Childhood obesity has increased six-fold since the 1970s. Is part of the problem too little appropriate training for pediatricians?
It would seem so, pediatric resident Steven Marek reported at a recent Johns Hopkins Children’s Center Grand Rounds, citing a lack of consistent obesity-management training programs for pediatric residents and pediatricians. Indeed, one survey showed that only 26 percent of 115 pediatric residency programs planned curricula for physical activity counseling, even though 93 percent of residents strongly agreed that physical activity training is an important part of residency training (Teach Learn Med 2010 Apr;22(2):107-11).
“As the obesity epidemic started to worsen,” Marek said, “there was this realization that residency programs were not doing much to train residents, at least not in any formal or structured curriculum.”
But such training can make a difference for patients, said Marek, pointing to a residency quality improvement project that resulted in a significant decrease in soda consumption when patients and families received structured counseling regarding the intake of sugar-sweetened beverages. Among the counseling messages – increased consumption of sugar-sweetened drinks contributes to osteoporosis, dental caries, and impaired calcification of growing bones (Clinical Pediatrics 2009;48(7):777-779).
Another teaching initiative, designed to build a physician’s confidence and increase the frequency of discussing obesity, surveyed both pediatric residents and community pediatricians before and after undergoing a one-hour training session using color-coded BMI charts and age-specific risk-assessment questionnaires completed by patients and families in the waiting room. The patients of those physicians who underwent training, Marek noted, significantly reduced obesity-related behaviors (Patient Education and Counseling 2008;73:179-185).
The authors wanted to include community pediatricians, Marek added, because they were concerned about a sense of apathy among this group related to the complexity of treating obesity and the lack of proven interventions. “Perhaps going through a re-education process could revitalize pediatricians’ efforts and energy for managing obesity,” Marek said.
In another community-based intervention with structured resident training – “5-4-3-2-1 Go!” – researchers distributed an educational flyer throughout the community. Patients were then asked to fill out a form at well-child visits regarding their diet, physical activity and screen time. Not surprisingly, those in this intervention group also showed significant improvement in obesity-reducing behaviors (Clinical Pediatrics 2011;50(3):215-224).
Similar obesity management training programs that focus on issues like BMI reduction and comorbid conditions like type II diabetes and hypertension, would be beneficial, Marek said. Citing Johns Hopkins Internet Learning Center (ILC) modules about obesity and motivational interviewing, and its Referral to Youth Fitness Circle and Weigh Smart programs, Marek added that model obesity management programs for pediatricians and their patients do exist.
“While there have been advances in educating residents about obesity,” he concluded, “there are still steps we can take.”