Heavy teens need more health talks: study

NEW YORK (Reuters Health) - Pediatricians often miss important opportunities to talk about nutrition, exercise, and emotional issues with overweight teens, suggests new research from California.

Focusing on these issues in overweight adolescents may give doctors a chance to stop unhealthy behavior that could be setting kids up for obesity before it's too late, said study author Dr. Carolyn Bradner Jasik.

"Once kids are obese, these behaviors are entrenched, and it's much more difficult," she told Reuters Health.

Her new research hints that while doctors may take the time to ask obese teens about diet and physical activity, and to help them work through ways to improve their health, they may overlook opportunities to have the same conversation with overweight teens.

"There's increased recognition that obesity is a problem and physicians are starting to do more with the population that is defined as obese," said Dr. Randall Stafford, who has studied obesity counseling at Stanford University in Palo Alto, California. "But they still are neglecting this population that is on a trajectory toward developing obesity."

Recent recommendations from the United States Preventive Services Task Force and the American Academy of Pediatrics say that this type of "preventive screening" can have a real benefit on kids' weight and health.

To see if pediatricians were already having these conversations with their patients, Jasik and her colleagues from the University of California, San Francisco looked at data from a statewide telephone survey of adolescents age 12 to 17.

In 2003, 2005, and 2007, researchers asked more than 9,000 teens about their height and weight, and whether their pediatricians had talked to them at their last appointment about nutrition, physical activity, and emotional issues like anxiety and depression.

By calculating their body mass index (BMI), a measure of weight in relation to height, the researchers were able to determine whether the teens were of normal weight, overweight, and obese.

Depending on the year, between six and eight of every 10 adolescents said they had discussed physical activity and nutrition at their last visit. Only two or three in 10 said they had talked about "emotional distress" with their pediatricians, according to findings published in Pediatrics.

While obese teens were more likely to say they talked with their doctors about diet and exercise, that wasn't the case for overweight teens. And over the course of the survey years, pediatricians became less likely to talk to their patients -- including the obese teens -- about any of those issues.

Jasik said that in an appointment with a normal-weight teen, pediatricians might just ask a few questions about food, exercise, and family history of obesity. Ideally, "with an overweight kid, they might spend 15 to 20 minutes really looking at what their diet and physical activity looks like," she said.

But with pediatricians' already busy schedules, Jasik said that it might not be realistic to expect them to sit down and talk with every overweight and obese kid -- especially now that as many as one-third of U.S. kids are obese or overweight.

"Pediatricians don't have 20 minutes during a preventive visit to do this kind of counseling," she said, and in most cases, insurance companies won't pay for them to bring kids back for a follow-up appointment related to weight issues.

"It's not like physicians don't want to do these things," Stafford, who was not involved in the new study, told Reuters Health. "But whether they have the tools, have the time, and get reimbursed for these things makes a lot of difference."

He said the findings likely apply to the whole country, not just California, and that many overweight and obese adults also aren't getting enough weight-related counseling from their primary care doctors.

Preventive screening rates may have gone down in recent years party because there are simply more obese kids for doctors to screen, but no more time for them to do it, Jasik explained. Also, pediatricians may be frustrated by a lack of places such as sports leagues and supermarkets with healthy foods to send kids who need to get healthier.

She's hopeful that with new guidelines published since her team's research was conducted, the trend may reverse and pediatricians may get better about talking to overweight and obese patients. But, she said, preventing obesity "needs to be a lot bigger than that" and has to require efforts from the whole healthcare system and in the community.

SOURCE: bit.ly/jsoh2P Pediatrics, online July 18, 2011.