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11-03-2017 | Obesity | Review | Article

Management of Childhood Obesity and Overweight in Primary Care Visits: Gaps Between Recommended Care and Typical Practice

Journal: Current Nutrition Reports

Authors: Huiying Guo, Melissa Pavek, Katie Loth

Abstract

Purpose of Review

There are many barriers that impact a physician’s ability to adhere to guidelines for the management of childhood overweight and obesity in the context of routine primary care visits. We reviewed current evidence on recommendations, guidelines, and interventions to address well-known barriers to effective management of childhood overweight and obesity.

Recent Findings

Intervention-based studies evaluating programs and treatment/screening options within primary care settings have shown positive outcomes for treatment of childhood overweight/obesity. However, the most effective programs are predominantly larger scale, time consuming, multidisciplinary efforts that are offered separately from the traditional primary care office visit.

Summary

Despite the existence of effective multidisciplinary interventions to treat childhood overweight and obesity, challenges in adopting these interventions within primary care visits continue to limit the impact primary care providers have on the prevention and treatment of pediatric obesity. Few programs and curriculums exist to help primary care providers effectively discuss lifestyle changes within the context of a regular clinical visit. Further research and education curriculum in physician training needs to be developed to address these gaps between recommended care and typical practice.

Hedley AA, Ogden CL, Johnson CL, Carroll MD, Curtin LR, Flegal KM. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2002. JAMA. 2004;291(23):2847–50.CrossRefPubMed

Ogden CL, Carroll MD, Kit BK, Flegal KM. Prevalence of childhood and adult obesity in the United States, 2011-2012. JAMA. 2014;311:806–14.CrossRefPubMedPubMedCentral

•• O’Connor EA, Evans CV, Burda BU, Walsh ES, Eder M, Lozano P. Screening for obesity and intervention for weight management in children and adolescents: evidence report and systematic review for the US Preventive Services Task Force. JAMA. 2017;317(23):2427–44. https://doi.org/10.1001/jama.2017.0332. A through evidence report supporting the most recent USPSTF guidelines for screening and intensive intervention for management of obesity in children and adolescents CrossRefPubMed

Asante PA, Cox J, Sonneville K, Samuels RC, Taveras EM. Overweight prevention in pediatric primary care: a needs assessment of an urban racial/ethnic minority population. Clin Pediatr (Phila). 2009;48:837–43. https://doi.org/10.1177/0009922809339347.CrossRef

Yanovski JA. Pediatric obesity: an introduction. Appetite. 2016;641:3–12. https://doi.org/10.1016/j.appet.2015.03.028.

Bindler RM, Bruya MA. Evidence for identifying children at risk for being overweight, cardiovascular disease, and type 2 diabetes in primary care. J Pediatr Heal Care. 2006;20:82–7. https://doi.org/10.1016/j.pedhc.2005.09.005.CrossRef

Dorsey KB, Wells C, Krumholz HM, Concato J. Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice. Arch Pediatr Adolesc Med. 2008;162(5):417. https://doi.org/10.1001/archpedi.159.7.632.CrossRef

Wethington HR, Sherry B, Polhamus B. Physician practices related to use of BMI-for-age and counseling for childhood obesity prevention: a cross-sectional study. BMC Fam Pract. 2011;12:80. https://doi.org/10.1186/1471-2296-12-80.CrossRefPubMedPubMedCentral

• Tanda R, Salsberry P. The impact of the 2007 expert committee recommendations on childhood obesity preventive care in primary care settings in the United States. J Pediatr Heal Care. 2014;28:241–50. https://doi.org/10.1016/j.pedhc.2013.05.009. This study evaluates the impact of expert committee recommendations upon release through broad survey collection and data gathering CrossRef

10.

Reed M, Cygan H, Lui K. Identification, prevention, and management of childhood overweight and obesity in a pediatric primary care center. Clin Pediatr (Phila). 2016;55:860–6. https://doi.org/10.1177/0009922815614350.CrossRefPubMed

11.

Kolagotla L, Adams W. Ambulatory management of childhood obesity. Obes Res. 2004;12:275–83. https://doi.org/10.1038/oby.2004.35.CrossRefPubMed

12.

