A number of barriers exist for the successful prevention and treatment of childhood obesity. Understanding the barriers is important, and allows physicians to adapt and make the changes necessary to help their overweight patients.
- Common physician barriers include a lack of confidence in the treatment of childhood obesity; the failure to appropriately recognize and diagnose obesity; the lack of successful treatment options for the primary care setting; and uncertainty over next steps.
- A recent survey of pediatricians indicated a marked lack of confidence in successfully treating childhood obesity. Eighty-five percent (85%) of pediatricians indicated they were better able to treat asthma than obesity; 80% of pediatricians were better able to treat ADHD than obesity; and, 40% of pediatricians were better able to treat sexually-transmitted diseases than obesity. (Preventing and Treating Obesity: Pediatricians' Self-Efficacy, Barriers, Resources and Advocacy, Ambul Pediatr 2005;5:150-156.) This lack of confidence results in physicians being less likely to address the problem, and less comfortable guiding patients and families toward a successful solution.
- In addition to lack of confidence in treating childhood obesity, pediatricians often fail to appropriately diagnose overweight and obese children. In a survey of pediatricians from 1999-2007, the most obese children (greater than the 99th percentile) were correctly diagnosed less than 60% of the time, and overweight children (85th-94th percentile) were diagnosed correctly less than 10% of the time. (Trends in the Diagnosis of Overweight and Obesity in Children and Adolescents: 1999-2007, Pediatrics 2009;123(1):e153-8). Children who are overweight, but have not yet developed refractory obesity or the presence of co-morbidities, are those we are most likely to be able to help. Therefore, the inability to correctly diagnose this category of children is particularly concerning.
- Additional physician barriers include the lack of treatment strategies for the primary care setting, and uncertainties over next steps. While evidence-based guidelines exist, these are often difficult to interpret and implement into the primary care setting. And, when pediatricians are uncertain about the appropriate next steps and available resources, they are less likely to successfully intervene.
- In addition to physician barriers, numerous barriers exist outside of the clinical setting. Parental perception of obesity is often inaccurate, leading parents to believe their children to be at a healthy weight when they are actually overweight. Studies indicate that parents of underweight children tend to overestimate their weight, while parents of overweight children tend to underestimate their weight. (Childhood Obesity: Do Parents Recognize this Health Risk? Obesity Research, 2003;11:1362-1368.) The result of a faulty perception of their child’s weight results in parents being less willing to make important lifestyle changes within their family.
- Childhood obesity is very complex, and is impacted by a number of different areas and sectors of life. Clinicians are accustomed to treating patients within the medical setting, with little experience in venturing outside the medical walls. However, following the traditional medical model for treatment, as well as for research, has been largely ineffective in the treatment of childhood obesity. Collaborative, community-wide efforts are needed that impact every area of a child’s life. However, connecting the medical centers with partners in all sectors represents a significant barrier to most communities.
- The recognition of barriers can lead to despair in physicians, community leaders, educators, parents, and even patients themselves. However, it is important for pediatricians to recognize the vital role that we play as advocates for children. Childhood obesity represents the most significant health risk to children of our era, and we must therefore address barriers as challenges to be overcome.
- One effort to address many of these barriers is through the HEALED program, a project of TNAAP designed to provide an efficient method to prevent and treat childhood obesity in the primary care setting.
Evidenced Based Guidelines
- The American Academy of Pediatrics has published expert committee guidelines for the prevention, assessment and treatment of childhood obesity. (Barlow, S E, and Expert Committee. “Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.” Pediatrics 120.Supplement 4 (2007): S164-S192. Pubmed. Web. 25 Mar. 2012. http://pediatrics.aappublications.org/content/120/Supplement_4/S164.long).
- To view a summary of these guidelines, click HERE.
HEALED Contact InformationRebecca Robinson, MPH