Fit for Los Angeles Evaluation*
As part of an evaluation of training on childhood overweight prevention and
management, please complete the following questionnaire. Your answers are entirely
anonymous. This information WILL NOT be used for personal evaluation. Do not record
your name anywhere on the sheet. If this information is ever published or
disseminated, we may identify the institution but not the individual. Participating in
this evaluation is completely voluntary and if you do not want to participate that is
fine or if you decide in the future not to participate that is fine too. This will not be a
part of your evaluations. The completion of the questionnaire will only be used to
evaluate the program itself, and not to evaluate the residents’ and health
professional's performance/academics.
We estimate the total completion time of the survey to be 30 minutes.
Thank you in advance for your participation.
Please be sure to answer all questions on both sides of pages.
Anonymous ID Code: Please enter one letter or number for each of the boxes. If you
don’t know a particular answer, enter “X”
The
The
The
The
first letter of my middle name……………………..
first letter of the month I was born………………
last digit of my social security number…………
first letter of the city I was born…………………..
Today’s Date: __________________________________________________
PAGE 1 OF 7
UCLA Fit for Los Angeles
6/15/2015 Approved by UCLA South General IRB # 11-002343
TELL US ABOUT YOURSELF
Which best describes you?
A. Pediatric Resident
B. Family Practice Resident
C. Other:__________________
If you are a resident, which year of training are you in?
A. PL-1
B. PL-2
C. PL-3
D. PL-4
E. Other:___________________
What is the name of your residency training program? (please indicate if PHABB)
__________________________________________
*This questionnaire incorporates items from the Arkansas CME Obesity module and the UC Davis Pediatric Obesity Curriculum
evaluation.
1. How much do you agree or disagree
with the following statements:
a. It is the primary care provider’s role
to identify obesity in children
b. It is the primary care provider’s role
to provide dietary counseling to
children
c. Primary care providers can be
effective in treating childhood obesity
d. Primary care providers in your
continuity clinic are currently effective
with their activity/exercise counseling
Strongly
Agree
Agree
Neither
Agree or
Disagree
Disagree
Strongly
Disagree
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
PAGE 2 OF 7
UCLA Fit for Los Angeles
6/15/2015 Approved by UCLA South General IRB # 11-002343
With respect to children 2-18 years old, please indicate whether you disagree or agree
with the following statements.
2. I feel confident in my
abilities to:
Strongly
Agree
Agree
1
a. interpret BMI values
b. make a difference in my
patients’ diet and eating habits
c. counsel my patients using openended questions
d. counsel parents on limit setting
and other parenting skills to help
support target behaviors around
patient diet/eating and physical
activity
e. partner with a community
agency around children’s nutrition
and physical activity
f. know what community resources
exist for children who are
overweight or obese
g. provide dietary and physical
activity counseling to individuals
Disagree
Strongly
Disagree
2
Neither
Agree or
Disagree
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
1
2
3
4
5
Quality Improvement Knowledge:
3. Please characterize
your knowledge and
experience with each of
the following Quality
Improvement (QI)
practices:
a. Using the Model for
improvement.
b. Setting goals for a QI
project.
c. Carrying out short
improvement testing
(“PDSA”) cycles.
d. Using process and flow
mapping.
e. Interpreting data for QI
activities.
Not familiar
with this
Know the
basics
Have done
this once or
twice
Feel comfortable
using these
practices
1
2
3
4
1
2
3
4
1
2
3
4
1
2
3
4
1
2
PAGE 3 OF 7
UCLA Fit for Los Angeles
6/15/2015 Approved by UCLA South General IRB # 11-002343
3
4
4.
A.
B.
C.
D.
E.
According to national data, what percentage of 2-5 year olds are overweight or obese?
2%
5%
10%
15%
>20%
5.
A.
B.
C.
D.
E.
F.
Which ethnic group is at highest risk for pediatric obesity?
Caucasians
African-Americans
Latinos
Native Americans
Asian/Pacific Islander
All groups are at equal risk
6.
A.
B.
C.
D.
The prevalence of pediatric overweight and obesity differ for males and females by:
Age
Ethnicity
A and B
Neither
7. In early childhood (0 to 5 years of age), the following are predictors of future risk of
obesity EXCEPT?
A. The child being underweight, or failure to thrive
B. One or both parents being overweight or obese
C. The family having a sedentary lifestyle
D. Infants born small for gestational age
E. All are predictors of obesity later in life
8. Which of the following is the most common reason given by mothers for discontinuing
breastfeeding within the 1st month?
A. Insufficient milk production
B. Problems with latching on the breast
C. Returning to work
D. A, B
E. All of the above
9. Write in the BMI percentile value that you use to diagnose children as:
A. Overweight __________
B. Obese ______________
10. The Centers for Disease Control and Prevention recommend the following strategies for
the prevention of childhood obesity:
A. promote breastfeeding
B. calculate and plot BMI once a year
C. track the change in BMI to catch abnormal weight gain early
D. recommend less than 4 hours of television viewing for children over 2 years old
E. A,B,C
F. all of the above
PAGE 4 OF 7
UCLA Fit for Los Angeles
6/15/2015 Approved by UCLA South General IRB # 11-002343
11.
