Melissa Santos

Parent Perspectives on Attrition From Tertiary Care Pediatric Weight Management Programs

Objective. To describe parent/caregiver reasons for attrition from tertiary care weight management clinics/programs. Study design. A telephone survey was administered to 147 parents from weight management clinics/programs in the National Association of Children’s Hospitals and Related Institutions’ (now Children’s Hospital Association’s) FOCUS on a Fitter Future II collaborative. Results. Scheduling, barriers to recommendation implementation, and transportation issues were endorsed by more than half of parents as having a moderate to high influence on their decision not to return. Family motivation and mismatched expectations between families and clinic/program staff were mentioned as influential by more than one-third. Only mismatched expectations correlated with patient demographics and referral patterns. Conclusions. Although limited by small sample size, the study found that parents who left geographically diverse weight management clinics/programs reported similar reasons for attrition. Future efforts should include offering alternative visit times, more treatment options, and financial and transportation assistance and exploring family expectations.

Parents and pediatric weight management attrition: Experiences and recommendations

BACKGROUND One of the most frequently cited challenges faced by pediatric weight management programs/clinics is attrition, with many studies reporting rates greater than 50%. Few studies have evaluated parental perspectives on recommendations for weight-management treatment enhancement. The aim of this study was to elicit perspectives on areas for improvement, discussions with staff about discontinuation, and potentially modifiable aspects of attrition from parents who prematurely discontinued stage 3 pediatric weight management treatment. METHODS This study was performed as a semistructured interview as part of a telephone survey assessing reasons for attrition. RESULTS Interviews were performed with 147 parents of children who attended programs/clinics at 13 childrens hospitals participating in the National Association of Childrens Hospitals and Related Institutions (now Childrens Hospital Association) FOCUS on a Fitter Future II collaborative. The majority of parents (65%) denied talking to staff about their decisions to stop coming. When describing what could have been done to retain families, parents most frequently discussed changing logistics (e.g., hours and locations). Parents described changes in logistics and components (i.e., nutrition education, exercise, and behavior education/support) when asked what would work best for their family for pediatric weight management. CONCLUSIONS Parental responses appeared to express frustration about flexibility with appointment times and treatment locations. The most frequently desired components were those traditionally offered by stage 3 pediatric weight management programs/clinics, and this may suggest a need for treatment delivery of these components to be more individualized. Additional discussion with families about their desire to discontinue treatment may provide a timely opportunity to address this need.

Recommendations for psychologists in Stage III pediatric obesity program

ABSTRACT The Children’s Hospital Association formed a national interprofessional workgroup to develop recommendations for the assessment and treatment of pediatric obesity. A subcommittee of psychologists created practice recommendations defining the role of psychologists in Stage III interprofessional pediatric obesity treatment teams. The committee carefully defined key issues for a psychological diagnostic interview assessment and treatment strategies within a Stage III obesity treatment center. Psychologist’s assessment and treatment within the interprofessional specialty care setting addresses the psychosocial needs of the youth and provides the additional support for behavioral change to achieve the overall treatment team goals.

Pediatric Obesity in Early Childhood A Physician Screening Tool

Obesity is a public health crisis and continues to affect youth of increasingly younger ages. With significant medical and psychosocial comorbidities, it is critical that front-line providers feel confident in their abilities to assess, and appropriately refer, children and families to subspecialties to aid in weight management treatment. This article describes the development and utility of a 1-page screening tool for pediatricians and other providers. Utilizing research, clinical experience, and consensus opinion, a brief tool was developed that could be incorporated into medical visits to facilitate medical care decisions and management of pediatric obesity.

The Status of Billing and Reimbursement in Pediatric Obesity Treatment Programs

Pediatric psychologists provide behavioral health services to children and adolescents diagnosed with medical conditions. Billing and reimbursement have been problematic throughout the history of pediatric psychology, and pediatric obesity is no exception. The challenges and practices of pediatric psychologists working with obesity are not well understood. Health and behavior codes were developed as one potential solution to aid in the reimbursement of pediatric psychologists who treat the behavioral health needs of children with medical conditions. This commentary discusses the current state of billing and reimbursement in pediatric obesity treatment programs and presents themes that have emerged from discussions with colleagues. These themes include variability in billing practices from program to program, challenges with specific billing codes, variability in reimbursement from state to state and insurance plan to insurance plan, and a general lack of practitioner awareness of code issues or reimbursement rates. Implications and future directions are discussed in terms of research, training, and clinical service.

Chronic Pain and Obesity Within a Pediatric Interdisciplinary Pain Clinic Setting: A Preliminary Examination of Current Relationships and Future Directions.

Objectives: Pediatric obesity and chronic pain are 2 of the most significant public health crises affecting youth today. Despite the high number of youth experiencing both chronic pain and obesity, little research has been done examining their relationship. This study aims to both replicate and extend this research base. Methods: A retrospective chart review of 99 patients presenting for evaluation in a pediatric pain clinic was conducted. Demographic information, including patient weight status, and self-report measures completed by both patients and their parents, including the Pain Frequency-Severity-Duration scale, the Functional Disability Inventory, and the Pain Catastrophizing Scale were examined. Results: Abdominal pain was the most frequently reported primary pain diagnosis category, with headache, diffuse musculoskeletal, localized musculoskeletal, and back pain categories reported from greatest to least frequency. Results show that 29% of our sample was obese. Age was related to weight status such that older children were more likely to have a higher body mass index. Among school-aged children, a higher body mass index percentile was associated with greater parent-reported pain catastrophizing. Obese youth had higher parent-reported Functional Disability Inventory scores than those in the normal weight group. Post hoc comparisons identified that this finding was only significant for girls. Further, obese youth were more likely to have a longer pain duration than those classified as normal weight. Discussion: The results of this study add to the growing literature regarding the importance of taking weight status into account when intervening with youth with chronic pain.

Medical neglect and pediatric obesity: Insights from tertiary care obesity treatment programs

ABSTRACT Interprofessional pediatric obesity treatment teams may consider filing a report for medical neglect with their state child protection agency when a child’s family is consistently non-adherent to treatment recommendations and the child is medically at risk. The multifactorial nature of the etiology and treatment of obesity makes this a challenging issue to navigate with families and child protection agencies. The aims of this article are to (a) highlight common challenges faced by teams when addressing medical neglect, and (b) offer insights on navigating the medical protection of children with obesity and associated medical conditions in a way that minimizes adverse outcomes.

Patient retention and engagement in adolescent bariatric surgery programs: A review of the literature and survey of programs

Bariatric surgery is becoming an increasingly used tool for the management of severe obesity in youth; however, outcomes after surgery are variable. Keeping adolescents engaged in treatment postsurgery is critical, yet little research has focused on this area. A review of the literature using Pubmed, Ebscohost, and PsycINFO and terms “bariatric surgery,” “gastric bypass,” “gastric band,” “sleeve gastrectomy,” “retention,” “attrition,” “engagement,” and “participation” was conducted. In addition, a survey to the psychologists working with adolescent bariatric surgery programs was conducted. Only 3 manuscripts met the inclusion criteria, demonstrating a significant lack of literature in this area. Age, baseline mood and eating symptoms, Body Mass Index (BMI) and parental history of bariatric surgery were some factors identified as being related to attrition. From the survey, members identified the following as the most common strategies to keep families within treatment: access to providers in between appointments, appointment reminders, and in person support groups. Little work exists focusing on retention, and follow-up for adolescent bariatric surgery patients. This is concerning given that these patients may be at high risk for negative consequences without follow up. This is a critical issue that adolescent bariatric surgery programs should commit to understand better, report findings, and systematically address.