RESUMO
OBJECTIVE: To compare primary care pediatricians' practices and attitudes regarding obesity assessment, prevention, and treatment in children 2 years and older in 2006 and 2017. STUDY DESIGN: National, random samples of American Academy of Pediatrics members were surveyed in 2006, 2010, and 2017 on practices and attitudes regarding overweight and obesity (analytic n = 655, 592, and 558, respectively). Using logistic regression models (controlling for pediatrician and practice characteristics), we examined survey year with predicted values (PVs), including body mass index (BMI) assessment across 2006, 2010, and 2017 and practices and attitudes in 2006 and 2017. RESULTS: Pediatrician respondents in 2017 were significantly more likely than in 2006 and 2010 to report calculating and plotting BMI at every well-child visit, with 96% of 2017 pediatricians reporting they do this. Compared with 2006, in 2017 pediatricians were more likely to discuss family behaviors related to screen time, sugar-sweetened beverages, and eating meals together, P < .001 for all. There were no observed differences in frequency of discussions on parental role modeling of nutrition and activity-related behaviors, roles in food selection, and frequency of eating fast foods or eating out. Pediatricians in 2017 were more likely to agree BMI adds new information relevant to medical care (PV = 69.8% and 78.1%), they have support staff for screening (PV = 45.3% and 60.5%), and there are effective means of treating obesity (PV = 36.3% and 56.2%), P < .001 for all. CONCLUSIONS: Results from cross-sectional surveys in 2006 and 2017 suggest nationwide, practicing pediatricians have increased discussions with families on several behaviors and their awareness and practices around obesity care.
Assuntos
Obesidade Infantil/prevenção & controle , Obesidade Infantil/terapia , Pediatras , Pediatria/organização & administração , Pediatria/normas , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Atitude do Pessoal de Saúde , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Sobrepeso , Valor Preditivo dos Testes , Análise de Regressão , Inquéritos e Questionários , Estados UnidosRESUMO
The objective of this technical report is to provide clinicians with actionable evidence-based information upon which to make treatment decisions. In addition, this report will provide an evidence base on which to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are effective clinically based treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori Key Questions.
Assuntos
Obesidade Infantil , Criança , Adolescente , Humanos , Obesidade Infantil/epidemiologia , Obesidade Infantil/terapia , Sobrepeso , ComorbidadeRESUMO
The objective of this technical report is to provide clinicians with evidence-based, actionable information upon which to make assessment and treatment decisions for children and adolescents with obesity. In addition, this report will provide an evidence base to inform clinical practice guidelines for the management and treatment of overweight and obesity in children and adolescents. To this end, the goal of this report was to identify all relevant studies to answer 2 overarching key questions: (KQ1) "What are clinically based, effective treatments for obesity?" and (KQ2) "What is the risk of comorbidities among children with obesity?" See Appendix 1 for the conceptual framework and a priori key questions.
Assuntos
Obesidade Infantil , Criança , Adolescente , Humanos , Obesidade Infantil/epidemiologia , Obesidade Infantil/terapia , Sobrepeso , ComorbidadeRESUMO
OBJECTIVE: Self-efficacy is a crucial factor in enabling pediatric primary care providers (PCPs) to deliver recommended care to children with overweight and obesity. This study, conducted with a large, national sample of PCPs, aimed to identify key factors, which may contribute to PCP self-efficacy for obesity-related care, from a list of previously reported barriers and facilitators. METHODS: A national random sample of American Academy of Pediatrics members was surveyed in 2017 (analytic n = 704). Factor analysis was used to identify self-efficacy variables from relevant indicators and assess fit. Multivariable linear regression analyses were conducted to identify key predictors of PCP self-efficacy from reported facilitators or barriers to care, including characteristics of the PCP, practice, community, and payment systems. RESULTS: Two PCP self-efficacy variables were identified: health risk assessment and patient-centered counseling. Both were positively predicted by relevant training, the belief that pediatricians play an important role in obesity, and awareness of barriers to payment for dietitians or weight management programs. Both were negatively predicted by a perceived lack of available PCP time for counseling and inadequacy of available referral resources to assist with treatment. Additional predictors of counseling self-efficacy included PCP beliefs that they are paid for treatment (+) and that patients/families lack time for healthy behaviors (-). Electronic health record clinical decision supports or registries and patient social disadvantage were not predictive. CONCLUSIONS: Results suggest multiple potential roles and strategies for local and national organizations seeking to facilitate improvements to PCP self-efficacy in caring for children with overweight and obesity.