What are the 3 sensitive growth periods to monitor for future overweight and
obesity?
A. in-utero, 1-2 years of age, 2-5 years of age
B. in-utero, 2-5 years of age, 11-18 years of age
C. in-utero, 2-6 years of age, 11-15 years of age
D. in-utero, 4-6 years of age, 11-18 years of age
12. The American Academy of Pediatrics recommends which of the following physical
activity strategies for the prevention and management of overweight/obesity?
A. Moderate to vigorous physical activity for at least 30 minutes each day
B. Moderate to vigorous physical activity for at least 45 minutes each day
C. Moderate to vigorous physical activity for at least 60 minutes each day
D. None of the above
13. Which of the following have the strongest-evidence for the prevention of childhood
overweight and obesity?
A. Eating breakfast daily
B. Limiting consumption of sugar-sweetened beverages
C. No television viewing before 2 years of age and thereafter no more than 2 hours of
television viewing per day
D. Eating a diet high in fiber
E. Promoting daily physical activity for at least 60 minutes per day
F. A, B, C
G. All of the above
14. The American Academy of Pediatrics recommends which of the following outcome goals
for the management of overweight/obesity?
A. Weight maintenance that results in decreasing BMI as age and height increase
B. Weight loss should not exceed 1lb/month for children 2-11 years of age or an average
of 2lb/week for older overweight/obese children and adolescents.
C. If no improvement in BMI/weight status is observed after 3-6 months then the patient
should advance to a comprehensive multidisciplinary intervention
D. A and B
E. All of the above
15. Which of the following are important aspects of a treatment plan for the management
of overweight and obesity according to the American Academy of Pediatrics?
A. Development of a plan for use of a balanced diet, emphasizing small amounts of
energy-dense foods
B. Provision of structured daily meals and snacks
C. ≥60 minutes of supervised active play per day
D. ≤1 hour of screen time per day
E. Self monitoring (ex., screen time, physical activity, dietary intake)
F. B, C only
G. All of the above
PAGE 5 OF 7
UCLA Fit for Los Angeles
6/15/2015 Approved by UCLA South General IRB # 11-002343
16.
Non-alcoholic fatty liver disease in childhood is often associated with:
A. Insulin resistance
B. hypothyroidism
C. Both A and B
D. Neither A nor B
17. All of the following factors are used in the diagnosis of metabolic syndrome EXCEPT:
A. high blood pressure
B. increased waist circumference
C. high LDL cholesterol
D. elevated triglycerides
18.
All of the following are conditions associated with obstructive sleep apnea (OSA)
EXCEPT:
A. Obesity
B. Down syndrome
C. Craniofacial anomalies
D. Failure to thrive (FTT)
E. Sinusitis
19.
The use of motivational interviewing in childhood obesity means that:
A. the clinician, child and family work together to identify problems and choose goals
B. the clinician increases the child’s motivation by telling them what to do in a very
positive way
C. group education is used to motivate the child and family
D. the clinician recommends a series of nonfood rewards to engage the child and increase
motivation
E. A,B only
20.
An overweight 12 year old girl says she wants to slim down but doesn’t know how
to get started. She doesn’t want diabetes like her grandmother, and she is tired of the kids
at school making fun of her. When you ask her if she can set a start date, she makes
excuses and says it will have to wait until school is out, which is 3 months away. At what
stage of change is this girl in the Readiness to Change Model?
A. Precontemplation
B. Contemplation
C. Preparation
D. Action
E. Maintenance
21.
An obese 10 year-old male returns to see you in clinic for a weight management
visit. Which of the following pieces of information about his clinical history and
presentation would be indications for a referral to a specialist?
A. Intermittent episodes of right upper quadrant pain and right upper quadrant
tenderness on examination
B. A fasting glucose level ≥100
C. Optic disk are blurred
D. Visible bowing of the lower extremity
E. A, C, D
F. All of the above
PAGE 6 OF 7
UCLA Fit for Los Angeles
6/15/2015 Approved by UCLA South General IRB # 11-002343
22. You are caring for a 16-year-old female who has a BMI of 28 and interested in losing
weight. What advice would you recommend:
A. Gastroplasty
B. Green tea extract
C. Intense aerobic training
D. Behavioral intervention
E. High protein, low-fat diet
23.
Do you know of at least 3 programs or agencies in your community that can help
support your clinical efforts in supporting families to optimize their physical activity and
access to healthy and fresh foods?
A. Yes
B. No
If yes, please list: (a)______________________________________________________
(b)______________________________________________________
(c)______________________________________________________
PAGE 7 OF 7
UCLA Fit for Los Angeles
6/15/2015 Approved by UCLA South General IRB # 11-002343