Rethinking Obesity Counseling: Having the French Fry Discussion

Childhood obesity is a complex problem that warrants early intervention. General recommendations for obesity prevention and nutrition counseling exist. However, these are notably imprecise with regard to early and targeted interventions to prevent and treat obesity in pediatric populations. This study examines family medicine primary care providers’ (PCPs) perceived barriers for preventing and treating pediatric obesity and their related practice behavior during well-child visits. 

Methods: A written survey addressing perceived barriers and current practices addressing obesity at well-child visits were administered to PCPs at eleven family medicine clinics in the Duke University Health System. 

Results: The most common perceived barriers identified by PCPs to prevention or treatment of obesity in children were families not getting enough exercise (93%) and families too often having fast food meals (86%). Most PCPs do not discuss fast foods at or prior to the twelve-month well-child visit. The two-year visit is the first well-child visit at which a majority of PCPs (68%) discuss fast food. 

Conclusion: No clear consensus exists as to when PCPs should discuss fast food in early well-child checks. Previous research has shown a profound shift in children’s dietary habits toward fast foods, such as French fries, that occurs between the one- and two-year well-child checks. Consideration should be given to having a “French Fry Discussion” at every twelve-month well-child care visit.

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Alex’s Notes: Two weeks ago we acknowledged many of the perceived barriers to losing weight of overweight and obese children and their parents. Some of the barriers centered on a lack of time to prepare healthy foods at homes, the belief by parents that providing fast food was a sign of affection, and that physicians were not helpful in educating them about their decisions. The study at hand builds upon these barriers by examining the perception of family medicine primary care providers (PCPs) in preventing and treating obesity children, the perceived barriers to doing so, and to analyze PCP’s reported behaviors at well-child checks. In other words, we previously looked at this issue from the child and parents viewpoint, so let’s now see it through the eyes of the doctor.

A survey that contained three independent sections, each with a brief introduction, was sent to eleven Duke Primary Care practices in January of 2012. The sections were as follows: (1) perceived barriers in treating obesity, (2) current PCP practices at well-child checks, and (3) demographic information. Surveys were completed by 56 PCPs (55% female), with approximately two-thirds aged 30-49 years, 27% 50+ years, and the remainder 20-29 years. About one-third were overweight according to BMI with 30% perceiving themselves as overweight and 2% thinking they were obese, suggesting that these PCPs have a very fair awareness of their own weight problems. Unfortunately, this also suggests that these doctors don’t lift.

Moving forward, the five barriers that were most often rated as either Very Important or Critically Important were:

  1. Families do not get enough exercise (93%);
  2. Families often have fast food meals (86%);
  3. Parent is not motivated to change diet or lifestyle (81%);
  4. Families watch too much TV (79%);
  5. Child is not motivated to change diet or lifestyle (75%)

It is notable that these perceived barriers are faults of the family, and yet PCP discussions do little to overcome these barriers. For instance, a lack of exercises is a perceived barrier by nearly all PCPs, and yet only two-thirds are discussing it by the 2-5 year mark. Moving down the list, fast food is only discussed by 30% at the 18-month mark despite this being a time when children can eat solid foods such as French Fries, and this number peaks at 67% by the 2-5 year mark. Similarly, by the 2-5 year mark, family screen time is only discussed by 73% of PCPs, and only 65% discuss eating three meals per day and minimizing snack foods.

So what’s the problem?

The problem is that PCPs share the same top concerns when dealing with perceptions surrounding obesity, and yet these concerns were inconsistently addressed in practice. This is especially troubling when we consider that the family claims that this lack of physician information is one of their barriers. Clearly there is a disconnect between the PCPs and their patients. Habits are built young and persist indefinitely, and it is the responsibility of both patients and practitioners to not assume anything about the other. Patients must ask for more information, while practitioners must remember to make these talks routine.

Focusing in on fast food for a moment, there is a profound shift in dietary habits toward fast foods, such as French fries, that occurs between the one- and two-year well-child checks. Accordingly, the current study authors suggest that PCPs have a universal “French Fry” discussion regularly at the 12-month well-child care visit. It’s not a bad idea by any means,

“The “French Fry Discussion” could take the form of a purposeful talk with family members about the importance of avoiding fast foods, fried foods, and sweetened beverages… This visit could additionally include handouts or printouts about alternative foods and snacks that are affordable and can be prepared quickly. This discussion can move beyond the unidirectional lecturing that often occurs. Rather, this should be an individualized discussion, in which family members are encouraged to voice their concerns and devise solutions that meet their unique situation… The goal of this discussion would be to leverage the patient-physician-family relationship to positively impact lifestyle choices for both the child and the family.”


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