Understanding Academic Clinicians' Decision Making for the Treatment of Childhood Obesity

• Published in: Childhood obesity 2015-12, Vol.11 (6), p.696-706
• Main Authors: Bailey, Karen, Cunningham, Charles, Pemberton, Julia, Rimas, Heather, Morrison, Katherine M
• Format: Article
• Language: English
• Subjects: Adult; Allied Health Personnel; Canada; Clinical Decision-Making - methods; Decision making; Diabetes Mellitus - drug therapy; Early Medical Intervention; Female; Hospitals, Teaching; Humans; Hypertension; Life Style; Lipids - blood; Male; Middle Aged; Obesity, Morbid - therapy; Pediatric Obesity - complications; Pediatric Obesity - therapy; Pediatrics; Physicians; Practice Patterns, Physicians; Prediabetic State
• ISSN: 2153-2168; 2153-2176
• DOI: 10.1089/chi.2015.0031

Although most clinicians agree that obesity is a major problem, treatment rates remain low. We conducted this discrete choice experiment (DCE) to understand academic clinicians' decisions in treating childhood obesity. A total of 198 academic pediatric surgeons, pediatricians, family physicians, and allied health professionals were recruited from 15 teaching hospitals across Canada to participate in this DCE. Participants completed 15 tasks choosing between three obesity treatment scenarios to identify the scenario in which they would most likely treat pediatric obesity. Latent class analysis revealed two classes with early intervention and late intervention preferences. Participants in the early intervention group (30%) were sensitive to variations in patient and family support. They would likely intervene if patients were obese, with normal lipid levels, were prediabetic, had high blood pressure, and when obesity was lifestyle associated. Late intervention clinicians (70%) were more likely to intervene if patients were morbidly obese, had abnormal lipid levels, required insulin for diabetes, had very high blood pressure, or when obesity impacted the patient's mental health. Simulations predicted that increasing colleague support for intervention, providing expert consultation, and mobilizing multidisciplinary support would increase the likelihood of treating pediatric obesity earlier from 16.1% to 81.5%. This DCE was implemented to understand the factors clinicians use in making decisions. Most academic clinicians choose to intervene late in the clinical course when more-severe obesity-related morbidities are present. Increased support from colleagues, expert consultation, and multidisciplinary support are likely to lead to earlier treatment of obesity among academic clinicians caring for children.