Pediatric Dentists Combating Obesity

Alison Grover, D.D.S., M.A. Pediatric Dental Resident

Donna Kritz-Silverstein, Ph.D.

27 July 2012

Problem
Obesity

Fastest growing healthcare crisis in children ~16.9% of children & adolescents aged 219 are obese (NHANES 2007-2008) Prevalence of obesity increased 13% for children 6-19y between1976-2008
American Academy

of Pediatrics recommends

Healthcare provider involvement to combat obesity

www.aapd.org; www.cdc.gov

Purpose
To determine if Dentists can effectively educate parents Childhood obesity and related factors

Parents will incorporate information about health and nutrition provided by

childs dentist

Method
92

parents of patients 2-12y

San Diego Childrens Dental Center Recruitment over 6 month period

Completed

survey about health and nutrition

English/Spanish
Educational
Resurveyed

intervention by dentist

3-6 months post-intervention

Survey
Behavioral

information Knowledge about

Obesity Health and nutrition
Attitudes

toward incorporating healthcare information from various healthcare professionals

Survey questions:

Does your child have free play time? No Yes How many days per week? ____ days How many minutes per day? ____minutes/day Does your child watch television? No Yes How many hours/day? _____hours Is there a TV in your childs bedroom? No Yes Do you give your child candy as a reward? No Yes How many glasses of water does your child drink per day? How many glasses of soda does your child drink per day?

Survey Question:
How willing are you to take information about what causes a child to be overweight from Completely Unwilling a. Teacher b. Nurse c. Nutritionist d. Dentist e. Physician 1 1 1 1 1 A Little Unwilling 2 2 2 2 2 Neutral 3 3 3 3 3 A Little Willing 4 4 4 4 4 Very Willing 5 5 5 5 5

Method
Educational

intervention

After initial survey

Presentation by pediatric dentist AAP health and nutrition guidelines ~2 minutes English/Spanish

Health and Nutrition Guidelines

Drink Limit Milk

water throughout day juice to 4-6 oz/day

only at mealtime

No
Do

soda
not reward with candy or sweets

Balanced

diet

Health and Nutrition Guidelines

Children
Eat No

should not clean their plate

with family - not in front of TV TV in childs bedroom

<2 hrs of TV/day >60 minutes/day

Exercise

Method
Post-intervention surveys
Uncompleted 22%

Completed 78%

Parents

completed post-intervention survey 5.3( 1.5) months after pre-intervention survey 72 (78%) post-intervention surveys completed

Table 1: Sample Characteristics of Parent and Child (n=92)

Mean Parent age Child age Parent BMI Child BMI Free play (d/wk) Free play (hrs/d) TV (hrs/d) Water (glass/d) Soda (glass/d) 36.8 6.8 26.5 17.9 6.0 1.5 2.2 4.1 0.47 S.D. 6.9 3.2 5.2 3.9 1.6 1.1 1.3 2.3 0.8 Range 21-53 2-12 15.7-39.1 10-29.4 1-7 0.5-5 0.5-7 0-9 0-4

Figure 1: Comparisons* of Behaviors Pre v. Post-Intervention (n=72)

7 6 5 4 3 2 1 0

P=.08 P=.08 P=.07

Pre-test Post-test

* Comparisons performed with paired t-tests

Figure 2: Comparisons* of Behaviors Pre v. Post-Intervention (n=72) P=.01

50
45 40 35 30 25 20 15 10 5 0

TV in bedroom % YES Pre-intervention

Reward with candy % YES Post-intervention

* Comparisons performed Chi square analysis

4.5 4.4

Figure 3: Comparisons* of parental knowledge before & after intervention

4.3
4.2 4.1 4 3.9 3.8

P=.05 Pre-Intervention Post-intervention

Good eating Their childs Their childs habits in overall need for children health exercise

Causes of childhood obesity

* Comparisons performed with paired t-tests

Table 2: Comparison* of parent willingness to take information about the causes of obesity and nutrition from different sources
Teacher Info on Obesity Pre4.0 training Post3.8 training Pre3.9 training Post3.9 training Nurse Nutritionist Dentist Physician 4.4a 4.6a 4.4a 4.6a

4.3a
4.4a 4.1a

4.5a
4.7a 4.6a

4.2a
4.4a 4.3a

4.5a
4.6a 4.6a

Info on Nutrition

*Comparisons performed with Analysis of Variance (ANOVA) a p<.05 as compared to teachers; results of Tukey HSD tests

Table 3: Comparisons* of mean characteristics of those who did and did not complete postintervention survey (participant bias analysis)
Completed Post-Intervention Survey
Yes (n=72) Parent age (years) 36 Child age (years) 6.8 2 Parent BMI (kg/m ) 26.8 Child BMI (kg/m2) Free play (days/week) Free play (minutes/day) TV (hours/day) Water (glasses/day) Soda (glasses/day) 17.9 6.0 83.9 2.2 4.1 .4 No (n=24) 32.6 6.7 28.7 18.9 5.7 94.1 2.3 4.0 .5 t 1.38 0.93 -1.08 -0.75 0.75 -0.63 -0.17 0.19 -0.83 p-value .09 0.90 .28 .46 .46 .53 .87 .85 .74

*Comparisons performed with independent t-tests using VassarStats

Discussion
Parental

behavior changed as result of health and nutrition intervention

More free play

Watched less TV
Drank less soda per day Rewarded less with sweets

Discussion
Changed

knowledge

After intervention parents knew more about

Causes of obesity

Childs need for exercise and good eating habits

Discussion
Parents

willing to take info from dentist

Equally willing to take info from dentist as

physician, nurse, and nutritionist

More willing to take info about health and

nutrition from dentist than teacher

Limitations
Limited

response range may have attenuated changes barrier

level

Cultural
Literacy

Strengths
Short

intervention

Bilingual Parents

of children with various health histories

Conclusions
Dentists

can effectively educate parents about childhood obesity

Parents with varied literacy levels and economic backgrounds retained info about health and nutrition, and changed behaviors

Dentists

should incorporate info about health and nutrition into visit