Racial and ethnic differences in pediatric obesity-prevention counseling: national prevalence of clinician practices

Objective: To assess the frequency of clinician‐reported delivery of obesity‐prevention counseling (OPC) at well‐child visits; evaluating for racial/ethnic discrepancies. Methods and Procedures: Combined, weighted well‐child visit data from the National Ambulatory Medical Care Survey (NAMCS) and National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2001 to 2004 were analyzed for patients aged 4–18 years. Obesity‐prevention counseling was defined as the combined delivery of diet/nutrition and exercise counseling. Patients receiving over‐ or underweight related diagnoses were excluded. Counseling frequencies were calculated. Multivariate logistic regression models examined the relationship of OPC with race, ethnicity, region, provider, sex, age, and payor type. Results: Of 55,695,554 (weighted) visits, 24.4% included OPC (90.8% of these from NAMCS). 15.4% of Hispanic patients received OPC compared to 28.8% of non‐Hispanics. Frequencies were similar between Whites and Blacks (25.0 and 27.1%). Patients with private insurance received more counseling (26.9%) than Medicaid (19.1%) or self‐pay (15.1%). In logistic regression models, non‐Hispanics were more likely to receive OPC (odds ratio (OR) = 1.94; confidence interval (CI) = 1.13–3.32), and patients in the West were less likely to receive OPC (OR = 0.39; CI = 0.18–0.85). Payor type was not predictive in regression analysis. Patients in hospital‐based practices received less OPC (11.9% vs. 25.7% with OR = 0.40; CI =0.22–0.74). Discussion: Obesity prevention, like treatment, is a complex and multifactorial process. With the documented racial and ethnic disparities in rates of pediatric obesity, reasons for discrepancies in the provision of OPC must be further investigated as preventive strategies are formulated.