Tackling the problem of childhood obesity.

Obesity has become one of the most important public health problems in the United States (US). Body mass index (BMI) is the standard measure for classifications of overweight and obesity in children who are two years and older. An overweight condition for a child of 2–19 years old is defined as BMI greater than or equal to the 85th percentile, but less than the 95th percentile; obesity is described as a BMI at the 95th percentile or greater. Currently, approximately one third of children and adolescents in the US are either overweight or obese. As the prevalence of obesity increases, the prevalence of the comorbidities associated with obesity also increases. Due to this reason, it is important that the healthcare providers identify overweight and obese children in order to counsel and treat them. The article by Holt et al attempts to address the issue in this month’s issue of the Southern Medical Journal. In this study, Holt et al assessed the attitudes, practices, perceived barriers, and skill levels of primary care physicians in managing childhood overweight and obesity at four clinics in Southern Appalachia. Although many studies have described healthcare providers’ attitudes and practices regarding obesity management, the majority of these have focused on adult obesity. This study is novel in that it is one of the few studies that have focused on childhood and adolescent obesity, and it is one of the very few studies focusing on the southeastern region of the US, where obesity is among the highest. Southern Appalachia is characterized by a greater burden from chronic diseases, including obesity, compared with people living in non-Appalachia. Health risk behaviors such as unhealthy diet and physical inactivity are also more prevalent in rural Appalachia in comparison with the national average. The study questionnaire used in Holt et al’s research was based on other questionnaires validated and used in other studies, and was the same as used in a previous study. It used a Likert-type scale for physicians’ responses. Not surprisingly, physicians’ opinions in this study did not differ substantially from those in the previous studies. This study found that even though most physicians shared the attitude that childhood overweight and obesity needed attention, their practices geared toward assessment, treatment, and monitoring of childhood overweight and obesity were limited. Physicians’ self-perceived skill level in managing childhood overweight and obesity was found to be a key factor related to childhood overweightand obesity-related practices. The current study did not report novel findings; however, it does reinforce the idea that primary care physicians in Southern Appalachia currently play a limited role in preventing and managing childhood overweight and obesity. Several possible limitations from this study temper our ability to generalize the results to other physician populations. The sample size in the study was small, limiting generalization. Approximately 66 percent of the responding physicians reported family medicine as their specialty, and 61 percent of total respondents were residents. It is fair to say that most of the respondents were family medicine resident physicians, which makes it difficult to generalize the results to residents, let alone physicians in general. The respondents were disproportionately younger than 35 years of age (approximately 59 percent), which also prohibits generalization of the findings to the general physician population. Nevertheless, the findings of the study are important, especially the physicians’ perceived barriers, which include lack of parental motivation and involvement, lack of supportive services, and lack of clinician time. These findings corroborate the findings of previous studies. These factors need to be taken into consideration to develop strategies for tackling this problem. As mentioned before, previous studies have found the lack of parental involvement to be a major barrier. Therefore, physicians in primary care should try to promote parental involvement in childhood overweight and obesity prevention and treatment. Secondly, at present, very few opportunities are available to primary care physicians to learn the most current assessment and management strategies for childhood overweight and obesity. Efforts should be directed at including this important and timely topic in the curricula of residents and medical students. Lastly, the limitation of physicians’ time in practice needs to be addressed. From Wayne State University, Detroit, MI.