A Resident-led Initiative to Counter Weight Stigma and Improve Management of Youth with Overweight and Obesity

Background: Management of children and adolescents with overweight and obesity is an essential competency for pediatricians, but many pediatricians report feeling inadequate in this skill. Management of overweight and obesity is also inconsistently integrated into pediatric residency curricula, which compounds this care gap. Data illustrates that physician-led behavioral interventions, including motivational interviewing, can improve health outcomes for those with overweight and obesity. In contrast, weight stigma and negative messaging toward those with obesity can exacerbate unhealthy behaviors and worsen health outcomes. We sought to improve resident physician comfort and understanding of the management of pediatric obesity by educating them regarding motivational interviewing, weight stigma, and guidelines for pediatric obesity.

Methods: We developed an educational module for pediatric residents regarding pediatric obesity and presented it during a 30-minute resident education conference at a large academic residency program. Participation was voluntary. Specific topics included (1) epidemiology of pediatric obesity, (2) a discussion of weight stigma and patient-friendly language, (3) a brief tutorial on motivational interviewing, and (4) evidence and guidelines on the clinical management of pediatric obesity. Participants completed a baseline survey prior to the educational module to assess their current knowledge level, and then completed a follow-up survey about their comfort with and knowledge of the topics. The data were collected anonymously via an electronic survey tool (Qualtrics) and were stored securely. Survey answers were graded on a 5-point Likert scale (3 being neutral) with a few additional short-answer items. Pre- and post- surveys were compared using a two-sample t-test.

Results: The study population included categorical pediatric residents and combined-program pediatrics residents. Twenty-one participants completed the baseline survey (see Table 1), and twenty-three completed the follow-up survey. Over one-third of participants reported they had not previously received education on how to discuss obesity with patients or how to treat obesity. Five items on the baseline survey were replicated on the follow-up survey; they addressed (1) comfort bringing up the topic of obesity, (2) knowledge of appropriate word choice regarding weight, (3) comfort with motivational interviewing, (4) comfort setting family-centered goals, and (5) knowledge of screening for co-morbidities. Across all five items, residents reported a statistically significant improvement following the educational module (see Figure 1).

Conclusion: Our study demonstrated improved knowledge of and comfort with the management of pediatric obesity among pediatric trainees following participation in a targeted educational module. The most notable improvement was knowledge of patient-friendly, non-stigmatizing language to use when discussing weight. Our study suggests a persistent need for educational programming for pediatric trainees on the topic of pediatric obesity. Future efforts to further refine these educational tools and disseminate them more widely are important next steps.