Predictors of Engagement in a Pediatric Weight Management Clinic after Referral.

Background: Little is known about factors that affect a family's ability to engage in pediatric weight management clinics (PWMCs). We aimed at comparing child and family characteristics of patients referred to a PWMC by participants' attendance at orientation, attendance at intake, or completing the program. Methods: We performed a retrospective study of patients ages 2-18 years referred to a PWMC between 2014 and 2017. We extracted data from electronic medical records and clinic databases, including age, sex, race/ethnicity, language, referral year, address, and insurance. We performed t-tests and chi-square tests to examine the association of engagement outcomes with covariates. We used separate multivariate logistic regression models to assess the predictors of engagement outcomes, including significant covariates from bivariate analyses. Results: Participants (N = 2020 referred) had a mean age of 11.5 ± 3.5 years; 72% had Medicaid, and 34% lived in city limits. Participants were 39% white, 30% black, and 27% Hispanic. Of those referred, 41% attended orientation, 14% attended intake, and 9% completed. Significant predictors of attending orientation were age [odds ratio (OR): 0.93, 95% confidence interval (CI): 0.91-0.96], male sex (OR: 0.74, 95% CI: 0.60-0.91), Hispanic ethnicity (OR: 1.69, 95% CI: 1.26-2.26), living in city limits (OR: 1.39, 95% CI: 1.11-1.75), and Medicaid (OR: 0.77, 95% CI: 0.60-0.98). Significant predictors of attending intake were age (OR: 0.93, 95% CI: 0.90-0.96), Medicaid (OR: 0.61, 95% CI: 0.46-0.81), and 2017 referral year (OR: 0.21, 95% CI: 0.12-0.35). Hispanic ethnicity was associated with twice the odds of completion (OR: 2.07, 95% CI: 1.10-3.91). Conclusions: Child and family characteristics more strongly predicted initial engagement with a PWMC than completion. Future research should examine how targeting these predictors (e.g., referring at younger age) can improve PWMC engagement.

Pediatric Obesity Treatment in Children With Neurodevelopmental Disabilities: A Case Series and Review of the Literature.

Obesity can affect any child, but it occurs disproportionately in children with developmental disabilities. Treatment efforts, however, have focused primarily on nondisabled children, and more research is needed to determine how current approaches can be modified for youth with neurodevelopmental disabilities. This article briefly reviews what is currently known about obesity treatment in these children and presents a case series describing methods employed by a family-based, multidisciplinary weight management program in the treatment of obesity. Lessons learned from clinical experience are also discussed, with implications for collaborating with families of children with disabilities in treatment, establishing healthy routines and schedules, setting the pace of treatment progression, and minimizing disruptions in the behavior change process. Though there are no expert recommendations specifically tailored to obesity treatment in children with neurodevelopmental disabilities, existing clinical programs such as the one described here can be adapted to better meet the needs of this underserved population. Further research is warranted to determine the most effective methods for addressing obesity in these children, as has been specified as a national health priority.

Motivational interviewing in a family-based pediatric obesity program: a case study.

Motivational Interviewing (MI) is an effective method for clinicians to guide and support individuals who wish to make complex health behavior changes; however, little research is available to support its use in the treatment of obesity, particularly in family based therapy and multidisciplinary team settings. The objective of this case report is to demonstrate the application of MI within a family based, multidisciplinary treatment program, and provide examples of MI in obesity treatment. We report a case study on the use of MI with behavioral therapy in a pediatric, family based, multidisciplinary weight management program (Brenner FIT Program). Tina, a 14-year-old White female, and her mother participated in the Brenner FIT Program where we successfully integrated MI into her obesity treatment. Further work is needed in the application of MI to diverse care teams to determine frequency of training required for effective use of MI in obesity treatment, its limitations, and its feasibility in community-based programs.