title: Preventing and treating obesity: pediatricians' self-efficacy, barriers, resources, and advocacy.
abstract: 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.
authors.affiliation: 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
authors.forename: Eliana Miller
authors.initials: EM
authors.lastname: Perrin
authors.forename: Kori B
authors.initials: KB
authors.lastname: Flower
authors.forename: Joanne
authors.initials: J
authors.lastname: Garrett
authors.forename: Alice S
authors.initials: AS
authors.lastname: Ammerman
mesh_terms: 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