title: Counseling to prevent obesity among preschool children: acceptability of a pilot urban primary care intervention.
abstract: OBJECTIVE
  To help design effective primary care-based interventions, we explored urban parents' reactions to a pilot and feasibility study designed to address risk behaviors for obesity among preschool children.
  
  
  METHODS
  We conducted 3 focus groups (2 in English, 1 in Spanish) to evaluate the pilot intervention. Focus group participants explored the acceptability of the pilot intervention components (completion of a new screening tool for risk assessment, discussion of risk behaviors and behavior change goal setting by physicians, and follow-up contacts with a lifestyle counselor) and the fidelity of the pilot intervention delivery.
  
  
  RESULTS
  Parents expressed a desire to change behaviors to achieve healthier families. They believed that doctors should increase their focus on healthy habits during visits. Parents were more accepting of nutrition discussions than increasing activity (citing a lack of safe outdoor space) or decreasing sedentary behaviors (citing many benefits of television viewing). Contacts with the lifestyle counselor were described as empowering, with parents noting her focus on strategies to achieve change for the whole family while recognizing that many food behaviors relate to cultural heritage. Parents expressed frustration with physicians for offering advice about changing behavior but not how to achieve it, for dismissing concerns about picky eating or undereating, and in some cases for labels of overweight that they believed were inappropriately applied.
  
  
  CONCLUSIONS
  Parents welcomed efforts to address family lifestyle change in pediatric visits. The model of physician goal setting with referral for behavior change counseling is highly acceptable to families. Future interventions should acknowledge parental concerns about undereating and perceived benefits of television viewing.
authors.affiliation: Department of Family and Social Medicine, Albert Einstein College of Medicine, 1300 Morris Park Avenue, Bronx, NY 10461, USA. mckee@aecom.yu.edu
authors.forename: M Diane
authors.initials: MD
authors.lastname: McKee
authors.forename: Stacia
authors.initials: S
authors.lastname: Maher
authors.forename: Darwin
authors.initials: D
authors.lastname: Deen
authors.forename: Arthur E
authors.initials: AE
authors.lastname: Blank
mesh_terms: D000328:Adult; D015362:Child Nutrition Disorders / Q000453:epidemiology / Q000517:prevention & control; D053198:Child Nutrition Sciences / Q000193:education*; D002675:Child, Preschool; D037001:Directive Counseling; D005240:Feasibility Studies; D005260:Female; D017144:Focus Groups; D015438:Health Behavior; D006293:Health Promotion; D006801:Humans; D008019:Life Style; D008297:Male; D009043:Motor Activity; D009518:New York / Q000453:epidemiology; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D010342:Patient Acceptance of Health Care; D011320:Primary Health Care / Q000458:organization & administration*; D015397:Program Evaluation; D018570:Risk Assessment; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014481:United States / Q000453:epidemiology; D019037:Urban Health Services
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