Assessment of weight-related factors of adolescents by private practitoners

Abstract

Background: Weight misperceptions are common in adolescents and doctors’ advice may help clarify these misperceptions. Few studies have examined how common physicians assess various weight-related factors, including physical measurements, lifestyle factors, and obesity-related medical risks, based on adolescents’ reports and patient characteristics that predict such assessments. Physicians’ weight comments were associated with weight perception in overweight patients, however, such association was unclear in non-overweight adolescents.

Objectives: The present study aimed to 1) examine how common adolescents received weight-related factors from private practitioners; 2) identify factors associated with these assessments; 3) assess how common adolescents received weight comments from private practitioners; 4) examine the association of body weight comments by private practitioners with weight perception in adolescents, intention to do more non-exercise physical activity (NEPA), and perceived risk of chronic disease for being overweight.

Methods: In the Hong Kong Student Obesity Surveillance (HKSOS) project, 33692 students (44.9% boys; mean age 14.8, SD 1.9 years) from 42 randomly selected schools completed an anonymous questionnaire. The students were asked whether in the past 12 months any private practitioner (or their nurses) had assessed their height, weight, waist circumference (WC), blood pressure (BP), body mass index (BMI), diet, and physical activity. Students were also asked to report any weight status comments received from private practitioners. Perceived risk of chronic disease for being overweight and intention to do more NEPA were also reported. Weight status was based on self-reported weight and height. Multiple imputation was used to replace missing values. Logistic (or ordinal logistic) regression was used to assess the association between student characteristics and assessment of each weight-related factor, and the association of weight comments with adolescent weight perception, perceived risk of chronic disease, and intention to do more NEPA.

Results: Among 13283 students who had doctor consultations in the past 12 months, 37.9% received physical measurements or lifestyle enquiries, with weight (20.8%), height (16.8%) and blood pressure (11.5%) being the most common, followed by diet (8.1%), BMI (6.3%), WC (4.6%), and physical activity (4.6%). In general, adolescents who were female, older, underweight or overweight/obese, had parents with higher education level, and had actively asked private practitioners for advice about weight were more likely to receive assessments of weight-related factors.

Less than one-fifth (16.8%) of adolescents received height and weight or BMI assessments. Nearly 3 in 10 (28.7%) adolescents reported receiving weight status comments from private practitioners, of which 59.8% were correct. Correct weight status comments were associated with correct weight perceptions among adolescents regardless of weight status. Being told by a private practitioner that one is too fat was positively associated with perceiving higher risk of chronic disease for being overweight in normal weight and overweight adolescents, and more intention to do NEPA in all adolescents.

Conclusions: Weight-related factors in adolescents were infrequently assessed by private practitioners in Hong Kong. Generally, unhealthy weight, higher parental education and advice-seeking by adolescents predicted these assessments. Receiving correct weight comments predicted correct adolescent weight perceptions. Practitioners should routinely assess and advise adolescents on weight status.