By: Terrill Bravender, MD, MPH
|"What's on your plate?" USDA nutrition initiative in Spanish.|
Photo by the USDA via Flickr
orthopedic complications, hypertension and other cardiovascular conditions among others. It is also clear that one component of the public health approach to childhood obesity is involvement of the primary care physician. It is important for primary care providers to review growth charts, identify children who are overweight or obese, screen for medical complications, and develop intervention plans for these children.
Latino children have particularly high rates of obesity, and non-English-speaking and immigrant Latino children have poorer health care access compared to US-born English-speaking Latino children. But once Latino children come into the doctor’s office, what kind of care do they receive? While physicians’ use of body-mass index (BMI) growth charts and identification of obese children has improved over the past 10 years, has it improved for Latino children? And once obese Latino children are identified, what kind of counseling do they receive?
These are the questions asked (and answered) by Dr. Christy Turer and colleagues in the December issue of Pediatrics (doi: 10.1542/peds.2014-1282). The researchers at University of Texas Southwestern Medical Center video/audio taped encounters between physicians and 26 Latino families with overweight or obese children between the ages of 6 and 12.
While it was encouraging that 81 percent of families were told of their child’s overweight status, only about half were helped to develop a weight management plan. Concerningly (but not surprisingly), language barriers played an important role. A number of physicians in the study were Spanish-proficient, so the non-English speaking status of the patients did not play much of a role.
However, language incongruency did play a role: for instance, when physicians and families did not speak the same language, using a growth chart to illustrate the child’s weight status was only used 13 percent of the time; when they spoke the same language, the growth chart was used 83 percent of the time.
The global increases in childhood obesity rates have many social and environmental causes, and the problem will continue to require a multifaceted approach. Identification of at risk children and office-based counseling is one small part, but the least we can do as physicians is to systematize our approach, and work to provide the highest level of care to all of our patients regardless of language status. This is a challenge for sure, but one that certainly can be met.