Racial, ethnic disparities exist when counseling on nutrition, lifestyle, and weight

Finding drivers of and barriers to counseling for pediatric patients with obesity and high blood pressure (BP) to reduce inequities of care are needed, after new research revealed racial and ethnic disparities exist.

These observations were observed in a secondary analysis study published in JAMA Network Open when it came to the receipt of nutrition, lifestyle, and weight counseling among pediatric patients with high BP.

It is known that pediatric obesity and hypertension are highly correlated, state the study investigators, who were led by Moonseong Heo, PhD, of the Department of Public Health Sciences, College of Social, Behavioral and Public Health Sciences, Clemson University, Clemson, South Carolina.

"Childhood obesity is prevalent, often originates early in life, and disproportionately affects children from racial and ethnic minority groups and disadvantaged backgrounds," wrote Heo and colleagues.

"Obesity-related health consequences encompass a broad range of comorbidities, including high BP, elevated cholesterol levels, type 2 diabetes, asthma, sleep apnea, joint problems, and mental health concerns. Despite such undesirable consequences, the CDC reported that the prevalence of pediatric obesity has remained persistently high at 19.7% (ie, 1 in 5; n = 14.7 million) among children and adolescents aged 2 to 19 years in the US from 2017 to 2020."

The American Academy of Pediatrics' (AAP) evidence-based Clinical Practice Guidelines recommend interventions for behavior modification, including counsel on weight, lifestyle, and nutrition amid pediatric primary care visits. These 3 areas are "of critical importance to mitigating weight and high BP problems in children and adolescents."

However, despite direct guidance and recommendation from the AAP, racial and ethnic disparities persist in the prevalence of hypertension and obesity among pediatric patients, noted the authors.

"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," said the authors. "Stratified analyses by race and ethnicity and weight groups were conducted using baseline data collected from the Boosting Primary Care Awareness and Treatment of Hypertension (BP-CATCH) quality improvement collaborative (QIC) study, which enrolled pediatric practices across the US."

In a post hoc secondary analysis design, urban, suburban, and rural pediatric primary care practices across the United States—compete with a team of at least 1 physician, 1 nurse and another practice associate, as well as a hypertension specialist—submitted baseline data from clinical encounters. These practices identified the first 17 eligible patients with high BP measurements each month.

With exposures including race and ethnicity and weight status (with or without) obesity, the primary outcome of the secondary analysis was receipt of counseling on nutrition, lifestyle, and weight during primary care visits.

In all, there were 2677 patients from 59 practices included in the analysis with a mean age of 10.8 (5.2) years, and of which 56.6% were male. A total of 593 patients were Black, 414 were Hispanic, 1111 were White, and 559 were "other race and ethnicity."

The overall crude unadjusted rates of receiving counseling were:

• 63.5% (n = 1564 of 2463) for nutrition
• 57.6% (n = 1419 of 2462) for lifestyle
• 47.5% (n = 571 of 1202) for weight
• 46.4% (n = 1142 of 2461) for all counseling topics

Hispanic participants, compared with the other 3 groups, received significantly higher adjusted rates of nutrition (78.6%; 95% CI, 73.5%-83.8%), lifestyle (69.3%; 95% CI, 63.6%-74.9%), and all 3 (52.1%; 95% CI, 46.1%-58.2%) counseling topics, according to study results.

When it came to rates of receiving weight counseling, there were no significant differences in between any pairs of groups. Findings were similar in general among those without obesity. The study investigators noted no significant pairwise differences were found among patients with obesity, except that "nutrition counseling rates were significantly different between White participants and those reporting other race and ethnicity (68.3% [95% CI, 61.1%-75.4%] vs 81.6% [95% CI, 74.2%-89.1%]; Bonferroni-corrected P = .02)."

In children with high BP measurements, there were significant racial and ethnic disparities in receiving nutrition, lifestyle, and all 3 counseling topics, this post hoc analysis found.

"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," the study authors concluded.

"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."

Reference:

Heo M, Rea CJ, Brady TM, et al. Racial and Ethnic Disparities in Pediatric Counseling on Nutrition, Lifestyle, and Weight: A Secondary Analysis of the BP-CATCH Randomized Clinical Trial. JAMA Netw Open. 2025;8(1):e2456238. doi:10.1001/jamanetworkopen.2024.56238