title: Dietary and Physical Activity Counseling Trends in U.S. Children, 2002-2011.
abstract: BACKGROUND
  In 2007 and 2010, Expert Committee and U.S. Preventive Services Task Force guidelines were released, respectively, urging U.S. practitioners to deliver preventive obesity counseling for children. This study determined the frequency and evaluated predictors of receiving counseling for diet and physical activity among a national sample of children from 2002 to 2011.
  
  
  METHODS
  Children aged 6-17 years were used from the 2002-2011 Medical Expenditure Panel Surveys and analyzed in 2016. Parental report of two questions assessed whether children received both dietary and exercise counseling from the provider. Children were grouped by weight category. Bivariate analyses compared the frequency of receiving counseling; logistic regression evaluated predictors of receiving counseling.
  
  
  RESULTS
  The sample included 36,114 children; <50% of children received counseling. Across all time periods, children were more likely to receive counseling with increasing weight. Logistic regression models showed that obese children had greater odds of receiving counseling versus normal-weight children, even after adjusting for covariates. Additional significant positive correlates of receiving counseling were Hispanic ethnicity, living in an urban setting, and being in the highest income stratum. Being uninsured was associated with lower odds of counseling. Years 2007-2009 and 2010-2011 were associated with increased counseling versus the benchmark year category in the multivariable model.
  
  
  CONCLUSIONS
  Counseling appears more likely with greater weight and increased after both guidelines in 2007 and 2010. Overall counseling rates for children remain low. Future work should focus on marginalized groups, such as racial and ethnic minorities and rural populations.
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina. Electronic address: odulana@musc.edu.
authors.forename: Adebowale
authors.initials: A
authors.lastname: Odulana
authors.affiliation: Department of Pediatrics, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: William T
authors.initials: WT
authors.lastname: Basco
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Kinfe G
authors.initials: KG
authors.lastname: Bishu
authors.affiliation: Department of Medicine, Medical University of South Carolina, Charleston, South Carolina.
authors.forename: Leonard E
authors.initials: LE
authors.lastname: Egede
mesh_terms: D000293:Adolescent; D001835:Body Weight; D002648:Child; D003376:Counseling / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D004035:Diet Therapy / Q000706:statistics & numerical data / Q000639:trends*; D005081:Exercise Therapy / Q000706:statistics & numerical data / Q000639:trends*; D005260:Female; D019538:Health Care Surveys / Q000706:statistics & numerical data; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data; D009765:Obesity / Q000517:prevention & control*; D017410:Practice Guidelines as Topic; D011314:Preventive Health Services / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends*; D012424:Rural Population; D012959:Socioeconomic Factors; D014505:Urban Population