Childhood Obesity: Variations in Management

Overview

Childhood obesity has been described as a growing national epidemic. Between 1980 and 1994 the prevalence of childhood obesity doubled with 10% to 15% of children and adolescents being obese. Childhood obesity has both immediate and long-term detrimental consequences for health and well-being. Obese children are at increased risk for coronary heart disease, type 2 diabetes, and hypertension. Obese children are more likely to be at risk for psychological stress and disturbed body image. Moreover, obese children are more likely to become obese adults, especially if weight reduction has not occurred by the end of adolescence. The pediatrician is in an ideal position to assess and manage childhood obesity. Recently, guidelines have been established for the assessment and treatment of childhood obesity. These "best practice" guidelines include recommended diagnostic criteria, assessment of contributing factors such as diet and lifestyle, family history, and treatment choices. Although these guidelines have been introduced little is known about pediatricians' actual practice patterns and their beliefs concerning childhood obesity. Project Description I plan to conduct a national survey of pediatricians to assess common strategies for the identification and management of childhood obesity, along with pediatricians' attitudes and beliefs about childhood obesity. In consultation with a panel of practicing general pediatricians and survey research experts, I plan to develop a survey that measures pediatricians' beliefs about the causes and consequences of childhood obesity, its prevalence in their practice settings, their approaches to diagnosis and management, and resources available for treatment. The survey will be administered to a randomly selected national sample of approximately 600 practicing general pediatricians. The response rate is expected to be approximately 60% or 360 pediatricians. The survey results will help to assess the degree to which recommended practice guidelines are being implemented, identify pediatricians' beliefs and attitudes that might serve as barriers to optimal care, and suggest areas for continuing medical education. The proposed time frame for the study is two years.

Project Goals Year One * Develop and Pilot Test Survey. The Pediatrician Survey will be designed to assess both practice patterns and attitudes/beliefs pertaining to childhood and adolescent obesity. From a review of the literature and the recently published guidelines, along with interviews with practicing pediatricians, we will generate items that assess relevant diagnostic and therapeutic approaches to childhood obesity, including patient and physician demographic data. We will also thoroughly review the literature to identify attitudes and beliefs that may impact pediatricians approaches to obesity management. The survey will be pilot tested with a small sample of practicing pediatricians, and appropriate modifications in the survey will be made. * Select Sample. We will use the American Academy of Pediatrics Fellowship Directory to identify a national pool of practicing pediatricians. To allow us to assess any regional differences in practice patterns, we will stratify the pool of practicing pediatricians by geographic region and randomly select 150 pediatricians from within each of four geographic regions. This will allow us to survey a total of 600 practicing pediatricians. * Mail Surveys. Using addresses provided by the Directory, we will send surveys via mail to selected pediatricians. All mailings will be coded and entered into a computerized master list that will facilitate tracking of surveys received and follow-up. Surveys sent and received will be tracked. Based on prior research experience, we expect an initial response rate of approximately 50%. One month after the initial mailing, we will conduct a second mailing to non--responders, sending a reminder postcard requesting the completion and return of the survey. Two months after the initial mailing, a second letter and survey will be sent to those who still have not responded. With this method, we expect a final response rate of 60% Year Two • Data Entry and Analysis. Data from returned surveys, including respondent demographic characteristics, practice structure and setting, practice patterns, and attitudes/beliefs will be entered into a database for subsequent analysis. Data will be double-entered and checked for accuracy. Data analysis will consist of establishing psychometric properties of attitude and belief measures, examining frequencies of responses to, individual items, looking for trends across geographic regions, and assessing common approaches to the diagnosis and management of childhood obesity. Moreover, we will analyze the data to determine the relationship of attitudes/beliefs and practice patterns. We anticipate that we will identify a number of important variations in the diagnosis and management of childhood obesity. We also expect to identify a number of personal and systems-related barriers to treatment of childhood obesity. For example, we expect that pediatricians with more recent training will have more optimistic attitudes toward successful management of childhood obesity. We also expect to find variations in reimbursement and clinic resources, and that these will impact pediatricians' approaches.