Predicting Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management

Perez, Arnaldo; Yaskina, Maryna; Maximova, Katerina; Kebbe, Maryam; Peng, Chenhui; Patil, Tanmay; Nielsen, Charlene C.; Holt, Nicholas L.; Ho, Josephine; Luca, Paola De; LaFrance, Rena; Godziuk, Kristine; Connors, Alison; Bennett, Tesia; Brunet‐Wood, Kim; Baron, Tim; Ball, Geoff D.C.

doi:10.1016/j.jpeds.2018.06.038

Cited by 16 publications

(10 citation statements)

References 26 publications

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“…In other words, as wait time increases, the proportion of children who enrol in weight management decreases (Perez, Yaskina, et al, 2018). In addition, the children referred in the current study were both younger (mean age: 4.4 years old) and referred directly to a weight management clinic, which is in contrast to our previous study (Gerards et al, 2012).…”

Section: Discussioncontrasting

confidence: 68%

“…We calculated numbers and proportions of children referred to and enrolled in multidisciplinary paediatric weight management and Our finding that ~60% of children referred by PHNs in our study enrolled in weight management was promising. We reported previously that only ~38% of children referred by physicians or nurse practitioners for multidisciplinary paediatric weight management in Alberta actually enrolled in care (Perez, Yaskina, et al, 2018). The lower proportion may be due to a variety of factors.…”

Section: Discussionmentioning

confidence: 99%

“…For instance, PHNs in our study recommended providing parents with a website or brochures to inform them about available services. This was echoed by parents interviewed in Perez, Yaskina, et al (2018) who indicated a lack of receptiveness towards enrolling in paediatric weight management due to a lack of clarity around the services offered. Similar to recommendations by PHNs in our study, healthcare professionals in another qualitative evaluation on family weight management services mentioned the need to receive updates on families' enrolment status from the respective clinic (Johnson, Oyebode, Walker, Knowles, & Robertson, 2018).…”

Section: Discussionmentioning

confidence: 99%

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Public health nurse referrals for paediatric weight management: A nested mixed‐methods study

Nguyen

Kebbe

Peng

et al. 2020

Journal of Clinical Nursing

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Aims and objectives To (a) characterise and determine proportions of referred and enrolled children and (b) explore public health nurses’ (PHNs) experiences, perspectives and recommendations regarding a new nurse‐led referral pathway for paediatric weight management. Background Children with obesity and their families in Canada access specialised services for obesity management through physician referral. Since this requirement can prevent timely access to health services, we established and tested a referral pathway whereby PHNs directly refer children to specialised care for obesity management. Design Nested mixed‐methods study reported using GRAMMS. Method Our research study included children (2–17 years of age; body mass index ≥85th percentile) referred by a PHN to the Pediatric Centre for Weight and Health (PCWH; Stollery Children's Hospital, Edmonton, Alberta, Canada) from April 2017–September 2018. We summarised referral and enrolment data using descriptive statistics and conducted one‐on‐one, semi‐structured telephone interviews with PHNs; interviews were audio‐recorded, transcribed verbatim, managed using NVivo 12 and analysed by two independent reviewers using content analysis. Results Our sample included 79 referred children (4.4 ± 1.8 years old; 3.4 ± 1.3 BMI z‐score; 52.7% male), of which 47 (59.5%) enrolled in care. PHNs’ (n = 11) experiences, perspectives and recommendations regarding the new referral pathway were grouped into four categories: (a) practicality of the referral pathway (e.g., simple and straightforward), (b) utility of the referral pathway (e.g., economic and timesaving), (c) uptake of the referral pathway (e.g., physician's influence) and (d) recommendations to improve the referral pathway (e.g., having electronic access to the referral form). Conclusions A PHN‐specific referral pathway led most children and families to enrol in paediatric weight management and overall was perceived as acceptable and appropriate among PHNs. Relevance to clinical practice Our results highlight the valuable role that PHNs can play in directly referring children to specialised services for weight management. This pathway has the potential to reduce wait times and enhance treatment enrolment.

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Section: Discussioncontrasting

confidence: 68%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Public health nurse referrals for paediatric weight management: A nested mixed‐methods study

Nguyen

Kebbe

Peng

et al. 2020

Journal of Clinical Nursing

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“…A small body of research has begun to identify specific factors that may promote treatment engagement in paediatric behavioural weight control programs. Complex enrollment processes may hinder engagement in paediatric weight management, 10 while involving patients (families and youth) in treatment decisions, tailoring advice to provide more specific recommendations, improved communication, and increased sensitivity of providers may promote improved treatment engagement. 11,12 Prior qualitative work has identified that although parents value being informed about available services, they often do not receive this information.…”

