title: A Preschool Obesity Treatment Clinical Trial: Reasons Primary Care Providers Declined Referrals.
abstract: To examine referral by primary care providers (PCPs) of preschool children with obesity (≥95th percentile for body mass index [BMI]) to a weight management intervention when offered through a randomized clinical trial (RCT), and identify reasons for not referring children.
  
  
  
  In phase I, 3 experts in obesity, psychology, and nutrition completed an open card sort and classified PCPs' reasons for declining referral into groups based on similarity of reasons. Categories were then defined and labeled. In phase II, 2 independent sorters placed each decline into 1 of the categories defined in phase I.
  
  
  
  PCPs referred 78% of eligible children to the RCT. Compared with children declined for referral, referred children had a significantly higher weight (48.4 lb vs 46.1 lb; P < .001) and BMI percentile (97.6 vs 97.0; P < .001). Eleven categories for decline were identified in phase I. In phase II, excellent reliability was obtained between each independent sorter and the phase I categories, and also between the 2 independent sorters (κ values, 0.72-1.0). The most common reason for declining was "family not a good fit" (23.6%), followed by "doesn't believe weight is a problem" (13.9%), "family would not be interested" (12%), and "doesn't believe measurement is accurate" (11.5%). Appropriately, exclusionary criteria of the RCT was a reason as well (11.8%).
  
  
  
  The availability of weight management for preschoolers through RCTs appeared to overcome barriers of resources, time, and credible treatment cited in previous studies. However, concerns about the family's response or interest in a weight management program remained barriers, as did PCPs' perceptions about obesity in young children.
  
  
  
  ClinicalTrials.gov:NCT01546727.
authors.affiliation: Department of Behavioral Health and Nutrition, University of Delaware, Newark, DE; Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Shannon M
authors.initials: SM
authors.lastname: Robson
authors.affiliation: Pediatric Associates, Crestview Hills, KY.
authors.forename: Christopher
authors.initials: C
authors.lastname: Bolling
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: McCullough
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Cathleen Odar
authors.initials: CO
authors.lastname: Stough
authors.affiliation: Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH.
authors.forename: Lori J
authors.initials: LJ
authors.lastname: Stark
mesh_terms: D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063766:Pediatric Obesity / Q000628:therapy*; D011320:Primary Health Care; D012017:Referral and Consultation; D045808:Refusal to Participate
keywords: Child; Pediatric obesity; Primary health care