Racial Disparities Significant in Children Receiving Nutrition, Lifestyle Counseling
In a post hoc secondary analysis of the BP-CATCH trial, researchers explored the best ways of screening children with high blood pressure and managing their care.
Children with high blood pressure (BP) experienced significant racial and ethnic disparities when receiving nutrition and lifestyle counseling, according to data from the BP-CATCH randomized clinical trial published in JAMA Network Open.1 Despite no significant disparities for participants receiving weight counseling, researchers did identify significant disparities among all 3 types of counseling used in combination.
“Childhood obesity is prevalent, often originates early in life, and disproportionately affects children from racial and ethnic minority groups and disadvantaged backgrounds,” wrote authors of the study. “Obesity-related health consequences encompass a broad range of comorbidities, including high BP, elevated cholesterol levels, type 2 diabetes (T2D), asthma, sleep apnea, joint problems, and mental health concerns.”
According to the Academy of Nutrition and Dietetics, obesity is best treated through family involvement and nutrition counseling from a registered dietician nutritionist. | image credit: Shutter B / stock.adobe.com
While millions of children and their families have been warned about the consequences of childhood obesity, it remains significantly high in the US with 19.7% of children and adolescents 2 to 19 years old living with obesity. Moreover, the prevalence of childhood obesity is known to disproportionately affect various ages, races, and ethnicities, with Hispanic children having the highest prevalence of childhood obesity at 26.2%.1
Treating childhood obesity at the source, rather than in adulthood, is important for patients looking to reduce their comorbidity burden later in life. While trial researchers examined childhood obesity and the common comorbidities associated with it, they also explored hypertension and elevated BP, exploring an important link between the 2. Similar to obesity, the impact of hypertension and high BP (prehypertension) during childhood can be detrimental to an individual’s long-term health.
READ MORE: Obesity in Adolescents: Prevalence, Health Effects, and Treatment Options
“Pediatric obesity and hypertension are associated with each other: the prevalence of hypertension among children with obesity ranges from 5.6% to 18.3%, higher than that among groups with other weight status, and the prevalence of obesity among children with hypertension (31.9%) is also higher than that among children with BP in the reference range (11.5%) or elevated BP (24.6%),” they continued.1
When it comes to treating childhood obesity, there are several recommendations from various academic groups. According to the Academy of Nutrition and Dietetics, it is best treated through family involvement and nutrition counseling from a registered dietician nutritionist.2 While several experts agree—including researchers from the current study—they too acknowledge the existence of racial, ethnic, and cultural disparities hindering children’s access to obesity management services.
“The present study aimed to examine and compare rates of receiving nutrition, lifestyle, and weight counseling during primary care visits in a pediatric population with at least 1 high BP measurement,” wrote the authors.1 To do this, researchers conducted a post hoc analysis of the BP-CATCH trial, which was designed to help better understand primary and specialty practitioner adherence to providing care recommended by the American Academy of Pediatrics (AAP).
The final analysis included a total of 2677 participants (mean age, 10.8 years; 56.6% boys; 22.1% Black) as researchers noted patients’ demographics, weights, systolic and diastolic BPs, and most common counseling topics: nutrition, lifestyle, or weight. For racial demographics specifically, researchers separated study participants into 4 groups: Hispanic, Black, White, and other (Asian, multiracial, and unknown races).
“This secondary analysis of the BP-CATCH randomized clinical trial baseline data found that in a pediatric population with elevated or higher BP, the overall rates of receiving counseling recommended to mitigate hypertension and obesity appeared to be suboptimal,” they said. Indeed, rates for receiving nutrition (63.5%) and lifestyle (57.6%) counseling were significantly higher than that of weight (47.5%) and all counseling topics combined (46.4%).1
Lifestyle, nutrition, and weight counseling are the most recommended interventions for treating childhood obesity, as opposed to pharmacologic options such as glucagon-like peptide-1 receptor agonists. Despite so many authoritative groups favoring counseling efforts to combat pediatric obesity, a “suboptimal” number of patients received these recommended services.
“Racial and ethnic disparities in receiving nutrition, lifestyle, and all counseling topics were significant, and the patterns of disparities were inconsistent between participants with and without obesity,” they continued. The Hispanic group had the highest rates of nutrition and lifestyle counseling and had higher rates of all counseling types compared with the White group. This displayed an unexpected result since the Hispanic group experienced less weight counseling while showing to have the highest rates of obesity.
With a staggered result highlighting significant racial disparities in treating childhood obesity, researchers believe the next step in bolstering these suboptimal rates is through quality improvement (QI). In hopes of presenting all groups with each counseling topic equally, they hope the future of childhood obesity management considers all patient populations.
“More effort may need to be invested into developing QI or other interventions to promote all topics of recommended counseling, perhaps more intensively among children with obesity, and to attenuate racial and ethnic disparities in pediatric primary care settings,” concluded authors of the study.1 “Our study also suggests that quality metrics should be stratified by demographic categories to highlight disparities and prevent worsening of inequities as efforts continue to improve and standardize care for all children.”
READ MORE: Obesity Management Resource Center
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