Research ArticleOriginal Research

Screening and Counseling for Childhood Obesity: Results from a National Survey

Tracy S. Sesselberg, Jonathan D. Klein, Karen G. O'Connor and Mark S. Johnson
The Journal of the American Board of Family Medicine May 2010, 23 (3) 334-342; DOI: https://doi.org/10.3122/jabfm.2010.03.090070

Article Figures & Data

Tables

  • Table 1.

    Respondent Demographics and Practice Characteristics (n = 455)

    n (%)
    Gender
        Male255 (59)
        Female180 (41)
    BMI
        Underweight7 (2)
        Normal weight234 (57)
        Overweight134 (32)
        Obese38 (9)
    Specialty
        General practitioner412 (96)
        Specialist17 (4)
    Primary practice setting
        Small family practice (solo or 2 physician)94 (22)
        Large family practice/multispecialty group/HMO229 (53)
        Med School/hospital/clinic/community health center95 (22)
        Other13 (3)
    Primary practice/position area
        Rural129 (30)
        Suburban170 (39)
        Urban135 (31)
    Use EHR175 (42)
    CME or training in childhood/adolescent overweight ≤ 3 years
        Yes180 (42)
        No253 (58)
    Participate in PBRN77 (17)

    • BMI, body mass index; HMO, health maintenance organization; EHR, electronic health record; CME, continuing medical education; PBRN, practice-based research network.

    • Note: n varies due to missing data.

  • Table 2.

    Family Physicians’ Practices during Children's Well Visits (n = 445)

    n (%)
    Measure height and weight during most or every visit422 (99)
    Visually assess for overweight for children >2     years old
        During every well visit329 (76)
        During most well visits96 (22)
    Compute BMI for children >2 years old
        During most or every well visit195 (45)
        During some well visits130 (30)
        Never or rarely41 (10)
    Plot BMI for children >2 years old
        During most or every well visit132 (31)
        During some well visits83 (20)
        Never or rarely111 (26)
    Use of BMI calculation tools
        BMI wheel140 (36)
        BMI calculator117 (30)
        EHR111 (29)
        PDA99 (26)
        CDC BMI table/chart77 (20)
        Wall chart61 (16)
        Handheld calculator21 (5)
    Topics discussed with all patients
        Breastfeeding370 (86)
        Physical activity367 (84)
        5-a-day fruits and vegetables346 (80)
        Screen time290 (67)
        Sugar-sweetened beverages271 (63)
        Snacks209 (48)
        Fast food/dining out174 (40)
        Food pyramid91 (21)

    • BMI, body mass index; EHR, electronic health record; PDA, personal digital assistant; CDC, Centers for Disease Control and Prevention.

    • Note: n varies due to missing data.

  • Table 3.

    Mean Scores on Attitudes and Factor Aanalysis (n = 455)

    QuestionsMean score (SD) (1 = strongly disagree, 5 = strongly agree)Factor 1* “Self-efficacy”Factor 2† “Reimbursement”Factor 3‡ “Resources”Factor 4§
    Overweight counseling is not effective.2.40 (0.949)0.732
    There is little family physicians can do to treat/manage overweight.2.28 (0.993)0.720
    How effective is your counseling about overweight management?2.38 (0.690)‖−0.713
    How effective is your counseling about prevention of obesity?2.35 (0.662)‖−0.687
    There is no evidence physicians can prevent overweight.2.43 (1.039)0.661
    Family physicians can help prevent childhood overweight.3.94 (0.970)−0.660
    I don't think screening will make a difference.2.10 (1.011)0.608
    There are effective means of treating overweight.3.17 (0.999)−0.581
    There are good treatment options for overweight.2.76 (1.096)−0.546
    My patients do not find these services helpful.2.59 (0.975)0.540
    I don't find dietitian/weight-management services helpful.2.28 (0.993)0.539
    How comfortable do you feel discussing overweight with overweight patients and their parents?3.28 (0.692)−0.4580.421
    I am not interested in addressing overweight prevention/management.1.62 (0.763)0.448
    Family physicians should address childhood overweight during well-child visits.4.55 (0.707)−0.415
    How well prepared do you feel you are to counsel patients and their parents about overweight?3.06 (0.674)−0.4540.513
    The AAFP recommendations on overweight screening are easy to follow.3.30 (0.686)−0.400
    Weight management programs are not covered by insurance.3.95 (0.939)0.575−0.420
    Dietitian services are not covered by insurance.3.60 (1.11)0.687
    Many of my patients are not able to pay for uncovered services.4.28 (0.942)0.475
    There is a lack of tools to assist with BMI calculations.1.87 (0.985)0.537
    It is more important to reduce fast food/soft drink availability in the community and at home than to counsel about overweight.3.16 (1.197)0.426
    I do not want to offend families by talking about weight.2.04 (1.019)0.432
    Variance explained (%)17.35.745.075.071

    • * Eigenvalue of 7.439.

    • † Eigenvalue of 2.468.

    • ‡ Eigenvalue of 2.181.

    • § Eigenvalue of 1.927.

    • ‖ 4-point scale.

    • AAFP, American Academy of Family Physicians; BMI, body mass index.

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