Treatment of Child and Adolescent Obesity: Reports From Pediatricians, Pediatric Nurse Practitioners, and Registered Dietitians
* St Louis University School of Medicine, St Louis, Missouri
Trowbridge & Associates, Inc, Decatur, Georgia
Pediatric Gastroenterology, Baylor College of Medicine, Houston, Texas
|| Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, Georgia
Objective. The primary aim of this study was to identify interventions used by pediatric health care providers in treatment of overweight children and adolescents to identify provider educational needs. A secondary aim was to examine the association of certain provider characteristics with recommended evaluation practices.
Study Design. A random sample of pediatricians, pediatric nurse practitioners, and registered dietitians (RDs) received questionnaires about their diet, activity, and medication recommendations for overweight patients and about referrals to specialists and programs. Results were examined for adherence to published recommendations and for associations with certain respondent characteristics.
Results. A total of 940 providers responded (response rate: 19%–33%). The majority recommended "changes in eating patterns" and "limitations of specific foods." Half or more used "low-fat diet" and "modest calorie restriction" in adolescents. Less than 15% used "very low-calorie diet." Fewer RDs recommended more restrictive diets. More than 60% of all groups followed recommended eating interventions for school-aged children and adolescents. More than 80% followed recommended physical activity interventions for all age groups. In each group, about 5% sometimes recommended prescription medication and herbal remedies for adolescents. None recommended surgery. Two thirds of pediatricians and pediatric nurse practitioners often referred to RDs. Approximately 20% referred to child/adolescent weight programs, but for 27% to 42%, these programs or pediatric obesity specialists were not available. No consistent associations between respondent characteristics and adherence to recommended interventions were identified.
Conclusions. The providers generally promoted healthy eating and activity with minimal use of highly restrictive diets or medication to control weight.
Key Words: child obesity • adolescent obesity • obesity treatment
Abbreviations: MCHB, Maternal and Child Health Bureau • HRSA, Health Resources and Services Administration • DHHS, Department of Health and Human Services • PNP, pediatric nurse practitioner • RD, registered dietitian • BMI, body mass index
Received for publication Jan 28, 2002; Accepted Mar 14, 2002.
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