Youths’ Perceptions of Overweight-related
Prevention Counseling at a Primary Care Visit
Elsie M. Taveras,* Arthur M. Sobol,† Cynthia Hannon,† Daniel Finkelstein,† Jean Wiecha,† and
Steven L. Gortmaker†
TAVERAS, ELSIE M., ARTHUR M. SOBOL, CYNTHIA
HANNON, DANIEL FINKELSTEIN, JEAN WIECHA,
AND STEVEN L. GORTMAKER. Youths’ perceptions of
overweight-related prevention counseling at a primary care
visit. Obesity. 2007;15:831–836.
Objective: We examined youths’ report of receiving spe-
cific overweight-related preventive counseling and per-
ceived readiness to adopt nutrition and physical activity
behaviors recommended by their clinicians.
Research Methods and Procedures: We surveyed 324
youth 10 to 18 years old who had a physical exam within the
past year. The survey included questions on height, weight,
race/ethnicity, mother’s education, and topics they dis-
cussed with their clinician during their visit. We used mul-
tivariable analyses to examine whether weight status and
sociodemographic characteristics were predictors of which
youth received counseling from their clinicians and which
youth were ready to change.
Results: The mean (standard deviation) age of participants
was 13.7 (1.8) years; 54% were black, and 22% were
Hispanic. Less than one-half of participants reported dis-
cussing sugar-sweetened beverages [38%; 95% confidence
interval (CI), 32% to 43%] or television viewing (41%; 95%
CI, 36% to 47%) with their clinicians. In multivariable
analyses adjusting for participant’s age, sex, race/ethnicity,
overweight status, and mother’s educational attainment,
youth whose mothers lacked education beyond high school
were significantly less likely to report receiving counseling
on any overweight-specific topic including television view-
ing [odds ratio (OR), 0.46; 95% CI, 0.27, 0.79], sugar-
sweetened beverage (OR, 0.47; 95% CI, 0.28, 0.80), and
fast food consumption (OR, 0.54; 95% CI, 0.32, 0.92). In
addition, youth 10 to 14 years old were more likely than
those 15 to 18 years old to report they would try to change
their television viewing (OR, 4.10; 95% CI, 1.78, 9.44) if
recommended by their clinician.
Discussion: Youth report infrequently receiving counseling
on specific overweight prevention topics during routine
primary care visits. Our findings suggest that greater efforts
may be needed to reduce social class disparities in over-
weight prevention counseling and that counseling to prevent
overweight in youth may be more acceptable to younger
Key words: counseling, primary care, television, sugar-
sweetened beverages, fast food
Primary preventive health services could play an impor-
tant role in addressing child and adolescent overweight,
given that the majority of youth in the United States interact
with the health care system at least once during any given
year (1). However, as many as 50% of pediatricians do not
regularly counsel youth about maintenance of a healthy
weight, and close to 40% of pediatricians do not regularly
counsel about physical activity (2). Furthermore, few pedi-
atricians believe their advice is effective in motivating be-
havior change around diet and activity (3).
Guidelines for pediatric and adolescent preventive care
recommend annual screening and counseling on nutrition
and physical activity (4–6) but are not very specific about
what aspects to focus on to prevent overweight. Both epi-
demiological and experimental evidence from the past de-
cade supports targeting reduction in television viewing (7–
11), sugar-sweetened beverages (12–14), and fast food
(15,16) as primary preventive intervention outcomes im-
Received for review February 6, 2006.
Accepted in final form October 27, 2006.
The costs of publication of this article were defrayed, in part, by the payment of page
charges. This article must, therefore, be hereby marked “advertisement” in accordance with
18 U.S.C. Section 1734 solely to indicate this fact.
*Obesity Prevention Program, Department of Ambulatory Care and Prevention, Harvard
Medical School and Harvard Pilgrim Health Care, Boston, Massachusetts; and †Department
of Society, Human Development and Health, Harvard School of Public Health, Boston,
Address correspondence to Elsie M. Taveras, Obesity Prevention Program, Department of
Ambulatory Care and Prevention, Harvard Medical School and Harvard Pilgrim Health
Care, 133 Brookline Avenue, Sixth Floor, Boston, MA 02215.
Copyright © 2007 NAASO
OBESITY Vol. 15 No. 4 April 2007831
young children, and to match counseling to youth’s readi-
ness to change their behavior.
This study was supported, in part, by grants from the Cen-
ters for Disease Control and Prevention (Prevention Research
Centers Grants U48/CCU115807 and U48DP000064). This
work is solely the responsibility of the authors and does not
represent official views of the Centers for Disease Control and
Prevention. E.M.T. is supported, in part, by the Minority Med-
ical Faculty Development Program of the Robert Wood John-
1. Dey AN, Schiller JS, Tai DA. Summary health statistics for
U.S. children: National Health Interview Survey, 2002. Vital
Health Stat. 2004;10:1–78.
