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Pediatric nutrition counseling may be ‘underutilized tool’ in primary care

Pediatric nutrition counseling occurred in fewer than 4% of annual wellness visits in South Carolina during an 8-year span despite national recommendations encouraging clinicians to do so, according to a presenter at the American Public Health Association Annual Meeting and Expo.

“Obesity affects 18.5% of U.S. children and is particularly prevalent in the Deep South. Pediatric primary care providers are advised to take an active role in obesity prevention by offering nutrition counseling to all children and families, yet few studies have examined these practices,” Jennifer Mandelbaum, MPH, PhD candidate at the University of South Carolina, wrote.

She matched recipients of pediatric nutrition counseling with nonrecipients based on their age and sex (n = 1,429 pairs) from 2008 to 2016. She also determined weight and sociodemographic disparities.

Mandelbaum found the counseling occurred at only 3.55% of wellness visits. Those who were obese vs. those with a healthy weight (OR = 3.21; 95% CI, 2.62-3.93) and those in rural areas vs. those from urban areas (OR = 2.18; 95% CI, 1.49-3.19) were more likely to receive counseling. In addition, African-American children and uninsured children had lower rates of receiving counseling vs. white children (OR = 0.41; 95% CI, 0.32-0.51) and those with commercial insurance (OR = 0.51; 95% CI, 0.29-0.91).

“Nutrition counseling may be an underutilized tool in primary care for the prevention and treatment of childhood obesity. Findings from the current study suggest missed opportunities for intervention and disparities in the provision of nutrition counseling in South Carolina,” Mandelbaum said in the abstract.

“Pediatric providers across four major health care systems rarely coded nutrition counseling as occurring, despite national recommendations to offer these services at every well-child visit. Providers also did not regularly record children’s BMIs within their [electronic medical record], which may limit their ability to track BMI across childhood and intervene when appropriate,” she added.

The study lends itself to future research to determine if the findings would be duplicated elsewhere; why the barriers to providing nutrition counseling at well-child visits and the disparities in providing the counseling exist; and the need for better collection and reporting of BMI data in electronic medical records, Mandelbaum concluded. – by Janel Miller

Reference:

Mandelbaum J. Provision of primary care nutrition counseling among South Carolina children: Disparities by weight status and sociodemographic characteristics. Presented at: American Public Health Association Meeting and Expo; Nov. 10-14, 2018; San Diego.

Disclosure: Healio Family Medicine was unable to determine Mandelbaum’s relevant financial disclosures prior to publication.