For a study, researchers sought to determine the characteristics of children referred for obesity management based on referral frequency, child- and referrer-related factors associated with re-referral, and if re-referral enhanced treatment start. Between April 2013 and December 2017, all 2- to 17-year-olds were referred for obesity treatment to one of three multidisciplinary clinics in Alberta, Canada. Children were divided into two groups based on how frequently they were referred, either once or more than once (re-referred). The information was gathered through standardized referral forms and patient registries. Models for logistic regression and generalized estimating equations were used in the analyses.

They examined data from 2,745 children (47.2% female; mean age: 11.4 years; mean BMI z score: 3.03) and 2,705 doctors (60.2% female; 65.6% pediatricians). Overall, 300 children (10.2%) were re-referred, with the majority (n=276; 92.0%) being referred twice. Children were less likely to be re-referred if they were referred by a family physician (vs. pediatrician) (aOR 0.62; 95% CI 0.46-0.84; P=.0018) or booked a clinic visit after their index referral (aOR 0.29; 95% CI 0.21-0.4; P=.001). Treatment initiation was greater in children who were only referred once (42.1%) compared to their re-referred peers (18.0%; P<.0001); but children who were re-referred were more likely to commence treatment after their second referral (aOR 2.3; 95% CI 1.22-4.31; P =.01). On future referrals, this improvement was not maintained (aOR 0.44; 95% CI 0.17-1.12; P=.08). Few children were referred for pediatric obesity management a second time; nevertheless, the second referral marginally improved the odds of treatment commencement among those who were.