O1036: Integrating Mental Health in Pediatric Obesity Care: Insights from US Weight Management Programs

Background: Pediatric weight management (PWM) providers are seeing an unprecedented number of patients with undiagnosed mental health (MH) concerns. Since MH conditions have a bidirectional relationship with obesity, experts emphasize addressing psychosocial concerns to help patients with obesity improve their quality of life. This study assessed how PWM programs address MH conditions in youth with obesity.

Methods: PWM providers from across the US created a survey to assess if and how PWM programs diagnose and treat patients with undiagnosed MH conditions. The survey was sent to medical and behavioral health providers working within PWM programs and asked how often patients received MH screenings, specifically for inattention, anxiety, depression, and Binge Eating Disorder (BED), and programs’ treatment practices for MH concerns. Survey responses from providers were analyzed using Chi-squared tests based on demographics of respondent programs such as size, location, or provider type and if the program offered 26 hours of intensive health behavioral lifestyle intervention (IHBLT) in a year.

Results: Survey respondents included 41 of 90 potential PWM programs, (46%) including 28 medical and 13 behavioral health providers. Programs were mostly in urban (83%) vs rural (17%) areas. Programs most frequently had a medical provider (98%) and registered dietitian (98%), followed by a psychologist (80%), social worker (56%), and exercise specialist (44%). Rural programs had fewer resources for providing MH counseling for anxiety (50% vs 92%; p=0.038), depression (33% vs 96%; p=0.002), and BED (33% vs 100%; p=0.002). Programs with psychologists more frequently incorporated assessments for general MH concerns (88% vs. 50%; p=0.033), anxiety (92% vs 50%; p=0.034) and depression (92% vs 33%; p=0.006) and were more likely to provide counseling for anxiety (92% vs 50%; p=0.038) and outside referrals for depression (80% vs 38%; p=0.031). Programs with social workers had shorter wait times for referrals for concerns regarding anxiety ( < 3 months: 100% vs. 60%; p=0.012) and depression ( < 3 months: 92% vs 58%; p=0.0497), were more likely to provide counseling for depression (91% vs 59%; p=0.023) and were more comfortable treating BED with medication (64% vs 31%; p=0.0487). Programs providing ≥26 hours of IHBLT more frequently offered MH screenings for attention (65% vs 19%; p=0.038) and BED (100% vs 36%; p< 0.001), ADHD counseling (91% vs 37%; p=0.004) and medication for ADHD (91% vs 30%; p< 0.001) and BED (91% vs 33%; p=0.003).

Conclusion: Rising rates of obesity and limited access to MH care among youth highlight a key public health concern. The interdisciplinary structure of PWM programs offers a unique opportunity to serve patients with comorbid obesity and MH conditions. The present study suggests that while MH services vary among PWM programs, including behavioral health providers as part of the interdisciplinary team is associated with increased engagement in MH management.