Kushner RF. Barriers to providing nutrition counseling by physicians: a survey of primary care practitioners. Prev Med. 1995;24:546–52. https://doi.org/10.1006/pmed.1995.1087.CrossRefPubMed

13.

Nelson JM, Vos MB, Walsh SM, O’Brien LA, Welsh JA. Weight management-related assessment and counseling by primary care providers in an area of high childhood obesity prevalence: current practices and areas of opportunity. Child Obes. 2015;11:194–201. https://doi.org/10.1089/chi.2014.0052.CrossRefPubMedPubMedCentral

14.

•• Bhuyan SS, Chandak A, Smith P, Carlton EL, Duncan K, Gentry D. Integration of public health and primary care: a systematic review of the current literature in primary care physician mediated childhood obesity interventions. Obes Res Clin Pract. 2015;9:539–52. https://doi.org/10.1016/j.orcp.2015.07.005. A detailed review of interventions for childhood obesity examining components, primary care provider role, and the use of the healthcare team CrossRefPubMed

15.

•• Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics. 2007;120:S164–92. A thorough overview of the history and origins of expert committee recommendations along with clear, detailed report of recommendations CrossRefPubMed

16.

Kuczmarski RJ, Ogden CL, Guo SS, et al. 2000 CDC growth charts for the United States: methods and development. Vital Health Stat. 2002;246:1–190.

17.

Plourde G. Preventing and managing pediatric obesity: recommendations for family physicians. Can Fam Physician. 2006;52:322–8.PubMedPubMedCentral

18.

• US Preventive Services Task Force, Grossman DC, Bibbins-Domingo K, Curry SJ, Barry MJ, Davidson KW, et al. Screening for obesity in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2017;317(23):2417–26. https://doi.org/10.1001/jama.2017.6803. A very new and updated recommendation statement from USPSTF for screening and referral of children with obesity age 6 or greater CrossRef

19.

Baker JL, Farpour-Lambert NJ, Nowicka P, Pietrobelli A, Weiss R, Childhood Obesity Task Force of the European Association for the Study of Obesity. Evaluation of the overweight/obese child—practical tips for the primary healthcare provider: recommendations from the Childhood Obesity Task Force of the European Association for the Study of Obesity. Obes Facts. 2010;3(2):131–7. https://doi.org/10.1159/000295112.CrossRefPubMed

20.

Daniels SR, Hassink SG. The role of the pediatrician in primary prevention of obesity. Pediatrics. 2015;136:e275–92. https://doi.org/10.1542/peds.2015-1558.CrossRefPubMed

21.

Moran R. Evaluation and treatment of childhood obesity. Am Fam Physician. 1999;59(4):861–8.PubMed

22.

Murray R, Battista M. Managing the risk of childhood overweight and obesity in primary care practice. Curr Probl Pediatr Adolesc Health Care. 2009;39:146–65. https://doi.org/10.1016/j.cppeds.2009.03.002.CrossRefPubMed

23.

Young KL. Treating overweight children and adolescents in the clinic. Clin Pediatr (Phila). 2005;647–53.

24.

Vine M, Hargreaves MB, Briefel RR, Orfield C. Expanding the role of primary care in the prevention and treatment of childhood obesity: a review of clinic- and community-based recommendations and interventions. J Obes. 2013;2013:172035. https://doi.org/10.1155/2013/172035.CrossRefPubMedPubMedCentral

25.

Neumark-Sztainer D. Preventing obesity and eating disorders in adolescents: what can health care providers do? J Adol Health. 2009;44(3):206–13.CrossRef

26.

Macpherson-Sánchez AE. Integrating fundamental concepts of obesity and eating disorders: implications for the obesity epidemic. Am J Public Health. 2015;105(4):e71–85. https://doi.org/10.2105/AJPH.2014.302507.CrossRefPubMedPubMedCentral

27.

Sivertsen LM, Woolfenden SR, Woodhead HJ, Lewis D. Diagnosis and management of childhood obesity: a survey of general practitioners in South West Sydney. J Paediatr Child Health. 2008;44:622–9. https://doi.org/10.1111/j.1440-1754.2008.01370.x.PubMed

28.

Story MT, Neumark-Stzainer DR, Sherwood NE, Holt K, Sofka D, Trowbridge FL, et al. Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals. Pediatrics. 2002;110(1):210–4.PubMed

29.

