Factors Affecting Subspecialty Referrals by Pediatric Primary Care Providers for Children With Obesity-Related Comorbidities

Objective. To determine referral patterns from pediatric primary care to subspecialists for overweight/obesity and related comorbidities. Methods. We used the National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey to identify overweight/obesity and 5 related comorbidities in primary care visits between 2005 and 2009 by children 6 to 18 years. The primary outcome was whether the visit ended in referral. We used multivariable analysis to examine factors associated with referral. Results. We identified 34 225 database visits. A total of 17.1% were with overweight (body mass index = 85th to 94th percentile) or obese (body mass index ≥ 95th percentile) patients. A total of 7.1% of primary care visits with overweight/obese children ended in referral. Referral was more likely when obesity was the reason for visit (odds ratio = 2.83; 95% confidence interval = 1.61-4.97) but was not associated with presence of a comorbidity (odds ratio = 1.35; 95% confidence interval = 0.75-2.44). Conclusions. Most overweight or obese children are not referred, regardless of comorbidity status. One reason may be low levels of appropriate diagnosis.