Management of child and adolescent obesity: psychological, emotional, and behavioral assessment.

OBJECTIVE The primary objective of this study was to describe the usual psychological, emotional, and behavioral evaluations of overweight children and adolescents to target education of pediatric health care providers. A secondary aim was to determine whether certain provider characteristics were associated with recommended evaluation practices. METHODS A total of 203 pediatricians, 293 pediatric nurse practitioners, and 444 registered dietitians completed questionnaires about their evaluation of overweight children and adolescents (response rates 19%, 33%, and 27%, respectively). Results were examined for adherence to published recommendations and for associations with certain provider characteristics. RESULTS All 3 groups generally followed recommended psychological and emotional evaluation practices. Nearly all respondents obtained a diet history, and >75% evaluated physical activity as recommended. Fifty to 61% routinely initiated treatment in overweight children with no obesity-associated medical conditions, and 13% to 29% initiated treatment in children and adolescents who did not want to control weight. The majority included parents in treatment, but one third or fewer involved all household members. More than 75% sometimes referred to a mental health specialist. In general, provider's body mass index, gender, years in practice, and practice specialty were not associated with following evaluation recommendations. CONCLUSIONS Emotional and behavioral assessments were generally consistent with recommendations. Providers will benefit from identification of methods to engage overweight youth who do not want to control weight.