Referring Child to Weight Management: Don't Assume Parents are Uninterested

Treating the most prevalent nutritional disorder in children—pediatric obesity—is usually frustrating for clinicians. The problem is measurable, obvious, and socially isolating. Repeatedly, clinicians refer patients and their families to specialized health services, but they don’t go. This underscores pediatric obesity’s complexity. Genetics, environment, metabolism, lifestyle, and eating habits play a role in its development, and we have no idea how or why 90% of cases develop. The journal Paediatrics & Child Health recently published results from a research study completed by a team of researchers from across Canada that explored factors that influence the decision to engage in pediatric weight management programs.

This small semi-structured interview study looked at 18 parents' reasons for declining pediatric weight management services. Their offspring were aged 10 to 17 years of age, and were considered morbidly obese. None of the parents initiated treatment at multidisciplinary weight management clinics despite strong referrals.

Parents tended to be middle-aged (range 34 to 55 years with a mean of 44.1). The majority (n=16) were women, and 66% were obese themselves. Almost three-quarters were college-educated.

The researchers sorted parents’ reasons into 5 themes:

• No perceived need for pediatric weight management (eg, perceived children did not have a weight or health problem)
• No perceived need for further actions (eg, perceived children already had a healthy lifestyle)
• No intention to initiate recommended care (eg, perceived clinical program was not efficacious)
• Participation barriers (eg, children's lack of motivation)
• Situational factors (eg, weather)

The researchers note that many clinicians assume that parents fail to initiate care because they are uninterested. This was not usually the case. Some parents had enrolled their children in other programs, while others cited barriers including time constraints (61%), opposition from the child (39%), distance (28%) and illness in the family.

Some parents also indicated that they believed that enrolling the child in the program would reinforce negative messages and increase stigma.

Clinicians need to ensure that parents completely understand that weight management is needed and they must take action. They should also ask parents specifically if they intend to seek help, and address reasons for non-initiation that are within their control. Families have pressing needs and competing obligations. Clinicians who recognize that are more likely to make recommendations that are acceptable and initiated.