RESUMO
Background. Pediatric obesity has become a significant public health concern. Pediatricians are the ideal group to help identify and treat this epidemic, but unfortunately, many pediatricians are not trained to discuss obesity with patients and their families. Standardized training initiatives for pediatric residents on prevention and/or management of obesity are needed to equip emerging pediatricians to combat the obesity epidemic. Objectives. This systematic literature review aims to examine the effectiveness of childhood obesity prevention/counseling resident training interventions. Methods. A comprehensive literature search was performed using preidentified search terms and limited to articles published prior to November 6, 2019. Articles were analyzed by 2 reviewers with a standardized evaluation tool. Results. A total of 698 articles were identified by the search. These were reduced to 111 articles after title review and 11 articles following abstract/full paper review. The 11 articles described 10 different obesity training interventions for residents. The articles varied in their size, length of training session, and study design. Despite these variations, all articles outlined positive outcomes, including an increase in physician confidence, positive changes in behavior, and/or improved electronic medical record documentation. Conclusions. With the continued increase in pediatric obesity, there is a need for practical, easy-to-implement, standardized trainings for pediatric residents on obesity prevention and treatment. More investigation needs to be done to look at long-term results of current interventions as well as other outcomes such as whether physicians are correctly identifying patients who are overweight or obese and whether there is improvement in patient follow-up.
RESUMO
Objective. To evaluate the impact of an obesity didactic session for pediatric physicians on confidence in counseling and identified overweight/obesity and follow-up recommendations. Methods. Pediatric residents underwent training and completed pre/post online surveys evaluating confidence in obesity prevention and identification. A booster training occurred 1 year later. Pre-/post-training scores were compared using χ2 or Fisher's exact tests. Electronic medical records data for patients ≥3 years with BMI-for-age percentile ≥85 during 3 months prior/following the training/booster compared frequency of overweight/obesity identification and follow-up recommendations (≤3 months recommended vs longer) using logistic regression adjusting for age and overweight/obese status. Results. Post trainings, improvements in confidence to define/screen for obesity were observed, with a decline between trainings. Overweight/obese identification and follow-up time recommendations improved post-training (identification: 14.2% to 27.4%, adjusted odds ratio [aOR] = 3.16, 95% confidence interval [CI] = 1.54-6.51; follow-up: 48.9% to 58.9%, aOR = 1.63, 95% CI = 1.01-2.64), aOR = 1.77, 95% CI = 1.10-2.85, and identification remained stable/above pre-training rates both pre-/post-booster (25.8%, aOR = 3.14, 95% CI = 1.53-6.45; and 22.1%, aOR = 2.57, 95% CI = 1.25-5.30, respectively). Recommended follow-up time rates continued to rise when measured pre-booster (60.6%, aOR = 1.77, 95% CI = 1.10-2.85), then declined (46.0%, aOR = 0.95, 95% CI = 0.60-1.52). Conclusion. This didactic session improved resident confidence in defining/screening, identification of overweight/obesity and follow-up recommendations; however, rates of identification remained low. The successes of this intervention support similar didactic sessions in residency programs and identifies opportunities for improved resident/attending education.