Original Article

Primary Care Clinicians’ Perceived Role in Addressing Childhood Obesity in the Southern United States

Authors: Jennifer Mandelbaum, MPH, Sayward E. Harrison, PhD


Objectives: Primary care is an opportune setting to promote healthy behaviors for children and families. In 2007, an expert committee recommended that pediatric primary care clinicians assess nutrition and physical activity at wellness visits and offer recommendations; however, little is known about what pediatric primary care clinicians perceive their role as in childhood weight management. This qualitative study aimed to describe the perceived role of pediatric primary care clinicians in the prevention and treatment of childhood obesity in South Carolina, a state in the southern United States with high rates of childhood obesity.

Methods: Pediatric primary care clinicians (n = 23) from South Carolina were recruited for two focus groups. Participants were asked semistructured, open-ended questions, and audio recordings were transcribed verbatim. Themes and subthemes were identified through an iterative coding and consensus-building process with two coders. Excerpts coded under the parent code of “clinician role” centered on three themes: conducting assessments, making referrals, and providing education.

Results: Pediatric primary care clinicians in South Carolina coalesced around the important role of addressing childhood obesity within primary care. Notably, clinicians primarily discussed treatment rather than prevention strategies and described changes in the scope of their practice over time as a result of the increasing numbers of pediatric patients with obesity.

Conclusions: Addressing childhood obesity within primary care is a critical component of obesity prevention and treatment in the southern United States. Effective, sustainable prevention and treatment within primary care will depend on the involvement of pediatric clinicians, thus emphasizing the importance of understanding how they perceive their role within this setting.

