Primary Care Clinicians' Perceived Role in Addressing Childhood Obesity in the Southern United States

Jennifer Mandelbaum, MPH; Sayward E. Harrison, PhD


South Med J. 2022;115(11):824-830. 

In This Article

Abstract and Introduction


Objectives: Primary care is an opportune setting to promote healthy behaviors for children and families. In 2007, an expert committee recommended that pediatric primary care clinicians assess nutrition and physical activity at wellness visits and offer recommendations; however, little is known about what pediatric primary care clinicians perceive their role as in childhood weight management. This qualitative study aimed to describe the perceived role of pediatric primary care clinicians in the prevention and treatment of childhood obesity in South Carolina, a state in the southern United States with high rates of childhood obesity.

Methods: Pediatric primary care clinicians (n = 23) from South Carolina were recruited for two focus groups. Participants were asked semistructured, open-ended questions, and audio recordings were transcribed verbatim. Themes and subthemes were identified through an iterative coding and consensus-building process with two coders. Excerpts coded under the parent code of "clinician role" centered on three themes: conducting assessments, making referrals, and providing education.

Results: Pediatric primary care clinicians in South Carolina coalesced around the important role of addressing childhood obesity within primary care. Notably, clinicians primarily discussed treatment rather than prevention strategies and described changes in the scope of their practice over time as a result of the increasing numbers of pediatric patients with obesity.

Conclusions: Addressing childhood obesity within primary care is a critical component of obesity prevention and treatment in the southern United States. Effective, sustainable prevention and treatment within primary care will depend on the involvement of pediatric clinicians, thus emphasizing the importance of understanding how they perceive their role within this setting.


Recent estimates suggest that more than 30% of children in the United States are overweight or obese (ie, body mass index [BMI] ≥85th percentile for age and sex),[1,2] and children in the southern United States are at particularly high risk for obesity.[3–6] Childhood obesity is a predictor of multiple negative health outcomes, including adult obesity, premature death, type 2 diabetes mellitus, hypertension, coronary heart disease, stroke, and cancer.[7–9] In addition, children with obesity are at risk of numerous negative psychosocial outcomes, such as depressed mood, bullying, discrimination, and poor self-esteem.[10,11] Early intervention to address obesity is critical, as long-term weight loss and management in adulthood remain a challenge.[12]

Primary care has been identified as an opportune setting to promote healthy behaviors for children and families,[13] as nearly all children in the United States (96%) have an established healthcare clinician, and, before the coronavirus disease 2019 (COVID-19) pandemic, the majority of children (75%) had contact with a physician in the previous 6 months.[14] Clear recommendations for integrating obesity prevention into primary care were established by an Expert Committee in 2007 that was convened by the American Medical Association in collaboration with the Centers for Disease Control and Prevention and the Health Resources and Service Administration to outline evidence-based obesity prevention, assessment, and treatment strategies for primary care clinicians.[15] The recommendations of the Expert Committee marked a shift in focus from treatment to prevention of childhood obesity and were also notable in that they emphasized targeting all children, starting at birth, with obesity-prevention messages (eg, healthy eating, physical activity, reduction of sedentary behavior). Clinicians are recommended to assess diet/nutrition and physical activity behaviors at every preventive pediatric visit (ie, well-child visit) and offer recommendations to families for adopting and maintaining specific healthy behaviors that promote energy balance.[13,15] The 2007 Expert Committee recommendations positioned primary care clinicians as part of a collaborative team intended to evaluate children's obesity-related behaviors, educate them as to healthy habits, and make referrals for additional services, as needed.[16] Despite these clear guidelines, evidence suggests that pediatric primary care clinicians often do not conduct weight assessments or engage pediatric patients and their families in discussions about weight management.[17,18] Although obesity prevention is clearly in the scope of practice of pediatric clinicians, less is known about how clinicians perceive this role,[17] including whether this is and/or should be a primary role, whether there are positive or negative attitudes toward this role, and whether the emphasis on obesity prevention role has shifted over time. Understanding clinician perceptions of their role may be helpful for engaging pediatric primary care clinicians in evidence-based weight management interventions, particularly in areas heavily burdened by childhood obesity. As such, the present study aimed to investigate the perceptions of pediatric clinicians of their role in preventing and treating childhood obesity in primary care settings.