title: FitwitsTMLeads to Improved Parental Recognition of Childhood Obesity and Plans to Encourage Change.
abstract: BACKGROUND
  Brief tools are needed to help physicians and parents reach consensus on body mass index (BMI) categories for children and to discuss health-improving behaviors. This study tested the FitwitsTMintervention with interactive flashcards and before and- after surveys to improve parents' perceptions of children's BMI status.
  
  
  METHODS
  We enrolled 140 parents and their 9- to 12-year-old children presenting for well child care, regardless of BMI status, scheduled with 53 Fitwits-trained physicians. The Fitwits tool guided a conversation with all parent-child dyads regarding understanding BMI, nutrition, activity, and portion sizes. A survey addressed BMI category perceptions before and after the intervention, requested 2 goal selections, and included open-ended comment areas.
  
  
  RESULTS
  Fifty-three percent of children were overweight or obese. The primary outcome variable was the rate of correct parental identification of their child's weight status (underweight, healthy, overweight, or obese). The survey before the intervention resulted in 50.0% correct BMI category designations. This changed to 60.6% correct perceptions after the intervention, with movement between correct overweight (34.5% to 51.7%) and obese (4.4% to 24.4%) categories. Secondary outcome variables included specific behavior change goals and the qualitative responses of parents, children, and physicians to the intervention. Parent-child dyads predominantly commented favorably and chose (75.8%) goals corresponding to Fitwits card suggestions.
  