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1. US Department of Agriculture. MyPlate. https://www.myplate.gov/. Accessed August 18, 2021.
2. Viswanathan M, Kahwati LC, Golin CE, et al. Medication therapy management interventions in outpatient settings: a systematic review and meta-analysis. JAMA Intern Med 2015;175:76–87.
3. Kramer MR, Raskind IG, Van Dyke ME, et al. Geography of adolescent obesity in the U.S., 2007-2011. Am J Prev Med 2016;51:898–909.
4. Singh GK, Kogan MD, van Dyck PC. A multilevel analysis of state and regional disparities in childhood and adolescent obesity in the United States. J Community Health 2008;33:90–102.
5. Singh GK, Kogan MD, van Dyck PC. Changes in state-specific childhood obesity and overweight prevalence in the United States from 2003 to 2007. Arch Pediatr Adolesc Med 2010;164:598–607.
6. Chrisman M, Diaz Rios LK. Evaluating MyPlate after 8 years: a perspective. J Nutr Educ Behav 2019;51:899–903.
7. Reilly JJ. Descriptive epidemiology and health consequences of childhood obesity. Best Pract Res Clin Endocrinol Metab 2005;19:327–341.
8. Reilly JJ, Methven E, McDowell ZC, et al. Health consequences of obesity. Arch Dis Child 2003;88:748–752.
9. Dietz WH. Health consequences of obesity in youth: childhood predictors of adult disease. Pediatrics 1998;101:518–525.
10. Harriger JA, Thompson JK. Psychological consequences of obesity: weight bias and body image in overweight and obese youth. Int Rev Psychiatry 2012;24:247–253.
11. Puhl RM, Heuer CA. Obesity stigma: important considerations for public health. Am J Public Health 2010;100:1019–1028.
12. Hall KD, Kahan S. Maintenance of lost weight and long-term management of obesity. Med Clin North Am 2018;102:183–197.
13. Harrison SE, Greenhouse D. Dietary and nutrition recommendations in pediatric primary care: a call to action. South Med J 2018;111:12–17.
14. Bloom B, Jones LI, Freeman G. Summary health statistics for U.S. children: National Health Interview Survey, 2012. Vital Health Stat 10 2013;(258):1–81.
15. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(suppl 4):S164–S192.
16. Tanda R, Salsberry P. The impact of the 2007 expert committee recommendations on childhood obesity preventive care in primary care settings in the United States. J Pediatr Health Care 2014;28:241–250.
17. Rhee KE, Kessl S, Lindback S, et al. Provider views on childhood obesity management in primary care settings: a mixed methods analysis. BMC Health Serv Res 2018;18:55.
18. Mandelbaum J, Harrison SE, Brittingham J. Disparities in nutrition counseling at pediatric wellness visits in South Carolina. Child Obes 2020;16:520–526.
19. SocioCultural Research Consultants. Dedoose version 7.0.23, web application for managing, analyzing, and presenting qualitative and mixed method research data. www.dedoose.com. Accessed April 22, 2021.
20. MacQueen KM, McLellan E, Kay K, et al. Codebook development for team-based qualitative analysis. CAM J 1998;10:31–36.
21. Post RC. A new approach to dietary guidelines communications: make MyPlate, your plate. Child Obes 2011;7:349–351.
22. Hettema J, Steele J, Miller WR. Motivational interviewing. Annu Rev Clin Psychol 2005;1:91–111.
23. Miller WR, Rollnick S. Ten things that motivational interviewing is not. Behav Cogn Psychother 2009;37:129–140.
24. Resnicow K, McMaster F. Motivational interviewing: moving from why to how with autonomy support. Int J Behav Nutr Phys Act 2012;9:19.
25. Rollnick S, Heather N, Gold R, et al. Development of a short ’readiness to change’ questionnaire for use in brief, opportunistic interventions among excessive drinkers. Br J Addict 1992;87:743–754.
26. Miller ST, Marolen KN, Beech BM. Perceptions of physical activity and motivational interviewing among rural African-American women with type 2 diabetes. Womens Health Issues 2010;20:43–49.
27. Westra HA, Arkowitz H, Dozois DJ. Adding a motivational interviewing pretreatment to cognitive behavioral therapy for generalized anxiety disorder: a preliminary randomized controlled trial. J Anxiety Disord 2009;23:1106–1117.
28. Neumark-Sztainer DR, Friend SE, Flattum CF, et al. New moves—preventing weight-related problems in adolescent girls: a group-randomized study. Am J Prev Med 2010;39:421–432.
29. Flattum C, Friend S, Neumark-Sztainer D, et al. Motivational interviewing as a component of a school-based obesity prevention program for adolescent girls. J Am Diet Assoc 2009;109:91–94.
30. Ball GD, Mackenzie-Rife KA, Newton MS, et al. One-on-one lifestyle coaching for managing adolescent obesity: findings from a pilot, randomized controlled trial in a real-world, clinical setting. Paediatr Child Health 2011; 16:345–350.
31. Macdonell K, Brogan K, Naar-King S, et al. A pilot study of motivational interviewing targeting weight-related behaviors in overweight or obese African American adolescents. J Adolesc Health 2012;50:201–203.
32. Vallabhan MK, Jimenez EY, Nash JL, et al. Motivational interviewing to treat adolescents with obesity: a meta-analysis. Pediatrics 2018;142:e20180733.
33. Silber M, Weiss L, Sharaf S, et al. Pediatric residency obesity and overweight training curricula: a systematic review. Glob Pediatr Health 2020;7:1–13.
34. Phelan SM, Puhl RM, Burke SE, et al. The mixed impact of medical school on medical students’ implicit and explicit weight bias. Med Educ 2015;49:983–992.
35. Sanchez-Ramirez DC, Long H, Mowat S, et al. Obesity education for front-line healthcare providers. BMC Med Educ 2018;18:278.
36. Acosta A, Azzalin A, Emmons CJ, et al. Improving residents’ clinical approach to obesity: impact of a multidisciplinary didactic curriculum. Postgrad Med J 2014;90:630–637.
37. Mastrocola MR, Roque SS, Benning LV, et al. Obesity education in medical schools, residencies, and fellowships throughout the world: a systematic review. Int J Obes (Lond) 2020;44:269–279.
38. Mulugeta WM. Obesity management in primary care during and beyond the COVID-19 pandemic. J Nurse Pract 2021;17:428–431.
39. Brown CL, Montez K, Amati JB, et al. Impact of COVID-19 on pediatric primary care visits at four academic institutions in the carolinas. Int J Environ Res Public Health 2021;18:5734.
40. Schweiberger K, Patel SY, Mehrotra A, et al. Trends in pediatric primary care visits during the coronavirus disease of 2019 pandemic. Acad Pediatr 2021; 21:1426–1433.
41. Jenssen BP, Kelly MK, Powell M, et al. COVID-19 and changes in child obesity. Pediatrics 2021;147:e2021050123.
42. Brooks CG, Spencer JR, Sprafka JM, et al. Pediatric BMI changes during COVID-19 pandemic: an electronic health record-based retrospective cohort study. EClinicalMedicine. 2021;38:101026.
43. O’Hara VM, Johnston SV, Browne NT. The paediatric weight management office visit via telemedicine: pre- to post-COVID-19 pandemic. Pediatr Obes 2020;15:e12694.
44. Abrams EM, Szefler SJ. COVID-19 and the impact of social determinants of health. Lancet Respir Med 2020;8:659–661.
45. Singu S, Acharya A, Challagundla K, et al. Impact of social determinants of health on the emerging COVID-19 pandemic in the United States. Front Public Health 2020;8:406.
46. Guest G, Namey E, McKenna K. How many focus groups are enough? Building an evidence base for nonprobability sample sizes. Field Methods 2016;29:3–22.
47. Carlsen B, Glenton C. What about N? A methodological study of sample-size reporting in focus group studies. BMC Med Res Methodol 2011;11:26.
48. Wang Y. Disparities in pediatric obesity in the United States. Adv Nutr 2011; 2:23–31.
49. Foster GD, Wadden TA, Makris AP, et al. Primary care physicians’ attitudes about obesity and its treatment. Obes Res 2003;11:1168–1177.
50. Jay M, Kalet A, Ark T, et al. Physicians’ attitudes about obesity and their associations with competency and specialty: a cross-sectional study. BMC Health Serv Res 2009;9:106. .
51. Seburg EM, Olson-Bullis BA, Bredeson DM, et al. A review of primary care-based childhood obesity prevention and treatment interventions. Curr Obes Rep 2015;4:157–173.