Year of Publication



Public Health

Date Available


Degree Name

Dr. of Public Health (Dr.P.H.)

Committee Chair

Dr. Richard Ingram

Committee Member

Dr. Julia Costich

Committee Member

Dr. Aurelia Radulescu


Background: Childhood obesity continues to be a serious international public health concern. Unfortunately, there are limited treatment options for obesity. One notable intervention option is the University of Kentucky (UK) Pediatric high BMI clinic intervention for childhood obesity. The Clinic provides intervention for childhood obesity through healthy lifestyle habits. This intervention has been reported to be effective.

Even though there is evidence that public health policies that promote healthy behaviors would substantially reduce and prevent the alarming prevalence of childhood obesity, the state of Kentucky does not have well-established practical policies that promote healthy behaviors in children. Studies have shown that a strong tool to reverse childhood obesity may be policies that provide an environment that promotes improved dietary and physical activity behavior. The school environment would be ideal for implementing policies that promote healthy environmental defaults. Replicating the UK Pediatric high BMI clinic intervention for childhood obesity in the school environment through policy changes would address the childhood obesity epidemic in the state of Kentucky.

Objectives: This study sought to (1) identify factors that impede the implementation of healthy lifestyle recommendations to children with obesity attending the UK Pediatric high BMI clinic, (2) identify policy changes that could address these factors at the population level, and (3) make recommendations, based on our findings, to policymakers for policy formulation.

Methods: Our study design was a qualitative study design employing the grounded theory approach. Our target study population was the healthcare providers to children with obesity attending the UK Pediatric High BMI Clinic. They served as key informants through whose perspectives we got information about the children. We collected data from our key informants through structured in-depth one-on-one interviews, using an interview guide modeled after a validated questionnaire. The questions were based on the Socio-ecological model (SEM). The data analysis involved transcribing the interview sessions professionally, line-by-line coding of the transcripts, and identifying themes consistent with the SEM.

Results: We interviewed 15 key informants who all work in various clinics within UK Healthcare. The results are the providers’ perceptions indicative of their actual patient encounters. Based on the SEM levels of influence, we identified barriers to healthy lifestyle habits and policy changes that would address these barriers at the population level. We labeled these barriers and policy changes as themes. The themes include intrapersonal barriers to physical activity (PA) and healthy diet (HD), interpersonal barriers to PA and HD, organizational barriers to PA and HD, community barriers to PA and HD, and public policy changes.

Conclusion: Our key informants perceived that the children with obesity that attend the UK pediatric high BMI clinic encounter personal, environmental, and social barriers that impede the implementation of the healthy lifestyle counseling that they receive from the clinic. These barriers could be addressed in the school setting through policy changes that would promote healthy lifestyle habits in the school environment. This strategy would provide a population-based intervention for the obesity epidemic that has plagued the state of Kentucky. Therefore, a school-focused intervention through a mandatory routine of daily physical activity and a healthy diet is a possible solution to childhood obesity in Kentucky.

Included in

Public Health Commons