Provider views on childhood obesity management in primary care settings: a mixed methods analysis

Kyung E. Rhee, Stephanie Kessl, Sarah Lindback, Marshall Littman, Robert E. El-Kareh

Pediatric providers are key players in the treatment of childhood obesity, yet rates of obesity management in the primary care setting are low. The goal of this study was to examine the views of pediatric providers on conducting obesity management in the primary care setting, and identify potential resources and care models that could facilitate delivery of this care. A mixed methods approach was utilized. Four focus groups were conducted with providers from a large pediatric network in San Diego County. Based on a priori and emerging themes, a questionnaire was developed and administered to the larger group of providers in this network. Barriers to conducting obesity management fell into four categories: provider-level/individual (e.g., lack of knowledge and confidence), practice-based/systems-level (e.g., lack of time and resources), parent-level (e.g., poor motivation and follow-up), and environmental (e.g., lack of access to resources). Solutions centered around implementing a team approach to care (with case managers and health coaches) and electronic medical record changes to include best practice guidelines, increased ease of documentation, and delivery of standardized handouts/resources. Survey results revealed only 23.8% of providers wanted to conduct behavioral management of obesity. The most requested support was the introduction of a health educator in the office to deliver a brief behavioral intervention. While providers recognize the importance of addressing weight during a well-child visit, they do not want to conduct obesity management on their own. Future efforts to improve health outcomes for pediatric obesity should consider implementing a collaborative care approach.