Researchers looking at ways to increase uptake of treatment programs for children with obesity

U of A experts provide recommendations targeted to the 62 per cent of families who don't act on referrals to attend weight management clinics in Canada.

New research by University of Alberta researchers shows that 62 per cent of Canadian families with children who have a high degree of obesity are not enrolling them in treatment after being referred by a family doctor.

"This is especially troubling since, compared with the United States, Canada has a structured process for families to enrol in multi-disciplinary weight management clinics-which is the most effective treatment approach for children with obesity," said Arnaldo Perez Garcia, who recently received his PhD through the U of A's Department of Pediatrics and is the lead author of the study published in The Journal of Pediatrics last month.

"The goal of our research wasn't just to confirm the the critical gap in accessing care that exists, but to examine whether there were factors that could be changed to boost enrolment for families," added Geoff Ball, a professor of pediatrics who is also the AHS Research Chair in Obesity Research and the director of the Pediatric Centre for Weight and Health at Stollery Children's Hospital.

Among the key recommendations from a second qualitative study they conducted, published earlier this year in The Journal of Pediatrics, were to simplify the enrolment process for parents, and provide them with more knowledge about the services offered and the effectiveness rates of multidisciplinary clinics.

"Enrollment processes can be long and are designed to inform parents rather than motivate," explained Perez Garcia. For example, parents indicated that they really wanted more information about what the clinics do and their potential effectiveness.

"What we've learned is that if family physicians provide more than just a name and number of a program, but also instil confidence in a pediatric weight management clinic's potential effectiveness, it leads to empowered decision making by families," explained Ball.

He added that at the Stollery clinic, they've made efforts to better inform referring physicians about their services.

"Because of what we learned through our research, we've also expanded beyond referring physicians to include Nurse Practitioners and Public Health Nurses, including all 22 Edmonton-area health units" he said.

Other recommendations that were adopted by the clinics participating in the study-the Pediatric Centre for Weight and Health (Edmonton, Alberta), Center for Healthy Weights: Shapedown British Columbia (Vancouver, British Columbia), Growing Healthy Weight Management Program (Hamilton, Ontario), and HealthyWeight Clinic (Montreal, Quebec)-included offering flexible appointment times, making reminder phone calls for upcoming clinic appointments, and providing support for transportation, for example, passes for public transit.

"Another big issue is the time gap that occurs between when families are referred and when their appointment is booked," noted Ball.

"There's a national push in our health-care system to reduce waiting lists for numerous medical procedures, but there just isn't urgency for weight management in kids, even though left untreated, obesity in children will have chronic, complex health consequences in adulthood that will contribute to higher health-care costs," he added.

While self-referral was a desirable option among parents, Ball said the ability of clinics to handle higher patient volume as a result of implementing that strategy may be mixed.

Both studies, "Parent Recommendations to Enhance Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management" and "Predicting Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management," were funded by grants from the Canadian Institutes of Health Research.