A descriptive study of childhood obesity monitoring practices used by Montana pediatric providers
Schwarzkopf, Nancy Denise.
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INTRODUCTION: The global prevalence of childhood obesity is increasing. Overweight children face risks of compromised physical and mental well being, increased incidence of disease processes, and increased risk of adult obesity. Pediatric providers play a unique role in reversing the prevalence of obesity, yet there is little understanding of what practices are utilized to monitor children's weight. PROBLEM: Identifying children who are obese or are at risk for becoming obese may rely on evidence based weight monitoring practices. For many providers there may be a gap in knowledge regarding recommended practices for measuring growth in children. The purpose of this study was to describe current practices for monitoring obesity of children used by Montana primary pediatric providers. METHODS: A descriptive, cross-sectional study was conducted using a mailed pencil and paper survey, sent to 300 primary pediatric providers in Montana selected from 900 Child Health Insurance Plan (CHIP) providers. Eighty-five surveys were returned for a response rate of 28%. Data analysis utilized SAS software; results were analyzed using frequencies and percentages. RESULTS: A total of 85.7% of respondents offered care in family practice settings; 17.6% are pediatric specialists, 31.8% are practicing rurally and 57.6% of providers saw 5 or fewer children/per day. Over 95% of providers measured height and weight, 61.2% calculated body mass index (BMI). Just 55.8% of those who measure BMI accurately plotted it on age/gender specific chart, or 34% of total respondents. All respondents perceived childhood obesity as a concern, with patient/parent resistance cited as the most common barrier to treatment. CONCLUSION: Health disparities in Montana associated with rural populations include fewer pediatric specialists, fewer child healthcare visits, and barriers of access, education level and money for patient and their families. In Montana, height and weight measurements are used predominately to monitor children's growth; BMI was accurately used by one third of respondents which may interfere with the provider's ability to accurately identify adiposity. These findings suggest a focus area for provider education, promoting BMI guidelines for children. Perceptions of barriers: patient/parent resistance, time constraints, and reimbursement; suggest treatment protocols could improve outcomes for childhood obesity.