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.
Highlights
Childhood obesity is a serious health problem associated with both physical and psychological consequences, including hypertension, hyperlipidemia, insulin resistance, asthma, weight stigma, and bullying, among others [1,2,3,4,5,6]
This paper aims to describe the management strategies and referral practices of clinicians who care for pediatric patients with obesity
Clinicians referred to clinic-based weight management programs, clinical subspecialists, health educators, and behavioral/mental health professionals with varying frequencies, ranging from 19% for behavioral/mental health professionals to 72% for registered dieticians
Summary
Childhood obesity is a serious health problem associated with both physical and psychological consequences, including hypertension, hyperlipidemia, insulin resistance, asthma, weight stigma, and bullying, among others [1,2,3,4,5,6]. Reductions of BMI in childhood might decrease the risk of developing insulin resistance, dyslipidemia, and hypertension [9, 10], as well as have positive benefits for psychological well-being [11]. A collective, multidisciplinary approach will likely require childhood obesity treatment and care management options delivered in community venues, clinics, and hospital-based settings, and involve different types of healthcare providers [13,14,15,16]. Childhood obesity care management options can be delivered in community-, clinic-, and hospital-settings. 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
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