Barriers in Pediatric Obesity Clinic Attendance

Background: Obesity is strongly associated with key drivers of morbidity and mortality. Pediatric weight management programs have been demonstrated as an important intervention to address childhood obesity. The Healthy for Life! program was established to provide comprehensive pediatric obesity evaluation and treatment. Our study served to identify barriers to pediatric obesity clinic attendance and inform policies designed to empower parents and clinicians. Methods: Attendance of 4,283 overweight and obese children referred to the Healthy for Life! clinic was analyzed. Statistical models were used to compare subject location and characteristics based on level of attendance. Physician interviews were performed to determine how factors of location, individual characteristics, and perceptions affected ability and decisions to attend the clinic. Results: Attendance rates of children referred to the clinic were lower in areas with existing health and socioeconomic disparities. Individual-level analyses showed that low education and income, male gender, and less severe obesity significantly lowered attendance rates. Physician interviews indicated complex mixtures of factors affecting both ability and willingness to attend treatment. Conclusions: Childhood obesity clinic attendance is affected by many factors that may encourage or hinder participation. This analysis identified important health equity issues related to providing services to populations already at higher risk for childhood obesity. Examination of these attendance rates has led to better understanding of barriers to service and resulting disparities. This work provides evidence on which to base development and implementation of health policies across a variety of areas in order to empower parents, clinicians, and policy makers.