Only 12 percent of pediatricians surveyed felt effective in treating overweight children

If North Carolina reflects what is happening nationally, most pediatricians across the country lack confidence in their ability to treat obesity, which is increasingly recognized as robbing children of physical vigor now and good health in later life, a new study shows.

The research, conducted at the University of North Carolina at Chapel Hill, found that only 12 percent of pediatricians surveyed felt effective in treating overweight children. Almost 40 percent, however, thought that they and their colleagues could handle the problem better if things were different.

A report on the findings appears in the current issue of the journal Ambulatory Pediatrics. Authors are Drs. Eliana M. Perrin, Kori B. Flower, Joanne Garrett and Alice S. Ammerman of the UNC schools of medicine and public health.

"When we compared their views on preventing obesity with their views on preventing sexually transmitted diseases, pediatricians felt more confident about the STDs," said Perrin, assistant professor of general pediatrics and adolescent medicine. "They said they felt much more confident about treating attention deficit hyperactivity disorder than treating obesity."

The investigation involved surveying by mail 738 N.C. pediatricians who belonged both to the American Academy of Pediatrics and the N.C. Pediatrics Society. The adjusted response rate was 71 percent.

"In the study, pediatricians' lack of confidence in managing obesity in children was most related to a scarcity of useful educational materials and other potentially modifiable factors," Perrin said. "In fact, pediatricians were able to identify many possibly helpful resources.

"We also found that 89 percent of the doctors said they were willing to take at least a small role in advocacy efforts to reduce childhood obesity," she said. "They told us that they may want to work on this big problem outside their offices more than inside. Now, we just have to figure out a way to mobilize collective efforts."

The most frequently cited barriers to reducing obesity were the easy availability of fast foods and sweetened soft drinks, questionable school food practices, limited physical activity in schools and the lack of reimbursement for health-care professionals other than doctors, she said. Also often cited were a lack of printed materials for patients, adults not perceiving obesity as a health hazard and fear of offending children and their families.

In a separate analysis that used the same survey and appeared recently in the journal Obesity Research, Perrin, Flower and Ammerman found that nearly half of all pediatricians who were overweight themselves did not identify themselves as such.

"Male pediatricians were nearly four times more likely than female pediatricians to misclassify their own weight as not excessive when they actually were overweight," she said. "Those who called themselves thin had nearly six times the likelihood of reporting counseling difficulty as a result of their weight than those who thought of themselves as average in weight."

Those who thought they were overweight also were four times more likely to report difficulties in counseling as a result of their weight than doctors who thought their weight was normal.

The findings came after adjusting for what those surveyed said about their actual height and weight and other variables so that "perception was more important than reality for the difficulty in counseling about weight management," Perrin said.

"We hypothesized that pediatricians who thought they were thin had the toughest time counseling because they worried that patients would consider them unsympathetic," she said. "Those who think themselves too heavy might have trouble counseling about weight for more obvious 'pot-calling-the-kettle-black' reasons. We hope all pediatricians will focus more on health habits in their counseling and not be concerned about their own weight when counseling kids."

Last spring, Perrin and colleagues released a study showing that pediatricians monitoring young patients' health were more likely to recognize children as being overweight if they employed a measure known as body mass index than if they simply reviewed of each child's height and weight.

Too few pediatricians -- only 11 percent of those surveyed -- used the body mass index in their physicals and evaluations, however, the UNC researchers found. Almost a third never considered the index, also called BMI, which is a mathematically derived number indicating how heavy a person is for his or her height.

"Despite their strong links to diabetes, high blood pressure and cardiovascular disease in later life, overweight and obesity frequently are under-diagnosed in both children and adults," Perrin said.

BMI is calculated by taking one's weight in kilograms and dividing that number by one's height in meters squared. That number is then plotted on charts that give population norms for both boys and girls ages 2 to 20.

"Whereas adults should ideally have body mass indexes that are less than 25, for children appropriate BMI is age and gender-dependent," Perrin said. "That's why it is useful to have BMI charts that help pediatricians see when a child is trending too heavy for his or her height."