2. Galuska DA, Fulton JE, Powell KE, et al. Pediatrician
counseling about preventive health topics: results from the
Physicians’ Practices Survey, 1998–1999. Pediatrics. 2002;
3. Nader PR, Taras HL, Sallis JF, Patterson TL. Adult heart
disease prevention in childhood: a national survey of pedia-
tricians’ practices and attitudes. Pediatrics. 1987;79:843–50.
4. Green M. Bright Futures: Guidelines for Health Supervision
of Infants, Children, and Adolescents. Arlington, VA: Na-
tional Center for Education in Maternal and Child Health;
5. Knishkowy B, Palti H. GAPS (AMA Guidelines for Adoles-
cent Preventive Services): where are the gaps. Arch Pediatr
Adolesc Med. 1997;151:123–8.
6. American Academy of Pediatrics, Committee on Psycho-
social Aspects of Child and Family Health. Guidelines for
Health Supervision. Elk Grove Village, IL: American Acad-
emy of Pediatrics; 1997.
7. Dietz WH, Gortmaker SL. Do we fatten our children at the
TV set? Obesity and television viewing in children and ado-
lescents. Pediatrics. 1985;75:807–12.
8. Gortmaker SL, Must A, Sobol AM, Peterson K, Colditz
GA, Dietz WH. Television viewing as a cause of increasing
obesity among children in the United States, 1986–1990. Arch
Pediatr Adolesc Med. 1996;150:356–62.
9. Epstein LH, Valoski AM, Vara LS, et al. Effects of decreas-
ing sedentary behavior and increasing activity on weight
change in obese children. Health Psychol. 1995;14:109–15.
10. Hu FB, Li TY, Colditz GA, Willett WC, Manson JE.
Television watching and other sedentary behaviors in relation
to risk of obesity and type 2 diabetes mellitus in women.
11. Gortmaker SL, Peterson K, Wiecha J, et al. Reducing
obesity via a school-based interdisciplinary intervention
among youth: Planet Health. Arch Pediatr Adolesc Med. 1999;
12. Giammattei J, Blix G, Marshak HH, Wollitzer AO, Pettitt
DJ. Television watching and soft drink consumption: associ-
ations with obesity in 11- to 13-year-old schoolchildren. Arch
Pediatr Adolesc Med. 2003;157:882–6.
13. Ludwig DS, Peterson KE, Gortmaker SL. Relation between
consumption of sugar-sweetened drinks and childhood obe-
sity: a prospective, observational analysis. Lancet. 2001;357:
14. Harnack L, Stang J, Story M. Soft drink consumption
among US children and adolescents: nutritional consequences.
J Am Diet Assoc. 1999;99:436–41.
15. Taveras EM, Berkey CS, Rifas-Shiman SL, et al. The
association of fried food consumption away from home with
body mass index and diet quality in older children and ado-
lescents. Pediatrics. 2005;116:e518–e24.
16. Bowman SA, Gortmaker SL, Ebbeling CB, Pereira MA,
Ludwig DS. Effects of fast-food consumption on energy
intake and diet quality among children in a national household
survey. Pediatrics. 2004;113:112–8.
17. Berkey CS, Rockett HRH, Gillman MW, Colditz G. One
year changes in activity and in inactivity among 10 to 15 year
old boys and girls: relationship to change in body mass index.
18. Epstein LH, Roemmich JN, Raynor HA. Behavioral therapy
in the treatment of pediatric obesity. Pediatr Clin North Am.
19. Bethell C, Klein J, Peck C. Assessing health system provi-
sion of adolescent preventive services: the Young Adult
Health Care Survey. Med Care. 2001;39:478–90.
20. Rollnick S, Mason P, Butler C. Health Behavior Change: A
Churchill Livingston; 1999.
21. Miller WR, Rollnick S. Motivational Interviewing: Prepar-
ing People to Change Addictive Behavior. New York: The
Guilford Press; 1991.
22. Goodman E, Hinden B, Khandelwal S. Accuracy of teen
and parental reports of obesity and body mass index. Pediat-
23. Kolagotla L, Adams W. Ambulatory management of child-
hood obesity. Obes Res. 2004;12:275–83.
24. Flores G, Olson L, Tomany-Korman SC. Racial and ethnic
disparities in early childhood health and health care. Pediat-
25. Klein JD, Wilson KM. Delivering quality care: adolescents’
discussion of health risks with their providers. J Adolesc
Youth Perceptions of Overweight Counseling, Taveras et al.
836OBESITY Vol. 15 No. 4 April 2007