Predicting Enrollment in Multidisciplinary Clinical Care for Pediatric Weight Management.

OBJECTIVES: To characterize the children who were referred, determine the proportion of referred children who enrolled, and examine factors associated with enrollment in multidisciplinary clinical care for pediatric weight management. STUDY DESIGN: This cross-sectional study included the population of children (2-17 years of age; body mass index of ≥85th percentile) referred to 1 of 3 hospital-based multidisciplinary weight management clinics in Alberta, Canada, from April 2013 to April 2016. Referral and enrollment data were obtained from Alberta Health Services databases. Bivariate and multivariable logistic regression models were used to determine the independent and combined effects of predictors of enrollment. RESULTS: Of the 2014 children (51.8% male; mean body mass index z-score: 3.42 ± 0.03) referred to multidisciplinary clinical care, 757 (37.6%) enrolled in care. Most referred children had severe obesity and were referred by physicians. Several factors independently predicted enrollment; however, in our most parsimonious multivariable model, only the time gap (OR, 0.94; 95% CI, 0.88-0.99; P = .03) between the attendance date of the orientation session and the booking date of initial appointment predicted enrollment for all children. Body mass index z-score (OR, 0.81; 95% CI, 0.67-0.98; P = .03) and time gap (OR, 0.92; 95% CI, 0.85-0.99; P = .02) predicted enrollment in children with severe obesity exclusively. CONCLUSIONS: Fewer than 40% of referred children enrolled in multidisciplinary clinical care. Reducing the duration of enrollment and providing additional support for treatment initiation to children with severe obesity may enhance treatment uptake for pediatric weight management.

Food portion estimation by children with obesity: the effects of estimation method and food type.

Several factors influence children's ability to report accurate information about their dietary intake. To date, one understudied area of dietary assessment research relates to children's ability to estimate portion sizes of food. The purpose of this cross-sectional research was to examine food portion size estimation accuracy in 7- to 18-year-old children with obesity. Two within-subject experiments (Experiment 1: n=28, Experiment 2: n=27) were conducted in Edmonton, Alberta, Canada, during 2007-2008. Three types of portion size measurement aids (PSMAs) (eg, measuring cups and spoons, household objects [full and half-sized], and modeling clay) were counterbalanced in a Latin Square design for participants to estimate four types of foods (ie, solid, liquid, amorphous pieces, and amorphous masses). Analyses of variance conducted on percent of signed and absolute errors yielded significant PSMA type×food type interactions (P<0.01) in both experiments. Across all food types, for Experiments 1 and 2, measuring cups and spoons produced the least accurate estimates with respect to absolute error (54.2% and 53.1%, respectively), whereas modeling clay produced the most accurate estimates (40.6% and 33.2%, respectively). Half sizes of household objects also yielded enhanced accuracy (47.9% to 37.2%). Finally, there were significant differences in accuracy between amorphous pieces (eg, grapes) vs amorphous masses (eg, mashed potatoes; P<0.01), indicating that there are qualitative differences in how different amorphous foods are estimated. These data are relevant when collecting food intake data from children with obesity and indicate that different PSMAs may be needed to optimize food portion size estimation accuracy for different food types.