Adoption of Body Mass Index Guidelines for Screening and Counseling In Pediatric Practice

• Published in: Pediatrics (Evanston) Vol. 125; no. 2; pp. 265 - 272
• Main Authors: Klein, Jonathan D, Sesselberg, Tracy S, Johnson, Mark S, O'Connor, Karen G, Cook, Stephen, Coon, Marian, Homer, Charles, Krebs, Nancy, Washington, Reginald
• Format: Journal Article
• Language: English
• Published: Elk Grove Village, IL Am Acad Pediatrics 01-02-2010; American Academy of Pediatrics
• Subjects: Biological and medical sciences; Body Mass Index; Child; Child development; Childhood obesity; Children & youth; Counseling; Diagnosis; Disease prevention; Family physicians; Female; General aspects; Humans; Male; Mass Screening; Medical sciences; Metabolic diseases; Multivariate Analysis; Obesity; Obesity in children; Overweight - diagnosis; Overweight - prevention & control; Pediatrics; Pediatrics - methods; Practice; Practice guidelines (Medicine); Practice Guidelines as Topic; Prevention and actions; Primary care; Public health. Hygiene; Public health. Hygiene-occupational medicine; Self Efficacy; United States; United States > US; Human; Obesity; Pediatrics; Nutrition disorder; Medical screening; Council; Recommendation; Body mass index; Professional practice; guidelines; CME; Child; Adoption; Nutritional status; BMI
• ISSN: 0031-4005; 1098-4275
• DOI: 10.1542/peds.2008-2985

The purpose of this study was to examine pediatrician implementation of BMI and provider interventions for childhood overweight prevention and treatment.
Data were obtained from the American Academy of Pediatrics (AAP) Periodic Survey of Fellows No. 65, a nationally representative survey of AAP members. Surveys that addressed the provision of screening and management of childhood overweight and obesity in primary care settings were mailed to 1622 nonretired US AAP members in 2006.
One thousand five (62%) surveys were returned; 677 primary care clinicians in active practice were eligible for the survey. Nearly all respondents (99%) reported measuring height and weight at well visits, and 97% visually assess children for overweight at most or every well-child visit. Half of the respondents (52%) assess BMI percentile for children older than 2 years. Most pediatricians reported that they do not have time to counsel on overweight and obesity, that counseling has poor results, and that having simple diet and exercise recommendations would be helpful in their practice. Pediatricians in large practices and those who had attended continuing medical education on obesity were more familiar with national expert guidelines, were more likely to use BMI percentile, and had higher self-efficacy in practices related to childhood and adolescent overweight and obesity. Multivariate analysis revealed that pediatricians with better access to community and adjunct resources were more likely to use BMI percentile.
BMI-percentile screening in primary pediatric practice is underused. Most pediatricians believe that they can and should try to prevent overweight and obesity, yet few believe there are good treatments once a child is obese. Training, time, and resource limitations affect BMI-percentile use. Awareness of national guidelines may improve rates of BMI-percentile use and recognition of opportunities to prevent childhood and adolescent obesity.