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confidence: 99%

Reactions to the U.S. Preventive Services Task Force guidelines for the management of adolescent obesity: A multi‐informant qualitative approach

et al. 2021

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The U.S. Preventive Services Task Force (USPSTF) has set forth recommendations for clinicians to screen youth (6-18 years) for obesity. Those identified should be referred to comprehensive weight management programs consisting of at least 26 contact hours and focus on multiple targets of behaviour (ie, diet, physical activity, behaviour change). However, these recommendations are primarily based upon outcomes from randomized controlled trials and the feasibility of meeting these guidelines for adolescents in a clinical setting is unknown. The present study employed a multi-informant qualitative approach with adolescents, parents, and physicians, to identify and understand multiple perspectives on the feasibility and acceptability of implementing the USPSTF guidelines. In-depth interviews with seven adolescents, seven parents, and four physicians were analysed. Generally, participants viewed the guidelines positively but identified changes that may be necessary to increase the feasibility of adolescents engaging in programs that meet these guidelines. Participants also noted the importance of flexibility within programs, indicating that it would be difficult for many adolescents to participate in a program that was not tailored to their needs and resources. Future research should focus on adapting clinical weight management programs to meet both USPSTF guidelines and the needs of adolescents and their families.adolescent, paediatric weight management programs, qualitative, USPSTF guidelines | INTRODUCTIONObesity during adolescence is a significant public health concern in the United States 1,2 In an effort to address high rates of paediatric overweight and obesity, the US Preventive Services Task Force (USPSTF) re-issued grade B recommendations for clinicians to screen youth (ages 6-18) for obesity and refer those identified to comprehensive behavioural weight management programs. 3 Specifically, the USPSTF statement suggests screening for obesity in children ages 6 and older, and refer those identified with obesity to intensive behavioural interventions in clinical settings. 3 Within these guidelines, the USPSTF identified a dose-dependent impact of behavioural interventions on zBMI and related cardiovascular risk factors, [3][4][5] with a minimum effective dose of 26 sessions (moderate intensity) and an increased effect with higher intensity interventions. Interventions meeting USPSTF guidelines include a minimum effective dose of 26 hours of contact, as well as focus on nutrition, physical activity, and behavioural management strategies to support diet and physical activity changes. 3,4

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“…Male subjects were more likely to be in the 1-year follow-up group compared with female subjects; this finding has not been found previously in studies that examined loss to follow-up in obesity programs. [22][23][24][25][26] Although more than one-half of the patients had a follow-up visit, only onequarter were seen for a 1-year follow-up visit. In 2016 and early 2017, the clinic wait list was overwhelmingly high, so the providers strategized to discharge patients after several follow-up visits.…”

Section: Discussionmentioning

confidence: 99%

Characteristics Associated with Successful Weight Management in Youth with Obesity

Gorecki

Feinglass

Binns

2019

The Journal of Pediatrics

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Objective To identify the medical, demographic, and behavioral factors associated with a reduction of body mass index percent of the 95th percentile (BMIp95) after 1 year for patients receiving care at a tertiary care obesity management clinic. Study design A retrospective review of data from first and 12 AE 3-month follow-up visits of subjects aged 8-17 years with obesity. Data included anthropometrics, demographics, medical/psychological history, reported diet patterns, and participation in moderate/vigorous physical activity. After analyzing factors associated with 1-year follow-up, we used a forward conditional logistic regression model, controlling for subject's sex, to examine associations with a BMIp95 ³5-point decrease at 1 year. Results Of 769 subjects, 184 (23.9%) had 1-year follow-up. Boys more often had follow-up (28.4% vs girls, 19.1%; P = .003). The follow-up sample was 62.0% male, 65.8% Hispanic, and 77.7% with public insurance; 33.2% achieved a ³5-point decrease in BMIp95. In regression results, the ³5-point decrease group was more likely to have completed an initial visit in April-September (OR 2.0, 95% CI 1.1-3.9); have increased physical activity by 1-2 d/wk (OR 3.4, 95% CI 1.4-7.8) or increased physical activity by ³ 3 d/wk at 1 year (OR 2.7, 95% CI 1.1-6.3); and less likely to have been depressed at presentation (OR 0.4, 95% CI 0.2-0.9). Demographic and dietary factors were not significantly associated with BMIp95 group status. Conclusions Strategies improving follow-up rates, addressing mental health concerns, and promoting yearround physical activity are needed to increase the effectiveness of obesity management clinics. (J Pediatr 2019;212:35-43). O ver the last decade, the prevalence of pediatric obesity has continued to climb, and in 2016, 18.5% of children in the US were obese. 1 Trends toward increasing body mass index (BMI) are not expected to slow. A recent study projected that 57.3% of today's children will be obese by the age of 35 years. 2 Pediatric obesity has been shown to have many negative effects on children's metabolic, cardiovascular, pulmonary, and psychological health. 3-7 Without intervention, the majority of children and teens with obesity will have obesity as adults. 2,8 Overall, treatment of pediatric obesity has had limited success even with intensive lifestyle interventions. The Institute of Medicine guidelines recommend at least 26 contact hours for a pediatric obesity intervention to be effective, and this is based on behavioral interventions with a modest drop in BMI z scores ranging from 0.05 to 0.59. 9 Behavioral interventions largely have been successful in stabilizing participants' BMIs, which is unlikely to achieve metabolically beneficial effects. 10-13 The Pediatric Obesity Weight Evaluation Registry (POWER) study of children with obesity found a 5-point reduction in BMI percent of the 95th percentile (BMIp95) to be associated with improved cardiometabolic risk. 14 The purposes of this study are to identify differences between patients with and without a 1...

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Predicting Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management

Cited by 16 publications

References 26 publications

Public health nurse referrals for paediatric weight management: A nested mixed‐methods study

Public health nurse referrals for paediatric weight management: A nested mixed‐methods study

Reactions to the U.S. Preventive Services Task Force guidelines for the management of adolescent obesity: A multi‐informant qualitative approach

Characteristics Associated with Successful Weight Management in Youth with Obesity

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