Abstract

Background. Behavioural therapy and lifestyle modifications are pillars of obesity management treatment. However, other treatment options like bariatric surgery (BarSx) and pharmacotherapy
(Pharm) are gaining more and more interest. Little is known about healthcare providers’(HCPs) attitudes towards pediatric obesity treatments in Canada. The purpose of this study was to explore the prior knowledge, attitudes and practices (i.e., frequency of treatment recommendations, referrals to specialists) of Canadian HCPs towards pharmacotherapy (Pharm) and bariatric surgery (BarSx) in children and adolescents. We also examined familiarity with pediatric obesity guidelines, differences in attitudes with regards to the type of HCP, prior obesity training and levels of confidence treating obesity and definitions of pediatric obesity management success.
Methods. Canadian physicians, nurse practitioners and medical residents completed 39 multiple choice and open-ended questions on LimeSurvey from October 2021 until September 2022. Participants were recruited through convenience and snowball sampling across Canada. Chi-square and Fisher’s exact tests compared attitudes between respondents who were familiar versus unfamiliar with pediatric obesity guidelines. Kruskal-Wallis tests and independent sample t-tests were used to analyze our exploratory objectives.
Results. A total of 130 HCPs responded to the survey. Of the respondents, 78% identified as women, 49% were physicians, 39% resided in Ontario, 54% had received pediatric obesity training before working in the field, 48% were most familiar with the 2015 Canadian Task Force Guidelines whereas only 12% were familiar with the 2018 American Society for Metabolic BarSx guidelines. HCPs did not respond favorably towards Pharm and BarSx. Responses varied regarding agreement about the effectiveness, safety, usefulness and willingness to refer adolescents and children. For Pharm, 48% of respondents agreed that it is an effective intervention in adolescents compared to 23% that agreed in children. As for BarSx, only 16% of respondents agreed that it’s a useful treatment for obesity-related co-morbidities in children compared to 47% who agreed that it was useful in adolescents. In general, there was more disagreement in regard to responses for children compared to adolescents. Reasons chosen for HCPs’ reluctance to refer were lack of long-term data (Pharm: 58%, BarSx: 41%) and patients’ unrealistic outcome expectations (Pharm: 45%, BarSx: 49%). Referrals to medical specialists (74%), like dietitians (85%), and multidisciplinary programs (61%) were the most common referrals for patients.
Conclusion. Pharmacotherapy and bariatric surgery are not highly endorsed by Canadian HCPs. Future studies should investigate other barriers to treatment recommendations, such as HCPs’ knowledge on obesity and potential bias towards the causes of obesity and severe obesity in youth.