Putting context in the statistics: Paediatricians' experiences discussing obesity during office visits

Introduction: Surveys poorly capture how paediatric providers interact with individual patients and families to encourage behaviour change for obesity treatment. Paediatrician' descriptions of their specific experiences may suggest new ways to approach office-based obesity care. Methods: Face-to-face interviews with eight paediatricians from diversebackgrounds and practice settings in the Saint Louis area. They described their experiences identifying and treating obesity, the perceived response and suggestions for improved office-based treatment. Transcriptions of audiotaped interviews were analysed using qualitative techniques. Results: Paediatricians believed they identify most overweight children but without the use of body mass index (BMI). They recognized excess weight using weight and height charts, which also helped them inform families of the condition. Consistent with available recommendations, the paediatricians emphasized health problems of obesity, advised simple behaviour changes for the entire household and adapted messages to individual families. They sometimes took extra time to discuss obesity. Despite their efforts, they observed almost no success. In addition to poor home environments in many families, they described low family commitment. In their experience, the rare, successful patients came to office visits already motivated. They suggested some office-based improvements, such as better handouts although they stressed the need for improved school and community environments. Conclusion: Despite following available obesity treatment recommendations, the paediatricians observed little success. These findings suggest that promoting paediatrician compliance with recommendations will not improve outcome. Instead, improving patient motivation prior to visits and new handouts designed with parent input may be more effective. BMI use will likely increase only when paediatricians are persuaded of its utility.