Screening and managing obesity: understanding paediatric residents' knowledge, attitudes and practice

Postgrad Med J. 2021 Feb 4;postgradmedj-2020-139318. doi: 10.1136/postgradmedj-2020-139318. Online ahead of print.

Abstract

Study purpose: Prior studies have identified paediatric attending physicians' screening and management patterns related to overweight/obesity, but less is known about resident physicians' behaviour. The objective was to understand paediatric resident physicians' knowledge, attitude and practice patterns of overweight/obesity screening and management.

Study design: We performed a retrospective chart review of preventive visits conducted by residents between August and October 2019. Charts of patients 2-18 years with body mass index ≥85th percentile at the visit were reviewed (85th-<95th for age and sex defined as overweight, ≥95th defined as obese). A survey was distributed to residents assessing knowledge, attitudes and barriers towards obesity management.

Results: Of 1250 visits reviewed, 405 (32%) patients met the criteria for overweight or obesity. 39% were identified correctly by the provider, 53% were not identified and 8% were identified incorrectly. 89% of patients had diet history, 31% had physical activity and 43% had family history documented. Patients with obesity received physical activity documentation/counselling, portion size counselling, at least one referral, laboratory tests and a diagnosis more often than overweight patients. 84% of residents completed the survey. Although the majority of residents felt 'somewhat' or 'very' well prepared to counsel families about overweight/obesity, the majority thought their counselling on overweight/obesity was 'not at all' or 'slightly' effective.

Conclusion: Despite residents feeling prepared and comfortable discussing overweight/obesity with patients, these diagnoses were often under-recognised or incorrectly made and appropriate counselling was lacking. Future work will focus on specific strategies to improve diagnosis, screening and management of overweight/obesity and include educational interventions and electronic medical record adaptations.

Keywords: medical education & training; paediatrics.