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Pediatric Obesity Management: Variation by Specialty and Awareness of Guidelines

Division of Endocrinology, Children's Hospital Boston, Boston, Massachusetts, erinn.rhodes{at}childrens.harvard.edu

Cara B. Ebbeling, PhD

Division of Endocrinology, Children's Hospital Boston, Boston, Massachusetts, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

Alan F. Meyers, MD, MPH

Department of Pediatrics, Boston University School of Medicine, Boston, Massachusetts

Cynthia T. Bayerl, MS, RD, LDN

Nutrition and Physical Activity Unit, Bureau of Family and Community Health, Massachusetts Department of Public Health, Boston, Massachusetts

Wee L. Ooi, DrPH

Applied Statistics Evaluation and Technical Services, Bureau of Family and Community Health, Massachusetts Department of Public Health, Boston, Massachusetts

Maria F. Bettencourt, MPH, LDN

Nutrition and Physical Activity Unit, Bureau of Family and Community Health, Massachusetts Department of Public Health, Boston, Massachusetts

David S. Ludwig, MD, PhD

Division of Endocrinology, Children's Hospital Boston, Boston, Massachusetts, Department of Pediatrics, Harvard Medical School, Boston, Massachusetts

A survey of 2727 pediatric clinicians evaluated pediatric overweight management and awareness of Expert Committee recommendations (ECR) on obesity. Adjusted response rate was 45%. ECR awareness was reported by 24.6%. Family practice specialists (FPS) were less likely than pediatric specialists (PS) to be aware of ECR (OR, 0.46; 95% CI, 0.30-0.71). Body mass index (BMI) was never used by 25.6% to identify overweight; 35.4% did not obtain laboratory tests. Among PS but not FPS, ECR awareness was associated with BMI use (OR, 2.70; 95% CI, 1.56-4.65) and frequent follow-up (OR, 2.48; 95% CI, 1.58-3.90). FPS were more likely than PS to use BMI (OR, 1.78; 95% CI, 1.15-2.75) and obtain thyroid function tests (OR, 2.58; 95% CI, 1.53-4.37), but less likely to obtain fasting lipids (OR, 0.47; 95% CI, 0.30-0.73). Specialty differences in dietary recommendations, referrals, and barriers to treatment were identified. Pediatric overweight management guidelines should consider specialty differences and be accessible to all pediatric care providers.

Key Words: obesity • pediatrics • body mass index • practice guidelines • screening

Clinical Pediatrics, Vol. 46, No. 6, 491-504 (2007)
DOI: 10.1177/0009922806298704


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