Identification of Preferred Healthy Weight Counseling Approaches for Children in the Dental Setting

Objective: There is a gap in the literature regarding optimal methods for the dental team to help address the childhood obesity epidemic; accordingly, this investigation sought to identify preferred communication approaches the dental team can rely upon to initiate dialogue with caregivers regarding the weight of their children. Study Design: A structured interview guide containing seven potential Healthy Weight Counseling (HWC) approaches and eight follow up questions was developed, pilot-tested, revised and utilized as a structured interview guide. Interviews were conducted at the Children's Clinic at the School of Dentistry at the University of North Carolina at Chapel Hill (UNC-CH) with 50 participants who are English-speaking caregivers of children ages 4–12. Results: Ninety-four percent of the participants were receptive to HWC in the dental setting. Caregivers indicated varying levels of acceptance for the seven HWC-approaches based on specific word choices in each approach. Sixty percent preferred HWC to be delivered with the child not present while 34% preferred the child's presence and 6% had no preference. Conclusions: Caregivers were open to weight-related conversations in the dental setting but to be well received, the dental team must choose their approach carefully and establish the proper doctor/patient relationship prior to HWC delivery. An individualized HWC-approach tailored to the specific needs of each family is indicated.

childhood obesity, healthy-weight counseling, dentists, caregivers, dental education, parental perceptions

1. Ogden C, Lawman H, Fryar C, Kruszon-Moran D, Kit B, and Flegal K . Trends in obesity prevalence among children and adolescents in the United States, 1988-1994 through 2013-2014. JAMA; 21: 2293-2299. 2016.

2. Freedman DS, Mei Z, Srinivasan SR, Berenson GS, Dietz WH. Cardiovascular risk factors and excess adiposity among overweight children and adolescents: the Bogalusa Heart Study. J Pediatr; 150(1): 12-17.e2. 2007.

3. Dietz William H. Health consequences of obesity in youth: Childhood predictors of adult disease. Pediatrics; 101(2): 518-525. 1998.

4. Morrison KM, Shin S, Tarnopolsky M, Taylor VH. Association of depression and health related quality of life with body composition in children and youth with obesity. Journal Affective Disorders; 172: 18-23. 2015.

5. Healthy People 2020. Nutrition, Physical Activity, and Obesity. https://www. healthypeople.gov/2020/leading-health-indicators/2020-lhi-topics/Nutrition- Physical-Activity-and-Obesity/data. Accessed December 28, 2016.

6. Hansen A, Duncan D, Tarasenko Y, Yan F, Zhang J. Generational Shift in Parental Perceptions of Overweight Among School-Aged Children. Pediatrics; 134: 481-488. 2014.

7. He M, Evans A. Are parents aware that their children are overweight or obese? Do they care? Canadian Family Physician; 53: 1493-1499. 2007.

8. Glick, M. A concern that cannot weight. JADA; 136: 572-573. 2005.

9. Vann WF Jr, Bouwens TJ, Braithwaite AS, Lee JY. The childhood obesity epidemic: a role for pediatric dentists? Pediatr Dent; 27(4): 271-276. 2005.

10. Tseng R, Vann WF, Perrin E. Addressing childhood overweight and obesity in the dental office: Rationale and practical guidelines. Pediatr Dent; 32: 417–423. 2010.

11. Greenberg B, Thomas P, Glick M, Kantor M. Physicians’ attitudes toward medical screening in a dental setting. J Public Health Dent; 75:225-233. doi: 10.1111/jphd.12093. Epub 2015 Mar 11. 2015.

12. Greenberg B, Kantor M, Jiang S, Glick M. Patients’ attitudes toward screening for medical conditions in a dental setting. J Public Health Dent, 2012; 72:28-35. doi: 10.1111/j.1752-7325.2011.00280.x. Epub 2011 Oct 10.

13. Tavares M and Chomitz V. A healthy weight intervention for children in a dental setting. J Am Dent Assoc,; 140: 313–316. 2009

14. Curran A, Caplan D, Lee, JY, Paynter L, Gizlice Z, Champagne C, Ammerman A, Agans R. Dentists’ attitudes about their role in addressing obesity in patients : A national survey. J Am Dent Assoc ; 141:1307-1316. 2010.

15. Lee JY, Caplan DJ, Gizlice Z, Ammerman A, Agans R, Curran AE. US pediatric dentists’ counseling practices in addressing childhood obesity. Pediatr Dent, 2012; 34: 245-250.

16. Swinney FV, Vann WF jr, Mihas P Burgette JH, Ammerman A, Lee JY. Caregivers perceptions about discussing children’s weight: A pilot study. Dent Open J; 2: 2(2): 47-54. 2015.

17. McHugh ML. The Chi-square test of independence. Biochemia Medica, 2013; 23(2): 143–9.

18. Ziegler J, Hughes CV. Weighing in on pediatric obesity. JADA; 147: 146–150. 2016.

19. Golan M, Crow S. Parents Are Key Players in the Prevention and Treatment of Weight-related Problems. Nutr Rev; 62 (1): 39-50. 2004.

20. Fowler-Brown A, Kahwati LC. Prevention and treatment of overweight in children and adolescents. American Family Physician; 69: 2591-98. 2004. 21. Yuan JC, Lee DJ, Afshari FS, Galang MT, Sukotjo C. Dentistry and obesity: a review and current status in U.S. predoctoral dental education. J Dent Educ; 76: 1129-1136. 2012.

22. Hisaw T, Kerins C, McWhorter AG, Seale NS. Pediatric obesity curriculum in pediatric dental residency programs. Pediatr Dent; 31:486-491. 2009.

23. Werner SL, Phillips C, Koroluk LD. Association between childhood obesity and dental caries. Pediatr Dent; 34: 23-27. 2012.

24. Spiegel KA, Palmer CA. Childhood dental caries and childhood obesity. Different problems with overlapping causes. Am J Dent; 25 (Feb): 59-64. 2012.

25. Lasater G, Piernas C, Popkin BM. Beverage patterns and trends among school-aged children in the US, 1989-2008. Nutr J; 10: 103. 2011.

26. Sandelowski M. Whatever happened to qualitative description? Research in Nursing & Health; 23: 334-340. 2000.