UC San Diego

The dissertation study focuses on care provider, parent, and child (5-11 years-old) discussions of diet, physical activity, and weight during well-child visits. The project utilized conversation analysis of 39 audio-recorded well-child visits (approximately 17 hours) in tangent with quantitative analysis of 39 post-visit parent-reported questionnaires.

Quantitative analysis explored possible variables related to parent-reported overall satisfaction with the medical visit, as well as parent-reported satisfaction with care provider communication about weight, diet, and physical activity. Two-tailed Spearman’s Rank Order Correlations revealed a strong, positive correlation between child age and parent-reported satisfaction with the care provider communication, rho (30)=.51 p=.004. Kruskal-Wallace tests revealed a statistically significant difference in parent-reported satisfaction with care provider communication across the three different visits with care provider groups, 2(2, n=33) =8.83, p=.012 as well as across the 5 categories of time with the care provider, 2(4, n=33) =10.25, p=.037. Parent satisfaction with care provider communication followed a u-shaped curve for both visits with the care provider and time with the care provider. These findings were used to inform and structure the qualitative analysis.

Qualitative analysis of the audio-recorded well-child visits were divided by child weight status. For normal weight patients, care providers applied weight-based labels (i.e., “slender guy”), excluded children from discussions, and neglected to fully address physical activity. For overweight/obese patients, care providers avoided weight-based labels, engaged in abstraction when discussing weight, and almost exclusively focused on encouraging changes in diet and physical activity. For approaching/underweight patients, care providers readily applied labels of thinness without adequately accounting for possible stigma; nutrition mostly treated as non-problematic; and physical activity discussions were minimal and not tailored to underweight status.

The results of the quantitative and qualitative analysis, taken together, elucidate several clinical recommendations for improving overall treatment of pediatric patients. These include avoiding stigmatizing weight-based labels and pejorative communication about diet and physical activity; considering a team-based strategy to fully address overweight/obese status; and more intentionally encouraging and tailoring physical activity for all weight groups.