The Wait for the Weight: Pediatricians' Communication about Weight to Overweight and Obese Latino Children and their Parents

BACKGROUND: Latinos are among the most overweight (OW) racial/ethnic groups of US children. It is unknown, however, whether language barriers impact the communication of childhood OW. Objective: To determine whether and how language incongruence is associated with communication about OW for Latino children. DESIGN/METHODS: Cross-sectional analysis of video- or audio-recorded primary-care visits with pediatricians and OW (body mass index ≥85th%) 6-12 year-old Latino children recruited from academic and community clinics. Language proficiency was assessed using US Census Bureau questions, with language incongruence (LI) defined as pediatrician limited Spanish proficiency combined with parent limited English proficiency (LEP). Recorded visits were analyzed and transcribed. Direct communication of OW, who broached the topic first, use of growth charts, and communication of a weight-management plan were determined by reviewing recordings and transcripts. RESULTS: The 26 visits (18 video and eight audio) included 26 participants and 15 pediatricians (including 10 resident/attending pairs). The mean child age was nine years old; 100% were OW and 84% were obese. 89% of parents were OW and 60% were LEP. 43% of pediatricians were Spanish-proficient. Pediatrician-parent language was incongruent in 24% of visits. Direct communication of OW occurred in 90% of language-congruent (LC) vs. 50% of LI visits (P=.03). Parents were the first to broach the topic of OW in 10% of LC vs. 50% of LI visits (P=.03). Pediatricians used growth charts in 80% of LC vs. 0% of LI visits (P<.001). Weight-management plans were conveyed in 55% of LC vs. 33% of LI visits (P=.4). One pediatrician stated, "You are not growing any taller, so you have to do the hard adult thing and [lose weight]." At least one culturally relevant dietary recommendation was made in 19% of visits. One pediatrician noted, "Less fat, less manteca, less avena, less sugar," and another, "No tacos. You need to buy fruit." CONCLUSIONS: Pediatrician-parent LI is associated with a lower likelihood of direct communication of child OW/obesity and use of growth charts, but a higher likelihood of parents, instead of doctors, being the first to broach the topic of OW. Regardless of LI, many OW Latino children do not receive weight-management plans or culturally relevant dietary recommendations.