Obesity prevention and the primary care pediatrician's office

Use of an electronic medical record system to support primary care recommendations to prevent, identify, and manage childhood obesity

Many primary care physicians are not providing care that is consistent with recommendations to prevent, to identify, and to manage childhood obesity. This report presents modifications made to the electronic medical record system of a large pediatric health care system, using a quality improvement approach, to support these recommendations and office system changes. Although it is possible to make practice changes secondary to electronic medical record system enhancements, challenges to development and implementation exist.

Bolstering confidence in obesity prevention and treatment counseling for resident and community pediatricians

OBJECTIVE

To assess whether equipping resident pediatricians and community pediatricians with both training and practical tools improves their perceived confidence, ease, and frequency of obesity-related counseling to patients.

METHODS

In 2005-2006, resident pediatricians (n = 49) and community pediatricians (n = 18) received training regarding three evidence-based obesity prevention/treatment tools and responded to pre- and post-intervention questionnaires. We analyzed changes in reported mean confidence, ease, and frequency of dietary, physical activity, and weight status counseling.

RESULTS

Baseline scores of confidence, ease, and frequency of counseling were higher in community pediatricians than residents. Mean scores increased significantly in the combined group, among residents only, and trended towards improvement in the community pediatricians following the intervention. Means for "control" questions were unchanged.

CONCLUSION

Training and tools for residents and community pediatricians improved their confidence, ease, and frequency of obesity-related counseling.

PRACTICE IMPLICATIONS

This study demonstrates that when feasible and appropriate tools and training were provided through a simple intervention, physicians gained confidence and ease and increased their counseling frequency. The results here suggest that widespread implementation of such educational interventions for community practitioners and practitioners in training could change the way physicians counsel patients to prevent the often frustrating problem of childhood obesity.

A pilot of a video game (DDR) to promote physical activity and decrease sedentary screen time

OBJECTIVE

We examined the feasibility of Dance Dance Revolution (DDR), a dance video game, in participants' homes, to increase physical activity (PA) and to decrease sedentary screen time (SST).

METHODS AND PROCEDURES

Sixty children (7.5 +/- 0.5 years) were randomized in a 2:1 ratio to DDR or to wait-list control (10-week delay). DDR use was logged, PA was measured objectively by accelerometry. SST was self-reported at weeks 0 and 10. At week 28, after both groups had access to DDR, accelerometry and SST were repeated.

RESULTS

Mean use of DDR was 89 +/- 82 (range 0-660 min) min per week (mpw). The DDR group showed increased vigorous PA and a reduction in light PA; the control group showed no increase in moderate and/or vigorous PA (MVPA) although they also had a reduction in light PA. Differences between the groups were not observed. The DDR group also reported a decrease in SST of -1.2 +/- 3.7 h per week (hpw) (P < 0.05), whereas the controls reported an increase of +3.0 +/- 7.7 hpw (nonsignificant). The difference in SST between the groups was significant, with less SST in the DDR group. Between weeks 10 and 28, numeric reductions in SST were reported in both groups. In the DDR group, SST at week 28 (8.8 +/- 6.0 hpw) was lower than baseline (10.5 +/- 5.5 hpw; P < 0.03).

DISCUSSION

This pilot study suggests that DDR reduces SST and may facilitate slight increases in vigorous PA. Further study is needed to better characterize children and contexts in which DDR may promote a healthy lifestyle.

Management approaches for pediatric obesity

Childhood obesity is a worldwide problem that has reached epidemic proportions, resulting in an increased prevalence of premature obesity-related morbidities, and, thus, probable increased health-care costs to treat children. The development of viable approaches to manage this epidemic is crucial. Most experts in the field of childhood obesity agree that the prevention of obesity in children should be the first line of management. Pediatricians must be adept at recognizing children at risk of obesity, calculating and plotting the BMI at all visits, using a change in the BMI to identify excessive weight gain, and monitoring for comorbidities associated with obesity. If obesity is present, the cornerstone of treatment is modification of dietary and exercise habits. Practice-based counseling and community-based programs that support and encourage lifestyle modifications have yielded promising short-term results. Children with severe comorbidities who are unable to achieve lifestyle modifications can be considered for either pharmacologic therapy or surgery, but these options should be considered as a last resort. Early intervention and prevention strategies are the most cost-effective methods of dealing with this issue.

Integrative approach to obesity

Integrative medicine blends conventional medicine with carefully evaluated complementary therapies and considers all elements of a patient's lifestyle (physical, mental, spiritual). Integrative medicine therapies and philosophies have characteristics similar to those of successful treatment programs for pediatric obesity. This article defines pediatric obesity and explores those similarities in more detail. It also updates the practitioner on selected integrative approaches as they relate to prevention and treatment of pediatric obesity.

Preventing Obesity in America: Is It Achievable?

The prevalence of obesity has increased significantly in the past 40 years. Although difficult to treat, physicians must continue contributing to the solution by not only advocating for dietary interventions and increased exercise but also should target at-risk populations and promote more prevention strategies for combating obesity. Given the close association with the comorbidities of diabetes and hypertension, obesity is closely linked with the number one killer of all Americans: heart disease. This alone makes obesity an enormous public health threat. General, broad public health strategies for supporting weight loss are also discussed.