Table 3.

Barriers Perceived By Pediatric Primary Care Providers to Use of BMI

Barriers	Sample Comments
1. Lack of familiarity
Not part of provider’s routine	”It’s a habit of not doing it... And now attention and awareness is being raised nationally and statewide as well, and the whole premise for pediatricians..., we’re supposed to be doing this. [...] In 2 years, I would suspect that that’s going to be the case here.”
2. Lack of agreement
Not appropriate as a diagnostic tool	“I think some people criticize the BMI ‘cause it takes no assessment for...body frames. You have this massive football player who’s all muscle, his BMI is yucky, but he’s...nothing but muscle.”
Competes with other visit priorities	“I only have so many minutes in a well-child checkup or whatever visit I’m fitting all this new stuff into, so I’ve got focus on what’s important and the BMI is just fluff for me, so I quit using it.”
Difficult to communicate results	“Most parents are not going to understand what a BMI means, or...what that means for the child... ”
Stigmatizing to be labeled overweight (labeling)	“I want to tell them the health information; at the same time, I worry about labeling the kid and making the family feel bad.”
3. Skepticism about treatment effectiveness
Not useful in the absence of effective treatment	“You just keep hearing this drumbeat..., ‘this child’s obese,’ ‘that one’s obese,’ ‘that one’s obese,’ and then if you don’t feel like you can do anything for them, then eventually it just becomes something you almost ignore, because you don’t know how to respond to that alarm that keeps going off when you look at the BMI.”
Not useful for counseling	“Until there are recommendations to trigger certain things at certain BMIs..., I wouldn’t really use it so much, to change my practice.”
4. Environmental factors
Not included on older growth charts	“If you’ve got a child over age 2 who has the older child growth chart in there that’s the old model, and they haven’t converted that chart to the new one...they might put in a second BMI chart, or they might not.”
Inaccurate measurement	“The nurse would just put the same one in from last time, or just ask them what their weight is right now instead of actually weighing...so it was impossible to know the accuracy of the actual weight.”
Office systems not compatible with calculating BMI	“I think we have to catch it in the context of all the other things that are going on in the practice. [...] Our nurses...sometimes feel like the whipping boy, because every time there’s extra work to be done, it’s not usually the doctors or the clerical staff that end up doing it, it’s the nurses.”