Assuntos
Sobrepeso , Autoeficácia , Criança , Aconselhamento , Humanos , Obesidade , Sobrepeso/terapia , Atenção Primária à Saúde/métodosRESUMO
BACKGROUND: Infants from low-income backgrounds receive nutrition care from both community and clinical care settings. However, mothers accessing these services have reported receiving conflicting messages related to infant growth between settings, although this has not been examined quantitatively. OBJECTIVE: Describe the agreement in infant growth assessments between community (Special Supplemental Nutrition Program for Women, Infants, and Children) and clinical (primary care providers) care settings. DESIGN: A cross-sectional, secondary data analysis of infant growth measures abstracted from electronic data management systems. PARTICIPANTS AND SETTING: Participants included a convenience sample of infants (N = 129) from northeastern Pennsylvania randomized to the WEE Baby Care study from July 2016 to May 2018. Infants had complete anthropometric data from both community and clinical settings at age 6.2 ± 0.4 months. Average time between assessments was 2.7 ± 1.9 weeks. MAIN OUTCOME MEASURES: Limits of agreement and bias in weight-for-age, length-for-age, weight-for-length, and body-mass-index-for-age z scores as well as cross-context equivalence in weight status between care settings. STATISTICAL ANALYSIS PERFORMED: Bland-Altman analyses were used to describe the limits of agreement and bias in z scores between care settings. Cross-context equivalence was examined by dichotomizing infants' growth indicators at the 85th and 95th percentile cut-points and cross-tabulating equivalent and discordant categorization between settings. RESULTS: Strongest agreement was observed for weight-for-age z scores (95% limits of agreement -0.41 to 0.54). However, the limits of agreement intervals for growth indicators that included length were wider, suggesting weaker agreement. There was a high level of inconsistency for classification of overweight/obesity using weight-for-length z scores, with 15.5% (85th percentile cut-point) and 11.6% (95th percentile cut-point) discordant categorization between settings, respectively. CONCLUSIONS: Infant growth indicators that factor in length could contribute to disagreement in the interpretation of infant growth between settings. Further investigation into the techniques, standards, and training protocols for obtaining infant growth measurements across care settings is required.
Assuntos
Antropometria/métodos , Desenvolvimento Infantil/fisiologia , Assistência Alimentar , Sobrepeso/diagnóstico , Obesidade Infantil/diagnóstico , Atenção Primária à Saúde , Estatura , Índice de Massa Corporal , Peso Corporal , Serviços de Saúde da Criança , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Nutricionistas , Pennsylvania , Pobreza , Aumento de PesoRESUMO
BACKGROUND: Over 2% of children between the ages of 2 and 5 have severe obesity; however, little is known about the characteristics of this population to guide healthcare professionals in providing care. An initial step is to examine observations of practitioners who manage children with severe early onset obesity in the clinical setting. METHODS: A total of 72 interdisciplinary healthcare providers with experience providing obesity treatment to children under age 5 with severe obesity completed a semistructured online questionnaire. Participants responded to 10 open-ended questions about provider observations on several topics, including nutrition, eating behavior, activity, family structure and history, medical history, psychological conditions, and household routines. Data analysis was conducted using grounded theory methods. Emerging themes and subthemes were analyzed based on topics and provider discipline (e.g., medical, nursing, and psychology). RESULTS: The most commonly observed and reported characteristic of young children with severe obesity was a parent-described dysfunctional approach to food, including frequent complaints about hunger, food seeking, and lack of satiety. Other characteristics included the presence of externalizing behaviors in the child such as temper tantrums and ADHD, developmental delays, medical comorbidities (e.g., asthma and sleep apnea), and unstructured home environments. CONCLUSIONS: Drawing on the experience of an interdisciplinary group of healthcare providers, this is the first study to describe provider observations of the young child with severe early onset obesity. If validated, these observations can serve to illuminate areas for further education and inform potential clinical subtyping, providing an opportunity to identify target areas for intervention.
