Weight Management-Related Assessment and Counseling by Primary Care Providers in an Area of High Childhood Obesity Prevalence: Current Practices and Areas of Opportunity

摘要

Background: Childhood obesity in Georgia exceeds the national rate. The state's pediatric primary care providers (PCPs) are well positioned to support behavior change, but little is known about provider perceptions and practices regarding this role. Purpose: The aim of this study was to assess and compare weight-management-related counseling perceptions and practices among Georgia's PCPs. Methods: In 2012-2013, 656 PCPs (265 pediatricians, 143 family practice physicians [FPs], and 248 nurse practitioners/physician assistants [NP/PAs]) completed a survey regarding weight-management-related practices at well-child visits before their voluntary participation in a free training on patient-centered counseling and child weight management. Data were analyzed in 2014. Likert scales were used to quantify responses from 1 (strongly disagree or never) to 5 (strongly agree or always). Responses of 4 and 5 responses were combined to denote agreement or usual practice. Chi-squared analyses tested for independent associations between pediatricians and others. Statistical significance was determined using two-sided tests and p value <0.05. Results: The majority of PCPs assessed fruit and vegetable intake (83%) and physical activity (78%), but pediatricians were more likely than FPs and NP/PAs to assess beverage intake (96% vs. 82-87%; p< 0.002) and screen time (86% vs. 74-75%; p< 0.003). Pediatricians were also more likely to counsel patients on lifestyle changes (88% vs. 71%; p< 0.001) and to track progress (50% vs. 35-39%; p < 0.05). Though all PCPs agreed that goal setting is an effective motivator (88%) and that behavior change increases with provider encouragement (85%), fewer were confident in their ability to counsel (72%). Conclusions: Our results show that many PCPS in Georgia, particularly pediatricians, have incorporated weight management counseling into their practice; however, important opportunities to strengthen these efforts by targeting known high-risk behaviors remain.