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Barriers to the management of obesity in children - A cross sectional survey of GPs
Australian Family Physician, 06/18/09

Dettori H et al. - Of the 33 (67%) respondents, 93% agreed child overweight and obesity was a medical problem, that GPs had a role in management, and that the KOALA study had made them more aware of identifying overweight children. Only 57% however, reported changing their practice. Although most GPs agreed they had a role in management and felt confident to assess overweight and obesity in children, only a minority were putting this into practice, suggesting there are other barriers. Practice systems that facilitate implementation of National Health and Medical Research Council guidelines may need to be put in place.

In this study, the following issues did not appear to be major barriers to GPs’ management of child overweight and obesity:

not perceiving child obesity as a problem
lack of knowledge about diagnosis and management options
lack of confidence in broaching the issue, and
perceptions of parental resistance.

The results suggest that a more important barrier was GPs not changing clinical practice to routinely assess risk of overweight and obesity using diagnostic criteria.
Although this study did not look at a lack of practice systems as a potential barrier, other research suggests this is a barrier to changing clinical practice. This could be investigated further using continuous quality improvement methodology. For example, while most practice software programs will calculate BMI, none contain BMI for age percentile charts for children. General practitioners may not plot BMI if a chart is not easily accessible during consultation. The vast majority of GPs reported that BMI charts in medical software would improve identification of overweight children. Development of IT software to facilitate GP screening of children’s BMI, along with education in intervention and referral pathways, have been recommended.