Barlow SE, Trowbridge FL, Klish WJ, Dietz WH. Treatment of child and adolescent obesity: reports from pediatricians, pediatric nurse practitioners, and registered dietitians. Pediatrics. 2002;110:229–35. https://doi.org/10.1037/0278-6133.13.5.373.PubMed

30.

Van Gerwen M, Franc C, Rosman S, Le Vaillant M, Pelletier-Fleury N. Primary care physicians’ knowledge, attitudes, beliefs and practices regarding childhood obesity: a systematic review: obesity review. Obes Rev 2009;10:227–236. doi: https://doi.org/10.1111/j.1467-789X.2008.00532.x.

31.

Walker O, Strong M, Atchinson R, Saunders J, Abbott J. A qualitative study of primary care clinicians’ views of treating childhood obesity. BMC Fam Pract. 2007;8:50. https://doi.org/10.1186/1471-2296-8-50.CrossRefPubMedPubMedCentral

32.

Turner KM, Shield JPH, Salisbury C, Reilly J, Methven E, McDowell Z, et al. Practitioners’ views on managing childhood obesity in primary care: a qualitative study. Br J Gen Pract. 2009;59:856–62. https://doi.org/10.3399/bjgp09X472269.CrossRefPubMedPubMedCentral

33.

Jones KM, Dixon ME, Dixon JB. GPs, families and children’s perceptions of childhood obesity. Obes Res Clin Pract. 2014;8:e140–8. https://doi.org/10.1016/j.orcp.2013.02.001.CrossRefPubMed

34.

Gerards SM, Dagnelie PC, Jansen MW, De Vries NK, Kremers SP. Barriers to successful recruitment of parents of overweight children for an obesity prevention intervention: a qualitative study among youth health care professionals. BMC Fam Pract. 2012;13:37. https://doi.org/10.1186/1471-2296-13-37.CrossRefPubMedPubMedCentral

35.

Mikhailovich K, Morrison P. Discussing childhood overweight and obesity with parents: a health communication dilemma. J Child Health Care. 2007;11:311–22. https://doi.org/10.1177/1367493507082757.CrossRefPubMed

36.

Davoli AM, Broccoli S, Bonvicini L, Fabbri A, Ferrari E, D’Angelo S, et al. Pediatrician-led motivational interviewing to treat overweight children: an RCT. Pediatrics. 2013;132:e1236–46. https://doi.org/10.1542/peds.2013-1738.CrossRefPubMed

37.

Lowenstein LM, Perrin EM, Campbell MK, Tate DF, Cai J, Ammerman AS. Primary care providers’ self-efficacy and outcome expectations for childhood obesity counseling. Child Obes. 2013;9:208–15. https://doi.org/10.1089/chi.2012.0119.CrossRefPubMedPubMedCentral

38.

Bailey K, Cunningham C, Pemberton J, Rimas H, Morrison KM. Understanding academic clinicians’ decision making for the treatment of childhood obesity. Child Obes. 2015;11:696–706. https://doi.org/10.1089/chi.2015.0031.CrossRefPubMed

39.

• Sargent GM, Pilotto LS, Baur LA. Components of primary care interventions to treat childhood overweight and obesity: a systematic review of effect. Obes Rev. 2011;12:219–35. https://doi.org/10.1111/j.1467-789X.2010.00777.x. A systematic review that looks at the rigor of interventional studies, largely randomized control studies and also examines the involvement of primary care, components, and intensity in each study CrossRef

40.

• Seburg EM, Olson-Bullis BA, Bredeson DM, Hayes MG, Sherwood NE. A review of primary care-based childhood obesity prevention and treatment interventions. Curr Obes Rep. 2015;4:157–73. https://doi.org/10.1007/s13679-015-0160-0. A comprehensive review that examines characteristics of effective studies and specific roles of primary care providers in interventions CrossRefPubMedPubMedCentral

41.

Anand SG, Adams WG, Zuckerman BS. Specialized care of overweight children in community health centers. Health Aff. 2010;29:712–7. https://doi.org/10.1377/hlthaff.2009.1113.CrossRef

42.

