title: Treatment of child and adolescent obesity: reports from pediatricians, pediatric nurse practitioners, and registered dietitians.
abstract: OBJECTIVE
  The primary aim of this study was to identify interventions used by pediatric health care providers in treatment of overweight children and adolescents to identify provider educational needs. A secondary aim was to examine the association of certain provider characteristics with recommended evaluation practices.
  
  
  METHODS
  A random sample of pediatricians, pediatric nurse practitioners, and registered dietitians (RDs) received questionnaires about their diet, activity, and medication recommendations for overweight patients and about referrals to specialists and programs. Results were examined for adherence to published recommendations and for associations with certain respondent characteristics.
  
  
  RESULTS
  A total of 940 providers responded (response rate: 19%-33%). The majority recommended "changes in eating patterns" and "limitations of specific foods." Half or more used "low-fat diet" and "modest calorie restriction" in adolescents. Less than 15% used "very low-calorie diet." Fewer RDs recommended more restrictive diets. More than 60% of all groups followed recommended eating interventions for school-aged children and adolescents. More than 80% followed recommended physical activity interventions for all age groups. In each group, about 5% sometimes recommended prescription medication and herbal remedies for adolescents. None recommended surgery. Two thirds of pediatricians and pediatric nurse practitioners often referred to RDs. Approximately 20% referred to child/adolescent weight programs, but for 27% to 42%, these programs or pediatric obesity specialists were not available. No consistent associations between respondent characteristics and adherence to recommended interventions were identified.
  
  
  CONCLUSIONS
  The providers generally promoted healthy eating and activity with minimal use of highly restrictive diets or medication to control weight.
authors.affiliation: St Louis University School of Medicine, St Louis, Missouri 63104, USA. barlowse@slu.edu
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Barlow
authors.forename: Frederick L
authors.initials: FL
authors.lastname: Trowbridge
authors.forename: William J
authors.initials: WJ
authors.lastname: Klish
authors.forename: William H
authors.initials: WH
authors.lastname: Dietz
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D018752:Diet, Fat-Restricted; D004038:Diet, Reducing / Q000379:methods; D004046:Dietetics / Q000706:statistics & numerical data*; D015444:Exercise; D005247:Feeding Behavior; D005260:Female; D006293:Health Promotion / Q000379:methods / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D004366:Nonprescription Drugs / Q000627:therapeutic use; D009722:Nurse Practitioners / Q000706:statistics & numerical data; D009765:Obesity / Q000628:therapy*; D010371:Pediatric Nursing / Q000706:statistics & numerical data*; D010372:Pediatrics / Q000706:statistics & numerical data*; D008517:Phytotherapy; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012017:Referral and Consultation / Q000706:statistics & numerical data; D011795:Surveys and Questionnaires; D014481:United States
chemical_list: D004366:Nonprescription Drugs