Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management: Predictors, Reasons, Facilitators, and Recommendations

• Author / Creator

  Perez Garcia, Arnaldo J

• Background: One-third of Canadian children meet the criteria for overweight or obesity. While multidisciplinary clinical care (MCC) can be effective to manage pediatric obesity, many eligible children are not referred to this level of care and many of those who are referred do not enroll in treatment. This is of concern given the limited effectiveness of alternative options to address obesity in children and the long-term, adverse consequences of excess weight. Objectives: (i) determining the proportion and the predictors of enrollment in children referred to MCC for pediatric weight management (PWM) (study 1), (ii) exploring parents’ reasons for (non)enrollment and facilitators of enrollment in MCC (studies 2 and 3), and (iii) exploring parents’ recommendations to enhance enrollment in MCC. Methods: Studies 1 through 4 were completed between 2013–2017 and applied multiple methods. Study 1 was quantitative and included 2–17 year olds referred to three multidisciplinary clinics for PWM in Alberta between 2013–2016. Studies 2, 3, and 4 included qualitative designs with data collected from parents of children with overweight and obesity referred to MCC for PWM in Vancouver, Edmonton, Hamilton, and Montreal. For study 1, analyses included generalized linear mixed models and multivariate logistic regression; studies 2–4 applied content and thematic analyses. Results: Study 1 showed that approximately two out of every five children (total n=2,014) referred to MCC for PWM enrolled in treatment. Most children referred and enrolled had severe obesity, were 2–12 years old, and lived in urban areas. Treatment clinic and time between the orientation session attended and the initial appointment booked predicted enrollment. Children’s BMI z-score negatively predicted enrollment in children with severe obesity, but not with their leaner peers. In study 2, parents’ (n=18) reasons for not enrolling their children in MCC for PWM were related to not perceiving the need for weight management (e.g., not recognizing a weight problem), not perceiving the need for further actions (e.g., believing that the child already had a healthy lifestyle), perceiving that the recommended care was not the most suitable option (e.g., preferring self-management to address the weight issue), and facing internal and external enrollment barriers (e.g., having scheduling issues). In study 3, reasons for enrollment were related to parents’ (n= 65) concerns about their children’s weight, health, and emotional well-being, perceived need for external support, and the benefits attributed to the recommended care (e.g., comprehensive assessment of children’s physical and mental health). Facilitators of enrollment were related to initiator of the referral (e.g., families asking physicians to refer them to an obesity program), treatment motivation (e.g., physicians highlighting the comparative advantages of the recommended care), and control over enrollment barriers (e.g., parents being able to overcome their children’s lack of interest in the recommended care). In study 4, parents (n=79) made several recommendations to enhance enrollment such as increasing enrollment opportunities (e.g., allowing families to self-refer), informing families and primary care providers about availability and characteristics of obesity services (e.g., using websites and brochures to inform the public on obesity services), motivating families for treatment (e.g., sharing successful stories of weight management), avoiding discouragement and making obesity services more appealing to parents and children, and improving families’ access to weight management services (e.g., offering families convenient appointment time options). Conclusions: Many children who can benefit from MCC for weight management are not referred in a timely manner or do not enroll in treatment. Strategies to improve enrollment should enhance and be tailored to families’ readiness for treatment, capitalize on facilitators of enrollment, and address individual, family and contextual barriers to enrollment. The feasibility and effectiveness of parents’ recommendations to enhance enrollment in MCC for PWM remain to be examined empirically.

• Subjects / Keywords

  • Obesity
  • Enrollment
  • Pediatrics
  • Interventions

• Graduation date

  Fall 2017

• Type of Item

  Thesis

• Degree

  Doctor of Philosophy

• DOI

  https://doi.org/10.7939/R3W95125N

• License

  This thesis is made available by the University of Alberta Libraries with permission of the copyright owner solely for non-commercial purposes. This thesis, or any portion thereof, may not otherwise be copied or reproduced without the written consent of the copyright owner, except to the extent permitted by Canadian copyright law.