Ball GDC, Mackenzie-Rife KA, Newton MS, Alloway CA, Slack JM, Plotnikoff RC, et al. One-on-one lifestyle coaching for managing adolescent obesity: findings from a pilot, randomized controlled trial in a real-world, clinical setting. Paediatr Child Health (Oxford). 2011;16:345–50. https://doi.org/10.1001/archpediatrics.2011.44.CrossRef

43.

Debar LL, Stevens VJ, Perrin N, Wu P, Pearson J, Jo B, et al. A primary care-based, multicomponent lifestyle intervention for overweight adolescent females. Pediatrics. 2012;129. doi: https://doi.org/10.1542/peds.2011-0863.

44.

Quattrin T, Roemmich JN, Paluch R, Yu J, Epstein LH, Ecker MA. Efficacy of family-based weight control program for preschool children in primary care. Pediatrics. 2012;130:660–6. https://doi.org/10.1542/peds.2012-0701.CrossRefPubMedPubMedCentral

45.

Taveras EM, Marshall R, Kleinman KP, Gillman MW, Hacker K, Horan CM, et al. Comparative effectiveness of childhood obesity interventions in pediatric primary care: a cluster-randomized clinical trial. JAMA Pediatr. 2015;169:535–42. https://doi.org/10.1001/jamapediatrics.2015.0182.CrossRefPubMed

46.

McKee MD, Deen D, Maher S, Fletcher J, Fornari A, Blank AE. Implementation of a pilot primary care lifestyle change intervention for families of pre-school children: lessons learned. Patient Educ Couns. 2010;79:299–305. https://doi.org/10.1016/j.pec.2010.02.025.CrossRefPubMed

47.

Owen SE, Sharp DJ, Shield JPH. The Bristol Online Obesity Screening Tool: experience of using a screening tool for assessing obese children in primary care. Prim Health Care Res Dev. 2011;12:293–300. https://doi.org/10.1017/S1463423611000132.CrossRefPubMed

48.

Park MH, Skow Á, Puradiredja DI, Lucas A, Syrad H, Sovio U, et al. Development and evaluation of an online tool for management of overweight children in primary care: a pilot study. BMJ Open. 2015;5:e007326. https://doi.org/10.1136/bmjopen-2014-007326.CrossRefPubMedPubMedCentral

49.

Ayash CR, Simon SR, Marshall R, Kasper J, Chomitz V, Hacker K, et al. Evaluating the impact of point-of-care decision support tools in improving diagnosis of obese children in primary care. Obesity. 2013;21:576–82. https://doi.org/10.1002/oby.20161.CrossRefPubMed

50.

Hollinghurst S, Hunt LP, Banks J, Sharp DJ, Shield JP. Cost and effectiveness of treatment options for childhood obesity. Pediatr Obes. 2014;9:26–34. https://doi.org/10.1111/j.2047-6310.2013.00150.x.CrossRef

51.

Dalton WT, Kitzmann KM, Burghen GA, Mallare JT, Stender SS. Family functioning and children’s response to primary care treatment for overweight: a preliminary study. J Pediatr Nurs. 2010;25:282–8. https://doi.org/10.1016/j.pedn.2009.04.005.CrossRefPubMed

52.

Robinson TN, Matheson D, Desai M, Wilson DM, Weintraub DL, Haskell WL, et al. Family, community and clinic collaboration to treat overweight and obese children: Stanford GOALS-A randomized controlled trial of a three-year, multi-component, multi-level, multi-setting intervention. Contemp Clin Trials. 2013;36:421–35. https://doi.org/10.1016/j.cct.2013.09.001.CrossRefPubMed

53.

Avis JL, Cave AL, Donaldson S, Ellendt C, Holt NL, Jelinski S, et al. Working with parents to prevent childhood obesity: protocol for a primary care-based eHealth study. JMIR Res Protoc. 2015;4:e35. https://doi.org/10.2196/resprot.4147.CrossRefPubMedPubMedCentral

54.

Sherwood NE, JaKa MM, Crain AL, Martinson BC, Hayes MG, Anderson JD. Pediatric primary care-based obesity prevention for parents of preschool children: a pilot study. Child Obes. 2015;11:674–82. https://doi.org/10.1089/chi.2015.0009.CrossRefPubMedPubMedCentral

55.

