Referrals and Management Strategies for Pediatric Obesity—DocStyles Survey 2017

Abstract

Background: Childhood obesity care management options can be delivered in community-, clinic-, and hospital-settings. The referral practices of clinicians to these various settings have not previously been characterized beyond the local level. This study describes the management strategies and referral practices of clinicians caring for pediatric patients with obesity and associated clinician characteristics in a geographically diverse sample.Methods: This cross-sectional study used data from the DocStyles 2017 panel-based survey of 891 clinicians who see pediatric patients. We used multivariable logistic regression to estimate associations between the demographic and practice characteristics of clinicians and types of referrals for the purposes of pediatric weight management.Results: About half of surveyed clinicians (54%) referred <25% of their pediatric patients with obesity for the purposes of weight management. Only 15% referred most (≥75%) of their pediatric patients with obesity for weight management. Referral types included clinical referrals, behavioral referrals, and weight management program (WMP) referrals. Within these categories, the percentage referrals ranged from 19% for behavioral/mental health professionals to 72% for registered dieticians. Among the significant associations, female clinicians had higher odds of referral to community and clinical WMP; practices in the Northeast had higher odds of referral to subspecialists, dieticians, mental health professionals, and clinical WMP; and clinics having ≥15 well child visits per week were associated with higher odds of referral to subspecialists, mental health professionals, and health educators. Not having an affiliation with teaching hospitals and serving low-income patients were associated with lower odds of referral to mental health professionals, and community and clinical WMP. Compared to pediatricians, family practitioners, internists, and nurse practitioners had higher odds of providing referrals to mental health professionals and to health educators.Conclusion: This study helps characterize the current landscape of referral practices and management strategies of clinicians who care for pediatric patients with obesity. Our data provide insight into the clinician, clinical practice, and reported patient characteristics associated with childhood obesity referral types. Understanding referral patterns and management strategies may help improve care for children with obesity and their families.

Exploring Pediatric Obesity Training, Perspectives, and Management Patterns Among Pediatric Primary Care Physicians

“…Our data also suggest that primary care physicians focused on the pediatric population perceive that a lack of adequate referral services for diet, physical activity, and weight management is a barrier to achieving successful obesity management. These perceptions align with the current literature that has reported limited geographic availability of obesity‐trained pediatrics physicians, as well as other concerns that come both with the lack of affiliation with teaching hospitals and with serving low‐income families (7,29‐31). A study focused on the American Board of Obesity Medicine found that only 38% of physicians who held this certification had a pediatric background (7), which is insufficient to meet the high demand of pediatric patients with overweight and obesity.…”

Sex-Specific Temporal Trends in Overweight and Obese Among Schoolchildren From 2009 to 2018: An Age Period Cohort Analysis

“…Reward options should not include snacks, sweetened beverages, or high-calorie foods; instead, outdoor sports or tours are recommended to promote physical activity. Management of childhood obesity is progressive and age-dependent, and it should be initiated as early as possible (29,30).…”

Comparison of Growth Velocity Among School Age Children With Different Body Mass Index From Childhood Into Early Adolescence in Hualien County, Taiwan: A Retrospective Cohort Study

“…Reward options should not include snacks, sweetened beverages, or high calorie foods; instead, outdoor sports or tours are recommended to promote physical activity. Management of childhood obesity is progressive and age-dependent, and it should be initiated as early as possible (32,33). Based on the report of the Commission on Ending Childhood Obesity by the WHO in 2016, comprehensive programs that promote healthy school environments, health and nutrition literacy, and physical activity among school-age children and adolescents should be established and assisted by family-based, multicomponent lifestyle weight management services (34).…”