RESUMO
OBJECTIVES: To examine characteristics of children referred for obesity management based on referral frequency, child- and referrer-related variables associated with re-referral, and determine whether re-referral increased treatment initiation. STUDY DESIGN: This population-level, retrospective analysis included all 2- to 17-year-olds referred for obesity management to 1 of 3 multidisciplinary clinics in Alberta, Canada between April 2013 and December 2017. Children were dichotomized based on referral frequency, specifically once only or more than once (re-referred). Data were retrieved from standardized referral forms and patient registries. Analyses included logistic regression and generalized estimating equations models. RESULT: We analyzed data from 2745 children (47.2% female; mean age: 11.4 years; mean body mass index z score: 3.03) and 2705 physicians (60.2% female; 65.6% pediatricians). Overall, 300 (10.2%) children were re-referred with most (n = 276; 92.0%) being referred twice. Children were less likely to be re-referred if they were referred by a family physician (vs pediatrician) (aOR 0.62; 95% CI 0.46-0.84; P = .0018) or scheduled a clinic appointment following their index referral (aOR: 0.29; 95% CI 0.21-0.4; P < .001). Treatment initiation was higher in children who were referred once only (42.1%) vs their re-referred peers (18.0%; P < .0001); however, for children who were re-referred, they were more likely to initiate treatment following their second referral (aOR 2.3; 95% CI 1.22-4.31; P = .01). This improvement was not sustained on subsequent referrals (aOR 0.44; 95% CI 0.17-1.12; P = .08). CONCLUSIONS: Few children were re-referred for pediatric obesity management; however, for those children who were re-referred, being re-referred once only increased the likelihood of treatment initiation.
Assuntos
Manejo da Obesidade , Alberta , Índice de Massa Corporal , Criança , Feminino , Humanos , Masculino , Encaminhamento e Consulta , Estudos RetrospectivosRESUMO
OBJECTIVES: To characterize the children who were referred, determine the proportion of referred children who enrolled, and examine factors associated with enrollment in multidisciplinary clinical care for pediatric weight management. STUDY DESIGN: This cross-sectional study included the population of children (2-17 years of age; body mass index of ≥85th percentile) referred to 1 of 3 hospital-based multidisciplinary weight management clinics in Alberta, Canada, from April 2013 to April 2016. Referral and enrollment data were obtained from Alberta Health Services databases. Bivariate and multivariable logistic regression models were used to determine the independent and combined effects of predictors of enrollment. RESULTS: Of the 2014 children (51.8% male; mean body mass index z-score: 3.42 ± 0.03) referred to multidisciplinary clinical care, 757 (37.6%) enrolled in care. Most referred children had severe obesity and were referred by physicians. Several factors independently predicted enrollment; however, in our most parsimonious multivariable model, only the time gap (OR, 0.94; 95% CI, 0.88-0.99; P = .03) between the attendance date of the orientation session and the booking date of initial appointment predicted enrollment for all children. Body mass index z-score (OR, 0.81; 95% CI, 0.67-0.98; P = .03) and time gap (OR, 0.92; 95% CI, 0.85-0.99; P = .02) predicted enrollment in children with severe obesity exclusively. CONCLUSIONS: Fewer than 40% of referred children enrolled in multidisciplinary clinical care. Reducing the duration of enrollment and providing additional support for treatment initiation to children with severe obesity may enhance treatment uptake for pediatric weight management.
Assuntos
Participação do Paciente/estatística & dados numéricos , Obesidade Infantil/terapia , Programas de Redução de Peso , Alberta , Índice de Massa Corporal , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Encaminhamento e Consulta , Estudos RetrospectivosRESUMO
BACKGROUND: We sought to determine if the rate of increase in body mass index (BMI) differs between first generation immigrant children (child and both parents born outside Canada); second generation immigrant children (child born in Canada with at least one parent born outside Canada); and native-born children (child and both parents born in Canada), and if the rate of increase varies across ethnic groups. METHODS: Data were available from the evaluation of a 5-year heart health promotion program targeted to elementary school children from 24 schools in multi-ethnic, disadvantaged, inner-city neighborhoods in Montreal, Canada. Participants were 6392 children aged 9-12 years born in and outside of Canada. Height and weight were measured annually according to a standardized protocol. BMI increases with age were examined using individual growth models stratified by immigrant status grouping (first generation immigrant, second generation immigrant, native-born). RESULTS: On average, BMI increased by 0.59, 0.73, and 0.82 kg/m2 with each year of age among first generation immigrant, second generation immigrant, and native-born children, respectively. These differences held across four family origin grouping (Europe, Asia, Central/South America, and Other). CONCLUSION: The protective effect of immigrant status on BMI increases with age dissipated in second generation immigrant children, whose rate of increase was similar to that of native-born children. Because immigrants constitute the fastest growing segment of the Canadian population, it is important to understand the causes of the higher BMI increases with successive generations.