Understanding knowledge, practices, and barriers in pediatric weight-management: a multisite cross-sectional study of primary care providers

Abstract

Background: Pediatric overweight and obesity (OW/OB) are growing global health concerns, with rapidly increasing prevalence in Latin America and the Caribbean.

Methods: This cross-sectional study was conducted from January to March 2025 in 15 pediatric clinics in the Dominican Republic. Surveys assessed healthcare providers’ knowledge, attitudes, self-reported counseling behaviors, and perceptions of the clinical environment related to pediatric OW/OB management. Descriptive statistics and multivariable regression analyses were used to examine the associations between provider characteristics and management practices.

Results: Of the 103 respondents, 79.6% were women and 93.2% were attending physicians. Correct identification of clinical OW/OB definitions ranged from 57.3% to 75.3%. Although 93.2% reported being confident in diagnosing OW/OB, only 27.2% consistently asked families about their priorities for healthy living, and 62.1% regularly addressed physical activity during well-child visits. While 91.3% of providers “always” referred patients to a dietician/nutritionist, only 51.5% consistently scheduled follow-up visits.

Discussion: The findings of this study highlight gaps in provider knowledge and inconsistencies in obesity-related counseling practices during well-child visits. Strengthening pediatric OW/OB management in LMICs will require targeted training and enhanced support systems that promote family-centered care in resource-limited settings.

Impact: The key message is that pediatric obesity management shows strong provider confidence but clear gaps in knowledge and counseling practices.

This article provides the first multisite evidence on pediatric weight-management practices in a low-resource Latin American setting.

Highlights discrepancies between confidence and consistent application of lifestyle counseling.

Underscores the urgent need for targeted training, family-centered approaches, and system-level support in LMICs to strengthen sustainable pediatric obesity care.