that many of the parents appear overweight and have a family history of diabetes. Her son is also overweight and has pre-diabetes. …
Obesity prevention in pediatric primary care
Pediatrician Problem scenarios
1 A pediatrician, Dr Bruschi, works at a community clinic in a lower
income area of Boston One of Dr Bruschis biggest concerns lately
is the increasing number of obese pediatric patients he is seeing He
notices that many of the parents appear overweight and have a family
history of diabetes He has tried many things to address the weight
gain problem such as going to various CME courses and seminars on how
to treat obesity but he when he gets back to the office, he finds it
difficult to implement what he has just learned He is very
frustrated because nothing seems to work and he feels that once a
patient has gained weight, there is little he can do He sees his
patients gain more and more weight with each visit so he feels that
his efforts are not worthwhile either But, he does not want to give
up Dr Bruschi asks his patients how much soda they drink and how
much exercise they get and then he tries to help them cut back on the
easiest thing, for example, cutting out soda He often runs out of
time during his
well-child visits which are only 15 minutes in length
There are a whole list of things he has to ask about so there is
seldom time to talk in depth about the childs weight problem In
summary, Dr Bruschi feels frustrated about pediatric obesity because
he doesnt know what to do and doesnt have much time to spend on the
problem but at the same time he wants to do something about the
problem
2 Dr Welker has been practicing pediatrics for 30 years now She is a
primary care pediatrician who enjoys seeing patients across their
lifespan Her primary place of practice is in a lower income part of
Boston that serves mainly immigrant population and patients Many of
her patients parents speak Spanish only and some parents are not
literate in either English or Spanish Dr Welker is concerned about
the growing number of patients who have been gaining weight at an
accelerated rate, higher than what they should be She finds that
many of her parents can get overwhelmed by too much information She
likes to work on a small thing they can do at home to eat healthier
foods or get more physical
activity Dr Welker will think of one
small thing at every visit but often she does not see her patients
more than once a year, sometimes she sees them two-three times a year
She finds it very hard to know what to say to her patients and
parents and she does not have a place where she can refer the family
There is one outpatient weight management clinic that is on the other
side of town but the family has to take a shuttle so she feels its too
complicated for her families to get there Dr Welker would like to
have resources in her clinic that are accessible to her families She
would also like to be able to spend more time on diet and exercise but
is under too many time constraints
3 Dr Moss is a busy pediatrician He takes great pride in his work and
keeps up with the latest research studies He is also an avid sports
buff himself He likes to exercise everyday and thinks that kids and
their parents arent getting enough physical activity In fact, he
attributes the obesity problem that he is seeing to lack of physical
activity Dr Moss works in a clinic that is affiliated with a
hospital in a middle-class area of Massachusetts The clinic gives
him 15 minutes for all appointments, even if its an annual appointment
well-child visit In those 15 minutes, he often asks parents about
their childrens physical activity and sport habits He wants to know
what they do but he isnt so sure that the parents are giving him an
accurate picture Most of the time he thinks that the parents
inflated the amount of physical activity He also believes that the
parents do not give him an accurate account of what the childs
dietary habits are Mostly, Dr Moss is a skeptic about patients
self-report but he asks his patients and parents anyway He wants to
help his patients maintain a healthy weight and he will often ask them
to come back for a follow-up visit to discuss weight in more depth
Dr Moss likes to help his patients commit to losing weight and
attempts to be as motivational as he can, like a coach But, more
times than not, he finds that the patients do not show up for their
follow-up visits or they do and have not followed through on the plans
he has discussed, ie, the
patient has gained more weight at the
follow-up
Parent/caregiver problem scenarios
4 Mrs Brady is a single mother of three children ages 4 to 10 Her 10
year old is considered obese, her six year old is normal weight and
her four year old is overweight Mrs Brady is constantly tired and
has struggled with her weight for years Her pediatrician has told her
that the children need to keep their weight within a healthy weight
range She tried to send her 10 year old to a weight management
clinic at the local hospital but it was hard to get her their on time
and she was not sure that the program did any good Mrs Brady doesnt
know what to do about her childrens weight gain, moreover, she does
not have time to spend worrying about it She thinks that her
pediatrician does not give her advice that she can really use or that
he says things that are too hard for her to change The last time Mrs
Brady brought her kids in for their annual well-child visit, all four
of them had to sit in the doctors exam room The doctor devoted
about 15 minutes to each child and went over a list of things with
her He asked her various questions for a good 30 minutes, and he
recommended a few things about health and diet but she forgot most of
it when she got home She was focused on getting her children their
shots and certificates for school but was a little worried that the
pediatrician was concerned about her childrens weight again
5 Mrs Seau has two grandchildren who are four and six She looks after
the kids for her son They all live in a small apartment in South
Boston The neighborhood is fairly rough and safety is an issue
There are many fast food restaurants within in two to three blocks of
the apartment Mrs Seau likes to bring the children to doctors
appointments during the day when her son is at work The pediatrician
treats her as the primary care giver of the children The doctor asks
many questions about the childrens health She tells the
pediatrician that her grandchildren are healthy, very active and good
eaters She often tells her son that doctors do not know what they
are talking about when it comes to raising kids Her son is also
overweight and has pre-diabetes The
family has some Native American
ancestry and no one has receive a degree beyond technical school Mrs
Seau has been told that she is obese and that her diabetes can be
managed if she lost some weight All of her friends are overweight
too so she does not see it as a problem She also thinks that her
grandchildren are normal weight When the pediatrician tells her that
the children are overweight and at risk for getting diabetes, Mrs Seau
disagrees The pediatricians do not argue with her
Source:wvu.edu
