Abstract
The purpose of this study was to examine obesity management practices and variables influencing those practices of members of the New Jersey Chapter of the American Academy of Pediatrics (n = 1246). The 3 primary methods used by the 424 respondents to determine overweight or obesity were weight-for-height (75%), weight-for-age (62%), and visual determination (52%). Over two thirds of respondents indicated that when a child is overweight or obese, weight was discussed, family, diet, and physical activity histories were taken, counseling was provided, and patients were referred to dietitians. The primary barriers to enhancing obesity management were patient compliance (87%), time (75%), and patient interest (51%). The primary strategies to expand obesity management were education materials (78%), seminar on pediatric obesity (65%), and better reimbursement (61%). Patient compliance had a significant impact on taking a diet history (P = .0011), providing diet counseling (P = .0043), and screening patients for type 2 diabetes mellitus (P = .0494); patient interest had a significant impact on use of body mass index to determine overweight or obesity (P = .0117). The majority of respondents view dietitians as a credible source of nutrition information.
THE PREVALENCE of pediatric obesity is increasing in the United States, as indicated by preliminary 1999 findings from the Centers for Disease Control and Prevention's (CDC) National Health and Nutrition Examination Survey (NHANES IV). An estimated 13% of children ages 6 to 11 years and 14% of adolescents ages 12 to 19 years are overweight. 1
This rising prevalence of overweight and obesity is a concern, given the associated health risks with pediatric obesity. Overweight children are at risk for type 2 diabetes mellitus, hypertension, sleep apnea, and other serious health problems. 2-5 Defining overweight or obesity in children and adolescents is difficult; there is no generally accepted definition of overweight or obesity. A variety of criteria have been used to identify overweight or obesity in children and adolescents. 6
Body mass index (BMI, body weight in kilograms divided by the square of height in meters), is recognized 7 as a clinically useful assessment of overweight and obesity in children and adolescents. The CDC pediatric growth charts, released in 2000, 8 include BMI-for-age growth charts; with this tool, available at http://www.cdc.gov/growthcharts/, health care providers can easily assess the relative percentile ranking of BMI in youth.
The prevention of childhood obesity and effective management of overweight children are essential to promote health and prevent medical illnesses. Health care providers need to be aware of children whose BMI percentile is increasing inappropriately, and to provide counseling before these children become overweight. Pediatricians' practices regarding the prevention and management of overweight children have not been studied. The purpose of this study was to examine obesity management practices in pediatricians' offices in New Jersey, and to gain a better understanding of the factors associated with identifying and managing overweight children by pediatricians.