Survey suggests overweight kids pose frustrating dilemma for many docs

Monday, July 1st 2002, 12:00 am

By: News On 6

CHICAGO (AP) _ Many children are not being adequately treated for weight problems because many pediatricians and other health workers lack expertise in helping them slim down, a survey suggests.

Though faced with an increasing number of overweight children, many pediatricians and nurse practitioners say they need more training to overcome weight-loss obstacles including a lack of patient motivation, insurance and parental involvement, according to the survey.

The eight-page survey involved 940 pediatricians, pediatric nurse practitioners and dietitians nationwide. Several reports about it are published as a supplement to the July issue of Pediatrics.

The 1999 survey is part of an effort by the federal Maternal and Child Health Bureau to examine the growing problem of obesity in children and to assess how doctors are dealing with it.

National data indicate that about 14 percent of children aged 6 through 19 are severely overweight, a near-tripling since the 1960s.

``A lot of pediatricians around the country don't feel confident that they know how to treat this problem _ so they don't (treat it),'' said Dr. William Dietz, who chaired a committee, convened by the bureau, that initiated the survey.

``It is a hard problem to treat,'' especially if doctors don't start addressing it until their patients become obese, said Dietz, director of the division of nutrition and physical activity at the federal Centers for Disease Control and Prevention.

Most survey participants said weight problems in children are a serious medical issue, putting patients at risk for chronic diseases including diabetes and heart ailments later in life. The bad news is that many may be inadequately addressing it, said St. Louis University's Dr. Sarah Barlow, one of the researchers.

``It's a very sensitive topic for pediatricians to bring up. They worry about offending the family'' and causing self-esteem problems in the child, she said.

More than a third of pediatricians and nurses, and about half of dietitians said they didn't initiate treatment in overweight children with no obesity-related medical problems. And most said they didn't initiate treatment in youngsters who didn't want to control their weight.

Dr. Elena Fuentes-Afflick, a San Francisco pediatrician, said it's not unusual to see young patients' weight balloon from visit to visit ``and their parents swear to you that they're not eating fast-food and that they're exercising.''

``This is clearly not a medical problem like I give them a pill and it will go away,'' Fuentes-Afflick said. ``It's much more complicated, the whole family has to be involved. It's a very frustrating problem and there is no magic bullet.''

More than a third of pediatricians surveyed said they had low proficiency in behavior management techniques to help patients lose weight; 25 percent said they lacked expertise in getting parents to help their children lose weight and nearly 20 percent said they were ill-equipped to help patients become less sedentary.