As the prevalence of childhood obesity approaches epidemic levels, physicians on the "front line" need to become more involved in obesity prevention and weight management to reverse this dangerous trend among their young patients. But several obstacles discourage pediatricians and other primary care physicians from taking a more active role in managing childhood obesity.
An expert panel identified these barriers and explored strategies for overcoming them in a Roundtable Discussion on "New Ways to Overcome Old Barriers: Engaging Pediatricians and Primary Care Physicians in Obesity Prevention and Intervention" presented in the current issue of Childhood Obesity, a journal published by Mary Ann Liebert, Inc. The article is available free online.
Melinda Sothern, PhD, Professor and Director, Section of Health Promotion, Behavioral, and Community Health Sciences Department in the School of Public Health at Louisiana State University Health Sciences Center (New Orleans, LA) and Pennington Biomedical Research Center (Baton Rouge, LA) moderated the Roundtable Discussion. Participants included Sonia Caprio, MD, Yale University School of Medicine (New Haven, CT); Stephen Daniels, MD, PhD, University of Colorado School of Medicine (Aurora); Stewart Gordon, MD, Louisiana State University School of Medicine (New Orleans, LA); and David Ludwig, MD, PhD, Harvard Medical School and Children's Hospital Boston (Massachusetts). The panelists identified several key barriers, including inadequate reimbursement for childhood obesity management and prevention; lack of office time to interact with and educate patients; lack of financial resources to support patient/family education and counseling; and a "toxic" culture that encourages poor nutrition, overeating, and a sedentary lifestyle.
"Unless government and insurance reimburses for primary care prevention and treatment of childhood obesity, it is not going to happen in a comprehensive way," said David Ludwig.
Moderator Melinda Sothern proposed the creation of "community hubs" in which primary care offices and clinics form alliances with schools, recreation departments, or community centers in the area and work together "to support efforts to identify, organize, and implement" group programs for children who are overweight or obese.
The panelists also discussed the need to include more information about childhood obesity and proper nutrition in the educational experiences of medical students and residents. To help overcome time limitations, primary care physicians can encourage their nursing staff to talk to parents about the significance of the measurements they are taking, such as weight and height, laying the groundwork for the physician to reinforce those messages.
Too often, pediatricians "do not plot the BMI (body mass index) over time and do not focus on the development of obesity," says Stephen Daniels, emphasizing the importance of identifying trends such as increasing BMI as a key step in prevention and management of childhood obesity.
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