JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
Childhood Obesity Screening and Treatment Practices of Pediatric Healthcare Providers Amanda Staiano, PhD; Arwen Marker, BA; Michelle Liu, BS; Ellery Hayden, Daniel Hsia, MD; Stephanie Broyles, PhD
Obesity is characterized by a body mass index (BMI) ≥ 95th percentile and affects 17% of youth in the United States. 1 Family- based, intensive, multidisciplinary behavioral intervention has been proven efficacious to treat childhood obesity, 2 including sustainedweight lossupto10yearsafter theprogram. 3 TheUnited States Preventive Services Task Force (USPSTF) recommends that clinicians screen all children ages six years and older for obesity, then offer or refer them to an intensive and comprehensive behavioral intervention for obesity treatment if necessary. 4 The interventions should include dietary, physical activity, and behavioral counseling; be moderate (>25 to 75 contact hours) to high (> 75 contact hours) intensity; and delivered over at least six months. 4,5 This recommendation aligns with the stage 3 comprehensive multidisciplinary intervention of the four-stage treatment approach recommended by the Expert Committee convened by the American Medical Association, Centers for Disease Control and Prevention, and American Academy of Pediatrics. 6 While one survey evaluating clinicians’ screening practices for obesity was recently conducted among tertiary care hospitals, 7 this study sought to document how pediatric primary care providers and allied health professionals manage their patients’ weight and whether these primary care providers follow clinic practice guidelines. Most pediatric medical visits occur in primary care settings, 8 and the primary care setting offers an opportunity for early detection and intervention to achieve a healthy weight. Further, the extent to which health care providers screen for obesity-related comorbidities such as type 2 diabetes mellitus (T2DM) in youth is not known, despite an escalation in cases of pediatric T2DM in recent years. 9 The American Diabetes Association 10 and American Academy of Pediatrics 11 recommend screening children who are overweight (BMI ≥ 85th percentile) This study evaluated physicians’ childhood obesity screening and treatment practices. A26-question surveywas delivered topediatric providers in-personor viamail, e-mail, or fax throughout Louisiana. Fifty-sevenproviders completed the survey, themajority inprimary care clinics. Five providers met at least four of seven clinical guidelines, but no provider met all of the guidelines. Whereas 88% of providers screened for obesity, 7% met guidelines for referring patientswithobesity toweightmanagement services. Six providers offered interventions that included all recommended components (i.e. dietary, physical activity, and behavioral counseling). One intervention met intensity guidelines (i.e. >25 hours delivered over at least six months). Barriers to offering services included lack of reimbursement and poor compliance by families. Solutions to overcome treatment barriers should be identified to increase the provision of health care services for children with obesity.
and have any two additional risk factors for diabetes every three years upon reaching age 10 or puberty. Recommended screening tools are based on hemoglobin A1c criteria or plasma glucose criteria. The objective of this study was to identify pediatric healthcare providers’ current obesity and T2DM screening practices and the referral or provision of behavioral interventions for the treatment of childhood obesity.
METHODS
Participants
A survey was directly distributed to 677 health care providers located in 164 clinics in 28 cities in the United States state of Louisiana. The survey was distributed to an additional 675 stakeholders including representatives from the Louisiana chapter of the American Academy of Pediatrics, insurance groups, advocacy groups, and academia throughout the state, with a letter requesting that the stakeholder forward the survey to primary care providers. In total, 70 providers started and 57 completed the survey (26 online and 31 completed by hand), for a response rate of 10% (among providers directly solicited) and a completion rate of 81%. Pennington Biomedical Research Center’s Institutional Review Board approved the protocol and survey. No formal written consent was administered, but the following was included on the survey to notify participants that responses were collected for research purposes: “Your participation in this survey is voluntary and you do not have to participate if you do not want
2 J La State Med Soc VOL 169 JANUARY/FEBRUARY 2017
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