's offices, and at professional conferences throughout the state of Georgia between August 2012 and September 2013 (Fig. …

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