Parent binge eating and depressive symptoms as predictors of attrition in a family-based treatment for pediatric obesity

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.

Health Care Providers' Perspectives on Family Compliance and Behavior Change in a Childhood Obesity Program

Background. Evidence suggests that children and adolescents growing up in low-income families and those with underrepresented ethnocultural backgrounds tend to have high prevalence rates of obesity and more difficulty adhering to childhood obesity interventions. However, less is known about how intergenerational, family-based approaches to lifestyle interventions for childhood obesity support sustained behavior change. Aims. The aim of this study was to explore the perspectives of health care providers regarding family adherence and behavior change in a childhood obesity program that served ethnoculturally diverse and low-income families. Method. Semistructured in-person interviews were conducted with 18 providers at one of three hospitals participating in a Canadian family-based childhood obesity program. Data were thematically analyzed using a constant comparative approach. Results. The following key themes emerged as challenges from the provider's perspective for family adherence and behavior modification in the childhood obesity program: divergent views about obesity, complicated lives and logistical priorities, parental role modeling, and intergenerational tensions. Discussion and Conclusion. This examination of providers' perspectives on family adherence and behavior modification relevant to the management of childhood obesity highlight the importance of tailoring childhood obesity programs to the complex and diverse needs of families from diverse backgrounds. Recommendations include methods of service delivery that address logistical challenges and are better suited to extended families, particularly grandparents.

Children of parents with BED have more eating behavior disturbance than children of parents with obesity or healthy weight

OBJECTIVE

A limited literature suggests an association between parental eating disorders and child eating-disorder behaviors although this research has focused primarily on restrictive-type eating disorders and very little is known about families with binge-eating disorder (BED).

METHODS

The current study focused on parents (N = 331; 103 fathers and 226 mothers), comparing parents with core features of BED (n = 63) to parents with obesity and no eating disorder (OB; n = 85) and parents with healthy-weight and no eating disorder (HW; n = 183).

RESULTS

Parents with BED were significantly more likely than OB and HW parents to report child binge eating, and more likely than HW parents to report child overeating. Parents with BED felt greater responsibility for child feeding than OB parents, and felt more concern about their child's weight than OB and HW parents. Dietary restriction of the child by the parents was related to child binge eating, overeating, and child overweight, and parental group was related to child binge eating (parental BED), overeating (parental BED), and child weight (parental OB).

DISCUSSION

Parents with BED report greater disturbance in their children's eating than OB and HW parents, and OB parents report higher child weight than HW parents. This suggests that it is important to consider both eating-disorder psychopathology and obesity in clinical interventions and research. Our cross-sectional findings, which require experimental and prospective confirmations, provide preliminary evidence suggesting potential factors in families with parental BED and obesity to address in treatment and prevention efforts for pediatric eating disorders and obesity. © 2016 Wiley Periodicals, Inc.(Int J Eat Disord 2017; 50:648-656).

Outcomes from an orientation model to reduce attrition in paediatric weight management

We aimed to reduce attrition of newly referred patients in a paediatric weight management programme by implementing an orientation to address families' expectations and screen for and support behavioural and mental health problems and psychosocial stressors at programme outset. Orientation impact was monitored with run charts with percentages of scheduled encounters completed. Long-term impact was assessed by comparing patients in the initial 6 months of the orientation to a baseline group of referred patients during the same 6-month time interval in the prior year (Pre-Orientation Group). The outcome measure was programme attrition within 15 months. Groups were compared using Kaplan-Meier survival analysis and Cox proportional hazards regression modelling. Patients in the Orientation Group had a 23% increased odds of attrition compared to patients in the Pre-Orientation group (adjusted Hazard ratio, aHR 1.23; 95% confidence interval, CI: 1.01, 1.51) and shorter median duration of follow-up (2.0 vs. 2.9 months, P = 0.004). An increase in body mass index z-score of 1 unit resulted in a nearly fivefold increased odds of attrition (aHR 5.24; 95% CI: 2.95, 9.3). An orientation for new patients did not reduce attrition within 15 months. We suggest that ongoing retention strategies should be embedded into the treatment phase of the programme.