Weight and Health Behavior Conversations in Adolescent Primary Care: A Qualitative Examination

Current clinical practice guidelines recommend that pediatricians screen all youth for overweight/obesity and provide or refer to treatment those with elevated weight status. Despite pediatricians' intentions to provide high-quality care, weight stigma and bias impede health care delivery. A shift in training is needed to optimize the experiences of adolescents with high weight status (body mass index ≥85 th percentile) during primary care visits. The present study sought adolescent, caregiver, and pediatrician perspectives on current practice, gaps in care, and needs for training to address health behaviors in youth at high weight status.

Individual qualitative interviews were conducted with adolescents with high weight status (ages 13-17), their caregivers, and pediatricians. Recruitment occurred primarily through a hospital-based primary care practice in the Northeastern United States. Interviews were audio recorded, transcribed, and analyzed using an applied thematic analysis approach.

A total of 13 adolescents, 13 caregivers, and 11 pediatricians participated in the study. Themes from adolescents and caregivers included preferences for weight-specific communication, the importance of patient centered care, and specific guidance for pediatricians delivering care. Themes from pediatricians included philosophy of addressing high weight status, gaps in training, and preferred components of a future training.

Multiple perspectives, including patients and pediatricians, emphasize the need to develop further training for pediatricians to improve care for adolescents at high weight status to meet current clinical practice guidelines. Findings provide specific guidance for development of pediatrician-focused training to navigating health behavior and weight-related conversations using a patient-centered approach.