Curbing childhood obesity one office visit at a time
Kids are getting larger, and adults are getting worried. The concern has spawned conferences, such as the one happening this week in Los Angeles, where doctors, nurses, health educators, dietitians and assorted obesity experts converged at the Fifth Biennial Childhood Obesity Conference at the Westin-Bonaventure to share stories, information, triumphs and frustrations in combating an issue that shows few signs of abating.
New healthcare guidelines were the topic of a panel titled "Improving Childhood Obesity Care" that focused in part on the Healthcare Effectiveness Data and Information Set, a performance measurement tool used by the vast majority of health plans. It now includes more frequent physician body mass index testing and counseling on nutrition and physical activity for kids. The hope is that more BMI testing and counseling -- at every office visit, for example, not just well-child visits -- will provide a more consistent gauge and help keep weight in check.
But there are stumbling blocks. Teens, for example, don't see the doctor as frequently for well-child visits, according to Dr. Scott Gee, medical director of the Permanente Medical Group Inc. and one of the panelists. "We’ve tried to do outreach and they don't want to come in." Less than 40%, he added, come in for annual well-child check-ups, so BMI tests may have to be done during other office visits.
Calculating a child's BMI is challenging as well, he said: "You try to do that in pediatrics -- how long does it take for a child to get his shoes off and get weighed? It's significant."
Gee is guardedly optimistic about how the new guidelines will shake down. "When we moved to this strategy," he said, "it was kind of a mind shift for us. Until this results in improved counseling and better eating, I don't know. Hopefully it will result in better care for children."
Of course, not every doctor is adept at counseling young patients about their weight, and many are reluctant to do it, an issue being addressed through more physician education. "This is different from asthma or ADHD," said panelist Dr. Victoria Rogers, a pediatrician and director of the Kids CO-OP, a division of the department of pediatrics at the Barbara Bush Children's Hospital at Maine Medical Center. "Some physicians are feeling like the whole burden is on them, or they feel who are they to talk -- they're 30 pounds overweight themselves. But patients are actually OK with it. They'd rather talk to someone who's been through this."
After the discussion, Gee added, "I don't think there's a practice in California where a physician hasn't noticed a dramatic increase in the number of overweight kids in their practice. I think for physicians, it's more an issue of being empowered, so that they're feeling their counseling is making a difference. Because a lot of them do provide counseling, and you get frustrated because the weight continues to go up. So part of the goal we're trying to accomplish is giving physicians more communication skills so they really can motivate families to make changes."
-- Jeannine Stein
Photo credit: Christine Cotter / Los Angeles Times