  
  CONCLUSIONS
  An improvement was observed in parental ability to identify the correct BMI category after the intervention during a preadolescent well child visit. Parent underrecognition of overweight/obese children was also observed. Most parent comments were appreciative of the physician interaction, Fitwits flashcards, and health improvement exchange.
authors.affiliation: From the University of Pittsburgh Medical Center Urgent Care Wexford, Wexford, PA (BAE); Renaissance Family Practice, Glenshaw, Pittsburgh (JRP); the St. Margaret Bloomfield Garfield Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (AM, EB); Penn Plum Family Medicine, St. Margaret Hospital, University of Pittsburgh Medical Center, Pittsburgh (VMPW); Faculty Development Fellowship Program and St. Margaret Lawrenceville Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (FJD, LH); Carnegie Mellon University School of Design, Pittsburgh (KH); Retired from Austen BioInnovation Institute in Akron, Akron, OH (IKJ); and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia (DJA).
authors.forename: Bethany A
authors.initials: BA
authors.lastname: Edwards
authors.affiliation: From the University of Pittsburgh Medical Center Urgent Care Wexford, Wexford, PA (BAE); Renaissance Family Practice, Glenshaw, Pittsburgh (JRP); the St. Margaret Bloomfield Garfield Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (AM, EB); Penn Plum Family Medicine, St. Margaret Hospital, University of Pittsburgh Medical Center, Pittsburgh (VMPW); Faculty Development Fellowship Program and St. Margaret Lawrenceville Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (FJD, LH); Carnegie Mellon University School of Design, Pittsburgh (KH); Retired from Austen BioInnovation Institute in Akron, Akron, OH (IKJ); and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia (DJA).
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Powell
authors.affiliation: From the University of Pittsburgh Medical Center Urgent Care Wexford, Wexford, PA (BAE); Renaissance Family Practice, Glenshaw, Pittsburgh (JRP); the St. Margaret Bloomfield Garfield Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (AM, EB); Penn Plum Family Medicine, St. Margaret Hospital, University of Pittsburgh Medical Center, Pittsburgh (VMPW); Faculty Development Fellowship Program and St. Margaret Lawrenceville Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (FJD, LH); Carnegie Mellon University School of Design, Pittsburgh (KH); Retired from Austen BioInnovation Institute in Akron, Akron, OH (IKJ); and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia (DJA). mcgaffeyal@upmc.edu.
authors.forename: Ann
authors.initials: A
authors.lastname: McGaffey
authors.affiliation: From the University of Pittsburgh Medical Center Urgent Care Wexford, Wexford, PA (BAE); Renaissance Family Practice, Glenshaw, Pittsburgh (JRP); the St. Margaret Bloomfield Garfield Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (AM, EB); Penn Plum Family Medicine, St. Margaret Hospital, University of Pittsburgh Medical Center, Pittsburgh (VMPW); Faculty Development Fellowship Program and St. Margaret Lawrenceville Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (FJD, LH); Carnegie Mellon University School of Design, Pittsburgh (KH); Retired from Austen BioInnovation Institute in Akron, Akron, OH (IKJ); and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia (DJA).
authors.forename: Valerie M P
authors.initials: VM
authors.lastname: Wislo
authors.affiliation: From the University of Pittsburgh Medical Center Urgent Care Wexford, Wexford, PA (BAE); Renaissance Family Practice, Glenshaw, Pittsburgh (JRP); the St. Margaret Bloomfield Garfield Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (AM, EB); Penn Plum Family Medicine, St. Margaret Hospital, University of Pittsburgh Medical Center, Pittsburgh (VMPW); Faculty Development Fellowship Program and St. Margaret Lawrenceville Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (FJD, LH); Carnegie Mellon University School of Design, Pittsburgh (KH); Retired from Austen BioInnovation Institute in Akron, Akron, OH (IKJ); and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia (DJA).
authors.forename: Elaine
authors.initials: E
authors.lastname: Boron
authors.affiliation: From the University of Pittsburgh Medical Center Urgent Care Wexford, Wexford, PA (BAE); Renaissance Family Practice, Glenshaw, Pittsburgh (JRP); the St. Margaret Bloomfield Garfield Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (AM, EB); Penn Plum Family Medicine, St. Margaret Hospital, University of Pittsburgh Medical Center, Pittsburgh (VMPW); Faculty Development Fellowship Program and St. Margaret Lawrenceville Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (FJD, LH); Carnegie Mellon University School of Design, Pittsburgh (KH); Retired from Austen BioInnovation Institute in Akron, Akron, OH (IKJ); and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia (DJA).
authors.forename: Frank J
authors.initials: FJ
authors.lastname: D'Amico
authors.affiliation: From the University of Pittsburgh Medical Center Urgent Care Wexford, Wexford, PA (BAE); Renaissance Family Practice, Glenshaw, Pittsburgh (JRP); the St. Margaret Bloomfield Garfield Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (AM, EB); Penn Plum Family Medicine, St. Margaret Hospital, University of Pittsburgh Medical Center, Pittsburgh (VMPW); Faculty Development Fellowship Program and St. Margaret Lawrenceville Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (FJD, LH); Carnegie Mellon University School of Design, Pittsburgh (KH); Retired from Austen BioInnovation Institute in Akron, Akron, OH (IKJ); and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia (DJA).
authors.forename: Linda
authors.initials: L
authors.lastname: Hogan
authors.affiliation: From the University of Pittsburgh Medical Center Urgent Care Wexford, Wexford, PA (BAE); Renaissance Family Practice, Glenshaw, Pittsburgh (JRP); the St. Margaret Bloomfield Garfield Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (AM, EB); Penn Plum Family Medicine, St. Margaret Hospital, University of Pittsburgh Medical Center, Pittsburgh (VMPW); Faculty Development Fellowship Program and St. Margaret Lawrenceville Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (FJD, LH); Carnegie Mellon University School of Design, Pittsburgh (KH); Retired from Austen BioInnovation Institute in Akron, Akron, OH (IKJ); and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia (DJA).
authors.forename: Kristin
authors.initials: K
authors.lastname: Hughes
authors.affiliation: From the University of Pittsburgh Medical Center Urgent Care Wexford, Wexford, PA (BAE); Renaissance Family Practice, Glenshaw, Pittsburgh (JRP); the St. Margaret Bloomfield Garfield Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (AM, EB); Penn Plum Family Medicine, St. Margaret Hospital, University of Pittsburgh Medical Center, Pittsburgh (VMPW); Faculty Development Fellowship Program and St. Margaret Lawrenceville Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (FJD, LH); Carnegie Mellon University School of Design, Pittsburgh (KH); Retired from Austen BioInnovation Institute in Akron, Akron, OH (IKJ); and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia (DJA).
authors.forename: Ilene Katz
authors.initials: IK
authors.lastname: Jewell
authors.affiliation: From the University of Pittsburgh Medical Center Urgent Care Wexford, Wexford, PA (BAE); Renaissance Family Practice, Glenshaw, Pittsburgh (JRP); the St. Margaret Bloomfield Garfield Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (AM, EB); Penn Plum Family Medicine, St. Margaret Hospital, University of Pittsburgh Medical Center, Pittsburgh (VMPW); Faculty Development Fellowship Program and St. Margaret Lawrenceville Family Health Center, University of Pittsburgh Medical Center, Pittsburgh (FJD, LH); Carnegie Mellon University School of Design, Pittsburgh (KH); Retired from Austen BioInnovation Institute in Akron, Akron, OH (IKJ); and the Department of Obstetrics and Gynecology, Thomas Jefferson University, Philadelphia (DJA).
authors.forename: Diane J
authors.initials: DJ
authors.lastname: Abatemarco
mesh_terms: D000328:Adult; D015992:Body Mass Index; D002648:Child; D005260:Female; D015438:Health Behavior; D006801:Humans; D008297:Male; D050177:Overweight / Q000175:diagnosis / Q000517:prevention & control*; D010290:Parents / Q000523:psychology*; D063766:Pediatric Obesity / Q000175:diagnosis / Q000517:prevention & control*; D021641:Recognition, Psychology; D011795:Surveys and Questionnaires
keywords: Body Mass Index; Body Weight; Childhood Obesity; Health Literacy; Portion Size; Surveys and Questionnaires