Assuntos
Pessoal de Saúde , Obesidade Mórbida/terapia , Obesidade Infantil/terapia , Inquéritos e Questionários , Comportamento Infantil , Pré-Escolar , Dieta , Ingestão de Alimentos , Exercício Físico , Família , Predisposição Genética para Doença , Nível de Saúde , Humanos , Fome , Estilo de Vida , Avaliação Nutricional , Pais , Saciação , Programas de Redução de PesoRESUMO
OBJECTIVE: To improve systems of care to advance implementation of the U.S. Preventive Services Task Force recommendations for childhood obesity treatment (i.e., clinicians offer/refer children with obesity to intensive, multicomponent behavioral interventions of >25 h over 6 to 12 months to improve weight status) and to expand payment for these services. METHODS: In July 2015, 43 cross-sector stakeholders attended a conference supported by the Agency for Healthcare Research and Quality, American Academy of Pediatrics Institute for Healthy Childhood Weight, and The Obesity Society. Plenary sessions presenting scientific evidence and clinical and payment practices were interspersed with breakout sessions to identify consensus recommendations. RESULTS: Consensus recommendations for childhood obesity treatment included: family-based multicomponent behavioral therapy; integrated care model; and multidisciplinary care team. The use of evidence-based protocols, a well-trained healthcare team, medical oversight, and treatment at or above the minimum dose (e.g., >25 h) are critical components to ensure effective delivery of high-quality care and to achieve clinically meaningful weight loss. Approaches to secure reimbursement for evidence-based obesity treatment within payment models were recommended. CONCLUSIONS: Continued cross-sector collaboration is crucial to ensure a unified approach to increase payment and access for childhood obesity treatment and to scale up training to ensure quality of care.
Assuntos
Redes Comunitárias/organização & administração , Acessibilidade aos Serviços de Saúde/organização & administração , Obesidade Infantil/prevenção & controle , Terapia Comportamental/métodos , Criança , Consenso , Humanos , Guias de Prática Clínica como Assunto , Estados UnidosRESUMO
OBJECTIVE: Given the increasing evidence that obesity increases the risk of developing and dying from malignancy, the American Society of Clinical Oncology (ASCO) launched an Obesity Initiative in 2013 that was designed to increase awareness among oncology providers and the general public of the relationship between obesity and cancer and to promote research in this area. Recognizing that the type of societal change required to impact the obesity epidemic will require a broad-based effort, ASCO hosted the "Summit on Addressing Obesity through Multidisciplinary Collaboration" in 2016. METHODS: This meeting was held to review current challenges in addressing obesity within the respective health care provider communities and to identify priorities that would most benefit from a collective and cross-disciplinary approach. RESULTS: Efforts focused on four key areas: provider education and training; public education and activation; research; and policy and advocacy. Summit attendees discussed current challenges in addressing obesity within their provider communities and identified priorities that would most benefit from multidisciplinary collaboration. CONCLUSIONS: A synopsis of recommendations to facilitate future collaboration, as well as examples of ongoing cooperative efforts, provides a blueprint for multidisciplinary provider collaboration focused on obesity prevention and treatment.
Assuntos
Neoplasias/complicações , Obesidade/prevenção & controle , Equipe de Assistência ao Paciente , Guias como Assunto , Humanos , Oncologia , Obesidade/complicações , Sociedades Médicas , Estados UnidosAssuntos
Insegurança Alimentar , Abastecimento de Alimentos , Criança , Humanos , Políticas , Pobreza , Fatores SocioeconômicosAssuntos
Saúde da Criança , Fome , Índice de Massa Corporal , Criança , Humanos , Obesidade/epidemiologiaRESUMO
BACKGROUND: The aim of the study was to define the prevalence and degree of advanced bone age (ABA) in normal vs. excessive weight children, and identify variables affecting ABA. METHODS: We studied 167 children (3-18 years) with normal weight (28 F, 28 M), overweight (8 F, 12 M), and obesity (OB) (63 F, 28 M) at AI duPont Hospital for Children. We assessed bone age (BA), insulin, leptin, estradiol (E2), DHEAS, and IGF-1 levels. RESULTS: Almost 25% of OB children have ABA>2 SDS, 33% >2 years (range 2-6.5 years advanced). ABA correlated with leptin, DHEAS and BMI z-score in girls, and with IGF-1 z-score and BMI z-score in boys (p<0.01). Girls with ABA had higher BMI z-score (p<0.001), insulin levels (p=0.02), and rates of weight gain (p=0.03). Boys with ABA had greater BMI z-score (p<0.001), but rate of weight gain did not differ. The greatest degree of ABA was found combining variables by tertiles. The top tertile of BA/CA had the highest insulin and IGF-1 z-scores. The top combined tertiles of DHEAS and BMI z-score or DHEAS and leptin in girls had the highest BA/CA. In boys, the top tertiles of BMI z-score and IGF-1 z-score produced the highest BA/CA. The lowest combined tertiles of any variables related to the lowest BA/CA. CONCLUSIONS: Multiple factors influence skeletal maturation. Almost 25% of children with OB have ABA, associated with BMI z-score, and one or more of the following: insulin, leptin, DHEAS, IGF-1, and rate of weight gain. This report delineates the prevalence and degree of ABA by sex, in children with normal versus excessive weight.
