Not Simple like the ABCs

In previous posts I’ve blogged about the barriers that primary care providers (PCPs) and families face to preventing and managing childhood obesity in primary care. In a recent paper (Kuhle et al., 2015), the authors discussed the following seven steps to addressing obesity in children in this setting:

1. The child has a regular PCP.
   
2. The child sees the PCP on a routine basis.
3. The PCP assesses weight regularly.
4. The child’s weight is accurately identified as ‘overweight’ or ‘obese’.
5. The PCP discusses the child’s weight with the family.
6. The PCP initiates weight management in primary care or refers the family to tertiary care.
7. The child and family initiate and adhere to the weight management program.

With each step, individual studies have highlighted barriers (actual and perceived). For example: a proportion of Canadian families access health care through walk-in clinics and thus continuity of care is lacking (barrier to steps 1&2); weight is a sensitive topic and the conversation is difficult to initiate (barrier to step 5). The authors reported that given the barriers associated with each step, the annual probability of an overweight child achieving clinically meaningful weight outcomes in primary care is low (~0.6%).