Paediatricians often miss important opportunities to talk about nutrition, exercise, and emotional issues with overweight teens, suggests new research from California.
Focusing on these issues in overweight adolescents may give doctors a chance to stop unhealthy behaviour before the youngsters become obese, said study author Dr Carolyn Bradner Jasik.
"Once kids are obese, these behaviours are entrenched, and it's much more difficult," she said.
Her new research hints that while doctors may take the time to ask obese teens about diet and physical activity, and to help them work through ways to improve their health, they may overlook opportunities to have the same conversation with overweight teens.
"There's increased recognition that obesity is a problem and physicians are starting to do more with the population that is defined as obese. But they still are neglecting this population that is on a trajectory towards developing obesity," said Dr Randall Stafford, who has studied obesity counselling at Stanford University in Palo Alto, California but wasn't involved in Dr Jasik's study.
Preventative screening helps kids
Recent recommendations from the United States Preventive Services Task Force and the American Academy of Paediatrics say this type of preventive screening can have a real benefit on kids' weight and health.
To see if paediatricians were already having these conversations with their patients, Dr Jasik and her colleagues from the University of California, San Francisco looked at data from a statewide telephone survey of adolescents age 12 to 17.
In 2003, 2005, and 2007, researchers asked more than 9,000 teens about their height and weight, and whether their paediatricians had talked to them at their last appointment about nutrition, physical activity, and emotional issues like anxiety and depression.
Depending on the year, between six and eight of every 10 adolescents said they had discussed physical activity and nutrition at their last visit. Only two or three in 10 said they had talked about "emotional distress" with their paediatricians, according to findings scheduled for publication online in Pediatrics.
Paediatricians need to talk to teens
While obese teens were more likely to say they talked with their doctors about diet and exercise, it wasn't the case for overweight teens. And over the course of the survey years, paediatricians became less likely to talk to their patients – Including the obese teens – about any of those issues.
Dr Jasik said that in an appointment with a normal-weight teen, paediatricians might just ask a few questions about food, exercise, and family history of obesity. Ideally, "with an overweight kid, they might spend 15 to 20 minutes really looking at what their diet and physical activity looks like," she said.
But she also said it might not be realistic to expect them to sit down and talk with every overweight and obese kid – especially now that as many as one-third of US kids are obese or overweight.
"Paediatricians don't have 20 minutes during a preventive visit to do this kind of counselling," she said, and in most cases, insurance companies won't pay for them to bring kids back for a follow-up appointment related to weight issues.
"It's not like physicians don't want to do these things," Dr Stafford said. "But whether they have the tools, have the time, and get reimbursed for these things makes a lot of difference."
He said the findings likely apply to the whole country, not just California, and that many overweight and obese adults also aren't getting enough weight-related counselling from their primary care doctors.
Preventive screening rates may have gone down in recent year’s party because there are simply more obese kids for doctors to screen, but no more time for them to do it, Dr Jasik said. Also, paediatricians may be frustrated by a lack of places such as sports leagues and supermarkets with healthy foods to send kids who need to get healthier.
She's hopeful that with new guidelines published since her team's research was conducted, the trend may reverse and paediatricians may get better about talking to overweight and obese patients.
But, she said, preventing obesity "needs to be a lot bigger than that" and has to require efforts from the whole healthcare system and in the community.
(Reuters Health, Genevra Pittman, July 2011)
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