Assuntos
Desenvolvimento Ósseo/fisiologia , Regeneração Óssea/fisiologia , Fator de Crescimento Insulin-Like I/análise , Obesidade/fisiopatologia , Aumento de Peso/fisiologia , Adolescente , Determinação da Idade pelo Esqueleto , Índice de Massa Corporal , Peso Corporal , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Insulina/sangue , Leptina/sangue , Masculino , Puberdade , Fatores SexuaisRESUMO
BACKGROUND: Little information is available to gauge residents' perceived receipt of comprehensive training and preparedness to manage children with obesity in practice. METHODS: A national, random sample of 1000 graduating pediatric residents were surveyed in 2013 on childhood overweight/obesity and preparedness to prevent and treat obesity. A composite training measure was created by summing the number of areas (10 possible) where training on overweight/obesity was received. Multivariable logistic regression explored relationships of resident and training characteristics to residents' belief that their own counseling on prevention and treatment of overweight/obesity is very effective (vs somewhat/slightly/not effective). RESULTS: Of 625 survey respondents (63% response), most (68-92%) reported receipt of training in each of 10 assessed areas on overweight/obesity prevention, assessment, and treatment. Most residents did not desire more training in the assessed areas; however, 54% wanted more training in motivational interviewing. About one-fourth believed that their own counseling on the prevention of overweight/obesity (26%) and treatment of obesity (22%) was very effective. Residents who rated their ability to use motivational interviewing as very good/excellent were more likely to rate their counseling on both the prevention and treatment of overweight/obesity as very effective (adjusted odds ratio [aOR] 4.33, 95% confidence interval [CI] 2.63-7.13; and aOR 4.69, 95% CI 2.72-8.07, respectively). Residents who received training in all 10 assessed areas were also more likely to rate their counseling on both prevention and treatment as very effective (aOR 2.58, 95% CI 1.61-4.14; aOR 2.41, 95% CI 1.46-3.97, respectively). CONCLUSIONS: Comprehensive training on overweight/obesity and inclusion of training in motivational interviewing may help residents feel better prepared to care for children with overweight/obesity.
Assuntos
Competência Clínica , Educação de Pós-Graduação em Medicina , Obesidade Infantil/prevenção & controle , Pediatria/educação , Adulto , Feminino , Humanos , Modelos Logísticos , Masculino , Entrevista Motivacional , Análise Multivariada , Razão de Chances , Obesidade Infantil/terapia , Autoeficácia , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The objective of this study is to describe the weight trajectory of refugee children after resettlement in the US. METHODS: A pilot study was conducted, utilizing longitudinal data obtained from the electronic health record of 129 children between 2 and 18 years of age (54% female, mean age 10 years) from the 3 primary countries of origin presenting to a refugee clinic (Bhutan, N = 71; Burma, N = 36, and Iraq, N = 22).. Mixed effects model analyses were utilized to characterize weight trajectory with calculation of a per year change in BMI-z score, adjusting for baseline BMI-z score, age, and time. RESULTS: There was a significant increase in BMI-z (mean 0.15 units/year, p=0.04) among refugee children during their initial period after resettlement. Female children from Bhutan demonstrated the most rapid increase in weight, with a mean BMI-z gain of 1.00 units/year. CONCLUSION: Female children from Bhutan demonstrated rapid weight gain after resettlement in the US. Further studies are needed to describe weight trajectory trends and evaluate possible reasons for rapid weight gain in this population.
RESUMO
The adoption of healthful lifestyles by individuals and families can result in a reduction in many chronic diseases and conditions of which obesity is the most prevalent. Obesity prevention, in addition to treatment, is an important public health priority. This clinical report describes the rationale for pediatricians to be an integral part of the obesity-prevention effort. In addition, the 2012 Institute of Medicine report "Accelerating Progress in Obesity Prevention" includes health care providers as a crucial component of successful weight control. Research on obesity prevention in the pediatric care setting as well as evidence-informed practical approaches and targets for prevention are reviewed. Pediatricians should use a longitudinal, developmentally appropriate life-course approach to help identify children early on the path to obesity and base prevention efforts on family dynamics and reduction in high-risk dietary and activity behaviors. They should promote a diet free of sugar-sweetened beverages, of fewer foods with high caloric density, and of increased intake of fruits and vegetables. It is also important to promote a lifestyle with reduced sedentary behavior and with 60 minutes of daily moderate to vigorous physical activity. This report also identifies important gaps in evidence that need to be filled by future research.