The COVID-19 pandemic should make it easier for children with obesity and their families to connect with the specialized care they need, according to the authors of a new study in the academic journal Family Practice .
The researchers examined referral records of 3,468 family physicians and 395 pediatricians in Alberta between January 2014 and December 2017, and found that only 35 per cent referred children to one of three pediatric obesity management clinics in the province. Female physicians, pediatricians and urban-based doctors were more likely to make referrals.
"We know that obesity is more common for children in rural areas, but they often don't have specialized care available in their proximity," said Nicole Gehring, research co-ordinator in pediatrics within the University of Alberta's Faculty of Medicine & Dentistry. "Our findings highlight how online appointments, which have now become the norm during COVID-19, can really help with access to weight management programs for families residing in rural areas."
"Our main message is that the service exists and it's way more accessible than it has been historically," said Geoff Ball, professor of pediatrics and Alberta Health Services Chair in Obesity Research.
"The services are designed to help families, and physicians are the gatekeepers."
Complex factors require multidisciplinary support
One-third of children and adolescents in North America deal with overweight or obesity. They face health problems such as high blood pressure, insulin resistance, breathing and orthopedic problems. They must be above the 85th percentile for body mass index (BMI) in order to be referred to one of the multidisciplinary clinics, which offer medical, nutritional, exercise and mental health support.
"It's not just about eating less or moving more. There are often a lot of complex factors related to unhealthy weight in kids, which is why programs like ours are so valuable," said Ball, who helped create the Pediatric Centre for Weight and Health, run by Edmonton's Stollery Children's Hospital. Alberta's two other obesity clinics for children are at the Misericordia Community Hospital in Edmonton and Alberta Children's Hospital in Calgary.
"Our main message is that the service exists and it's way more accessible than it has been historically."
It's the psychological impact that often leads families to seek help, Ball said.
"It's tough to live in a big body in our culture," he said. "Many of the children we care for face bullying, stigma and obesity-related bias every day—these are real challenges with friends, other children in the playground or in the classroom."
The impact of COVID-19
Ball and Gehring noted that COVID-19 pandemic restrictions have led to less recreational activity, more screen time and more stress for kids, and have likely exacerbated unhealthy weight gain, although it's too soon to have solid data. At the same time, the quantum leap forward in terms of the acceptance of telephone and internet delivery of health services during the pandemic is a positive change.
"Successful treatment is predicated on frequent contact over a long period of time," said Ball, who is a member of the Women and Children's Health Research Institute. "Now, instead of families having to take time off work and school, drive to the clinic, park and pay, they can have a quick 15- or 20-minute video call to get some support and have their questions answered. All those touch points matter."
Ball and Gehring are also leading efforts to update the Canadian clinical practice guidelines for managing pediatric obesity, first asking families for direction.
"We are asking approximately 30 families across Canada to get their opinions about which outcomes are most important to them," said Gehring.
Next steps for their research include evaluating the effectiveness of medication in managing obesity in children, and adding family navigator positions at clinics in Edmonton, Calgary and Mississauga, to examine their impact on family engagement in obesity management.
