Preventing and treating obesity: pediatricians' self-efficacy, barriers, resources, and advocacy.
OBJECTIVE
With respect to obesity prevention and treatment, to determine pediatricians' 1) treatment self-efficacy; 2) perceived barriers and relationships to management self-efficacy; 3) desired resources; and 4) willingness to be involved in advocacy.


METHODS
A cross-sectional, self-administered mail survey queried members of the North Carolina Pediatrics Society and the American Academy of Pediatrics who were practicing routine care.


RESULTS
The adjusted response rate was 71% (n = 356). Only 12% of respondents reported high self-efficacy in obesity management, yet 39% believed that physicians could potentially be effective. The most frequently encountered barriers to obesity management included availability of fast food (97%) and soft drinks (95%). However, some practice-based barriers were most strongly associated with self-efficacy. Odds of high self-efficacy were lower for respondents who reported lack of non-MD staff reimbursement (odds ratio [OR] = 0.73; 95% confidence interval [CI] = 0.58, 0.92), lack of on-site dietitian (OR = 0.65; 95% CI = 0.50, 0.83), or lack of patient educational materials (OR = 0.67; 95% CI = 0.50, 0.89), compared with those who reported encountering these barriers infrequently. Respondents chose better counseling tools (96%) as the most helpful clinical resource for obesity management. Most (89%) were willing to take at least a small role in advocacy efforts.


CONCLUSIONS
Most pediatricians reported feeling ineffective in their ability to treat obesity. Some practice-based barriers were specifically associated with low self-efficacy. However, pediatricians welcomed multiple clinical resources for obesity management and expressed willingness to advocate for policy change. Practice-based tool kits and efforts to engage willing participants in advocacy may help pediatricians combat this epidemic.
Perrin
Eliana Miller
EM
Division of General Pediatrics and Adolescent Medicine, Department of Pediatrics, University of North Carolina at Chapel Hill, School of Medicine, Chapel Hill, NC 27599-7220, USA. eliana_perrin@med.unc.edu
Flower
Kori B
KB
Garrett
Joanne
J
Ammerman
Alice S
AS
D000704:Analysis of Variance; D001291:Attitude of Health Personnel; D002648:Child; D002675:Child, Preschool; D016001:Confidence Intervals; D003430:Cross-Sectional Studies; D005260:Female; D006801:Humans; D008297:Male; D009657:North Carolina; D009765:Obesity / Q000517:prevention & control* / Q000628:therapy*; D016017:Odds Ratio; D017063:Outcome Assessment, Health Care; D010353:Patient Education as Topic / Q000592:standards* / Q000639:trends; D010372:Pediatrics / Q000592:standards* / Q000639:trends; D010818:Practice Patterns, Physicians'; D018570:Risk Assessment; D020377:Self Efficacy; D012720:Severity of Illness Index; D011795:Surveys and Questionnaires