Childhood overweight is an important public-health problem in the US. Current estimates indicate that one in three children is overweight. Over half of overweight 5-10 year-old children have at least one cardiovascular disease risk factor, and overweight increases the lifetime risk of cardiovascular morbidity and premature death, but these risks are reduced in overweight children who attain a normal weight. During well-child visits, pediatricians have an opportunity to address weight and weight-management. Little is known, however, about clinical practice elements and pediatrician-patient communication strategies associated with weight improvement in overweight children. The overall objective of the proposed project is to identify specific clinical practice elements and pediatrician-patient communication strategies during well-child visits that predict improvement in relative weight among overweight children. This will be accomplished through three specific aims, which are to 1) identify specific clinical practice elements in pediatric primary care that predict improvement in weight status; 2) determine communication strategies that predict improvement in weight status; and 3) develop and test the feasibility and acceptability of a pilot intervention to improv pediatricians' communication and use of specific clinical practice elements when addressing weight and weight management during primary-care visits with overweight children.
For Aim 1, electronic medical records (EMR) will be analyzed to determine clinical practice elements (such as lab assessments and follow-up interval) associated with improvement in weight status at one year follow-up.
For Aim 2, Roter Interaction Analysis of video- recorded well-child visits will be used to analyze pediatrician-patient communication regarding weight and weight-management (including assessment and counseling regarding overweight status, and communication dynamics, including patient-centeredness), and children will be followed, by tracking interval visits, weights/heights, and referrals using the EMR, over one year. Findings from Aims 1 and 2 will be used in Aim 3 to develop and test the feasibility and acceptability of a pilot intervention aimed at improving pediatricians' observed and self-reported competence in using specific clinical practice elements and effective communication when addressing overweight during primary-care visits, compared with a control group of standard practice. The proposed Career Development Award addresses how to improve overweight/obesity management in primary care, a research priority of an NHLBI Working Group convened to set future research priorities in childhood obesity prevention and treatment. The exceptional resources and institutional support at UT Southwestern, outstanding multi-disciplinary mentorship team, and proposed career development activities will allow the candidate to achieve her long-term goal of becoming an independent investigator and nationally recognized expert on primary-care based interventions that are effective in improving childhood overweight and obesity.
There is an urgent need to identify strategies that lead to successful weight improvement for overweight children: although overweight increases the lifetime risk of heart disease and early death, these risks are reduced in overweight children who attain a healthy weight by adulthood. The goal of the proposed research is to identify specific clinical practice elements and communication strategies in pediatric primary care that pediatricians already are using which help children attain healthier relative weights, and pilot an intervention to translate study findings into clinical practice. Achievement of the study aims has the potential to be a significant contribution to promoting weight improvement for overweight children, as the proposed research could lead to the development of an effective intervention to improve pediatricians' communication and use of specific clinical practice elements when addressing weight and weight management for overweight children in primary care.
