Although obesity interventions frequently involve changes in family lifestyle, schools, community environment, and national policies, family physicians can play an integral role in the management and prevention of pediatric obesity, as they have longstanding relationships with obese children and their parents.1–3
Family physicians can readily identify children at high risk of becoming obese, intervene, and follow up on progress.1–3 However, most family physicians believe they are unprepared to manage childhood obesity, or they perceive their efforts as ineffective. Table 12–9 shows multiple barriers that are associated with family physicians’ failure to recognize childhood obesity early and provide appropriate interventions.
Barriers to pediatric obesity prevention identified by family physicians
With the increasing prevalence of childhood obesity and the commitment of governments and the World Health Organization to addressing the problem, more pressure will obviously be put on family physicians to further intervene. These constraints and pressures create an urgent need in the primary care setting to develop and evaluate novel clinical strategies that directly address these barriers. The objective of this article is to identify barriers to pediatric obesity management and prevention, and to provide simple and practical strategies to overcome these barriers.
Strategies
Table 21,2,10–19 outlines strategies proposed by family physicians to overcome barriers in the prevention of pediatric obesity. Some of the studies reviewed here are surveys; they are subject to sampling and self-reporting biases and low response rates. In the case of interviews, the open nature meant that the interviewed practitioners could detail their views and raise issues salient to them and ignore other issues. The attitudes and behaviour of family physicians not surveyed or interviewed might be different. Therefore, the information gathered from surveys and interviews cannot be generalized to all family physicians. However, the information provided by these studies is sufficient to identify solutions to most family physicians’ concerns.
Strategies proposed by family physicians to overcome barriers to prevention of pediatric obesity
It is encouraging to note that family physicians who reported receiving obesity-management training rated themselves as considerably more competent. Likewise, family physicians aware of recommendations more readily have positive attitudes about their personal counseling abilities and their overall effectiveness in obesity prevention.5,10 The availability of these tools will eventually help family physicians follow clinical practice recommendations on the management and prevention of pediatric obesity.
Davis et al10 and Koplan et al17 recommended that family physicians in primary care settings 1) calculate and plot age- and sex-specific body mass index (BMI) percentiles in all children and adolescents once a year; 2) use changes in BMI to identify rate of excessive weight gain relative to growth; and 3) encourage children and parents to eat a healthy diet, be physically active, and limit sedentary activities.
The Canadian Medical Association11 published clinical practice guidelines for the management and prevention of obesity in adults and children. For the prevention of pediatric obesity, the authors recommended limiting screen time to 2 or less hours a day, encouraging more activity and less food consumption, and limiting exposure to food advertising. In 2006, I provided recommendations for family physicians specific to pediatric patients. I explained that family physicians needed to identify patients at risk; encourage reduced consumption of sugar-sweetened soft drinks; decrease sedentary behaviour; involve parents; and provide age-appropriate anticipatory guidance and early surveillance.1 Nevertheless, the prevalence of pediatric obesity continues to rise in Canada and worldwide. Obviously, efforts to develop better ways of preventing pediatric obesity are needed.
Greater roles
It is difficult to confirm the effectiveness of family physicians’ interventions in the management of pediatric obesity. Nevertheless, with the tools provided here, family physicians should be able to improve their roles in the management of pediatric obesity. To further help family physicians, policy makers should support education and training, and facilitate collaboration between family physicians and community organizations to ensure that the use of existing infrastructure and local resources is maximized. They should promote good lifestyle habits such as using the following “5, 3, 2, 1, 0” daily slogan: 5 or more servings of fruits and vegetables; 3 structured meals (including breakfast); 2 hours or less of television or video games; 1 hour or more of moderate to vigorous physical activity; and 0 sweetened beverages. Finally, family physicians should take an active stance in the management and prevention of obesity, as well as take advantage of resources such as continuing medical education training to keep well informed on BMI measurements and new effective counseling techniques.
Footnotes
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La traduction en français de cet article se trouve à www.cfp.ca dans la table des matières du numéro de mai 2012 à la page e239.
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Competing interests
None declared
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The opinions expressed in commentaries are those of the authors. Publication does not imply endorsement by the College of Family Physicians of Canada.
- Copyright© the College of Family Physicians of Canada
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