Stark LJ, Spear S, Boles R, Kuhl E, Ratcliff M, Scharf C, et al. A pilot randomized controlled trial of a clinic and home-based behavioral intervention to decrease obesity in preschoolers. Obesity (Silver Spring). 2011;19:134–41. https://doi.org/10.1038/oby.2010.87.CrossRef

56.

Berkowitz RI, Rukstalis MR, Bishop-Gilyard CT, Moore RH, Gehrman CA, Xanthopoulos MS, et al. Treatment of adolescent obesity comparing self-guided and group lifestyle modification programs: a potential model for primary care. J Pediatr Psychol. 2013;38:978–86. https://doi.org/10.1093/jpepsy/jst035.CrossRefPubMedPubMedCentral

57.

Chen J-L, Kwan M, Liu K, Yu F. The feasibility and efficacy of healthy weight management program for low income Chinese American overweight and obese children in a primary care clinic. J Pediatr Nurs. 2015;30:821–8. https://doi.org/10.1016/j.pedn.2015.01.026.CrossRefPubMed

58.

Gonzalez G. Primary care interventions to reduce childhood obesity in Latino families. J Pediatr Heal Care. 2016;30:499–505. https://doi.org/10.1016/j.pedhc.2015.11.002.CrossRef

59.

Bourgeois N, Brauer P, Simpson JR, Kim S, Haines J. Interventions for prevention of childhood obesity in primary care: a qualitative study. CMAJ Open. 2016;4:E194–9. https://doi.org/10.9778/cmajo.20150081.CrossRefPubMedPubMedCentral

60.

Gorin AA, Wiley J, Ohannessian CM, Hernandez D, Grant A, Cloutier MM. Steps to Growing Up Healthy: a pediatric primary care based obesity prevention program for young children. BMC Public Health. 2014;14.

61.

Wald ER, Moyer SCL, Eickhoff J, Ewing LJ. Treating childhood obesity in primary care. Clin Pediatr (Phila). 2011;50:1010–7. https://doi.org/10.1177/0009922811410871.CrossRefPubMed

62.

Cloutier MM, Wiley J, Huedo-Medina T, Ohannessian CM, Grant A, Hernandez D, et al. Outcomes from a pediatric primary care weight management program: Steps to Growing Up Healthy. J Pediatr. 2015;167:372–7.e1. https://doi.org/10.1016/j.jpeds.2015.05.028.CrossRefPubMed

63.

Kwapiszewski RM, Lee WA. A pilot program to identify and reverse childhood obesity in a primary care clinic. Clin Pediatr (Phila). 2011;50:630–5. https://doi.org/10.1177/0009922811398389.CrossRef

64.

Pollak KI, Alexander SC, Østbye T, Lyna P, Tulsky JA, Dolor RJ, et al. Primary care physicians’ discussions of weight-related topics with overweight and obese adolescents: results from the teen CHAT pilot study. J Adolesc Health. 2009;45:205–7. https://doi.org/10.1016/j.jadohealth.2009.01.002.CrossRefPubMedPubMedCentral

65.

Pollak KI, Coffman CJ, Alexander SC, Østbye T, Lyna P, Tulsky JA, et al. Weight’s up? Predictors of weight-related communication during primary care visits with overweight adolescents. Patient Educ Couns. 2014;96:327–32. https://doi.org/10.1016/j.pec.2014.07.025.CrossRefPubMedPubMedCentral

66.

Wislo VMP, McGaffey A, Scopaz KA, D’Amico FJ, Jewell IK, Bridges MW, et al. Fitwits: preparing residency-based physicians to discuss childhood obesity with preteens. Clin Pediatr (Phila). 2013;52:1107–17. https://doi.org/10.1177/0009922813492012.CrossRef

67.

Pollak KI, Tulsky JA, Bravender T, Østbye T, Lyna P, Dolor RJ, et al. Teaching primary care physicians the 5 A’s for discussing weight with overweight and obese adolescents. Patient Educ Couns. 2016;99:1620–5. https://doi.org/10.1016/j.pec.2016.05.007.CrossRefPubMed

68.

Stahl CE, Necheles JW, Mayefsky JH, Wright LK, Rankin KM. 5-4-3-2-1 go! Coordinating pediatric resident education and community health promotion to address the obesity epidemic in children and youth. Clin Pediatr. 2011;50:215–24. https://doi.org/10.1177/0009922810385106.CrossRef

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