JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY
and 18% of patients aged 2-18 years received diet/nutrition and exercise counseling, respectively, and this counseling was less frequent among socioeconomically disadvantaged children. 17 The present study found even fewer physicians in Louisiana are providing behavioral counseling, with only one program that met USPSTF intensity guidelines (i.e. > 25 hours contact time delivered over at least six months). In a 2006 survey of family practitioners, 86% said families could not afford services not covered by insurance and 55% lacked referral services for weight management programs. 15 Since then, the USPSTF recommendation for obesity screening and comprehensive, intensive behavioral intervention was rated as Grade B, indicating that the task force recommends that practitioners offer or provide this service due to the high certainty that a net benefit is moderate, or moderate certainty that the net benefit is moderate to substantial. 5 The USPSTF recommendation applies to all practitioners, not just tertiary care providers. Under the Patient Protection and Affordable Care Act of 2010, private insurance plans are mandated to cover preventive services with a USPSTF Grade A or B rating without patient cost-sharing. In spite of these recommendations and insurance mandates, providers still reported reimbursement for services as a barrier, are not providing or referring weight management services, and reported using numerous billing codes for obesity screening and treatment. Strengths of this study included responses from 17 areas that covered the major populated regions of the state of Louisiana and from a range of healthcare providers. Focusing on Louisiana providers may pose a challenge for generalizability to other
geographic regions. Yet Louisiana and the lower Mississippi delta region is one of the most medically underserved, at-risk populations living in the United States, characterized by high levels of poverty, food insecurity, obesity, and related diseases. Therefore, the state of Louisiana represents a prime opportunity to establish baseline values of childhood obesity screening and management in order to monitor changes with the enactment of policy and programmatic interventions. This study included several limitations. Despite outreach to over 1,300 providers and affiliated stakeholders and a high number of website visits to the survey, only 10% of the contacted providers participated in the survey. The sample may have been biased towards providers more interested or more active in obesity screening and treatment. Despite including “not applicable” or “do not know” as response items, some questions were skipped by providers, making it difficult to determine practices for the entire sample. In conclusion, obesity and T2DM screening practices were common but the referral and provision of weight management services for children with obesity remained rare among these pediatric healthcare providers. When offered, the interventions did not meet the recommended contact time. Despite clinical guidelines, coupled with legal requirements for insurance coverage, there is a continued lack of behavioral treatment for the most common medical disease among the nation’s youth. To address this deficit in health care access, weight management programs should be developed and disseminated and include reimbursement for services, ongoing provider training, and family input to assure patient commitment.
TABLE 2: Comparison of current screening and treatment practices to the national guidelines among 57 clinicians. Note: Values represent number of respondents unless otherwise noted. (A) includes outpatient clinic, student health center, federally qualified health center; (B) includes adolescent medicine.
J La State Med Soc VOL 169 JANUARY/FEBRUARY 2017 9
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