Arkansas Physicians' Perceptions of State-wide Childhood Obesity Legislation and Initiatives

With the passage of Act 1220 in 2003, Arkansas began a coordinated, multi-faceted effort to change physical activity and nutrition policies and practices within public schools to reduce childhood obesity. Since 2004, stakeholders have been surveyed and interviewed concerning their views of Act 1220 and related initiatives, as well as its impact on the health of Arkansas' youth. In 2010 a mailed survey of family practitioners and pediatricians was conducted to gauge perceptions of the legislation and its influence on their practices and interactions with school-aged patients and their parents. Of the 1768 surveys mailed, 304 were returned (17.4%). Physicians reported an average of 30% of the children they cared for were overweight and an additional 17% were classified as obese, proportions corresponding closely to statewide BMI data collected as mandated by Act 1220. The majority (84%) felt BMI percentiles were a useful tool for evaluating a child's weight. Only 16% mentioned receiving accredited training on nutrition and weight management within the past year; however, most (82%) felt they had the necessary training and skills to counsel children and parents regarding weight status. Just under half (43%) reported a lack of time to counsel children and parents about weight; however, 77% agreed they would devote more time to these services if they were reimbursed. Physician responses also revealed some differences among pediatricians' child-patient interactions and experiences, and those of other physicians. When compared to other physicians surveyed, pediatricians reported calculating patients' BMI percentiles with greater frequency when height and weight were measured (89% versus 69%), as well as more frequently plotting measurements to growth charts during well-child or sports physicals (67% versus 50%). Results also indicated a higher proportion of pediatricians (89%) observed parents expressing concern for their child's overweight or obese weight status than other physicians (76%). Overall, the effect of the legislation was viewed as a complement to Arkansas physicians' efforts; yet, findings suggest that most physicians treating children are not amenable to educational approaches to enhance their weight management counseling skills. Enhanced reimbursement was viewed as being the major way to enhance weight counseling. These results highlight an opportunity, perhaps through health care reform and enhanced reimbursement, to increase physician involvement in efforts to reduce the burden of childhood obesity.