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Strategies to Recruit a Diverse Low-Income Population to Child Weight Management Programs From Primary Care Practices


Figure 1. Resources: Patient resources include accessible programs and reduced language and cultural barriers. Office resources include material for brief counseling, EHR alerts, EHR guidance for obesity evaluation, and a simple referral process. The health care systems to which the practices belong modify EHRs to include discussions and counseling on body weight and extraction of de-identified EHR data for the researchers. Activities: Patients communicate with bilingual research staff. Training for providers and their staffs address each practice’s priorities. The research staff provides health care practices with ongoing support and information on patient participation and outcome. The health care systems extract de-identified data. Outputs: The resources and activities described above generate data on the volume and characteristics of the clinical population, the referred patients, and the enrolled patients. Other outputs are how referrals vary by office and the providers’ qualitative assessment of program material, training, and support. Data indicate recruitment strengths and weaknesses. Short-term outcomes: In addition to the improved health of enrolled patients, findings lead to design and implementation of improved recruitment strategies for future programs as well as increased provider satisfaction: Long-term outcomes. Dissemination of improved recruitment strategies positions primary care practices as effective referral sites for many children. As the proportion of children with obesity using weight management programs increases, obesity prevalence in children and ultimately in adults decreases.

Figure 1. Framework to optimize recruitment of patients for the Texas Childhood Obesity Research Demonstration (TX CORD) study, Texas, 2012–2014.

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Figure 2. Prevalence of overweight and obesity among patients with a body mass index at or above the 85th percentile (N = 7,845) seen in Texas Childhood Obesity Research Demonstration (TX CORD) study practices, by racial/ethnic groups. Data are from NHANES 2011–2012 (2) and from participating TX CORD practices, 2012–2014. Abbreviations: NHANES, National Health and Nutrition Examination Survey.

Age Category Percentile by Data Source Hispanic, % Non-Hispanic Black, % Non-Hispanic White, %
Early childhood (aged 2–5 y) NHANES ≥85th 29.8 21.9 20.9
TX CORD ≥85th 27.2 19.4 20.7
NHANES ≥95th 16.7 11.3 3.5
TX CORD ≥ 95th 13.2 8.3 9.7
Middle childhood (aged 6–12 y) NHANES ≥ 85th 46.2 38.1 29.4
TX CORD ≥ 85th 44.8 37.5 35.9
NHANES ≥ 95th 26.1 23.8 13.1
TX CORD ≥ 95th 27.5 20.9 18.9

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Figure 3. Outcome of patients with a body mass index at or above the 85th percentile (N = 2,030) referred to the Texas Childhood Obesity Research Demonstration (TX CORD) study. Among patients referred to the study, eligibility and interest varied by age group.

Outcome Age Group, %
2–5 y, n = 822 6–8 y, n = 567 9–12 y, n = 641
Not interested/not responsive 52.2 42.7 34.0
Enrolled 19.5 31.9 32.4
Did not meet research criteria 19.0 17.6 23.6
No transportation 5.2 4.4 3.9
Did not meet medical criteria 4.0 3.2 4.2
Unknown 0.1 0.2 1.9

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Figure 4. Percentage of patients in 12 primary care practices with a body mass index at or above the 85th percentile referred (N = 2,030) and enrolled (N = 549) in the Texas Childhood Obesity Demonstration (TX CORD) study, by primary care practice. Asterisks indicate that electronic health records for that office were modified to include a referral process for overweight or obesity. Numbers in parentheses are the total number of eligible patients in each practice.

Practice No. Eligible Patients % Eligible Patients Referred Eligible Patients Enrolled
1 202 66.8 25.7
2* 684 52.0 10.8
3 513 49.5 17.7
4 96 44.8 16.7
5* 716 40.9 10.8
6* 712 38.2 8.7
7* 540 35.9 6.3
8 91 30.8 15.4
9 677 25.3 9.0
10 263 21.3 10.3
11 436 18.8 3.4
12* 1,364 8.5 1.9

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The opinions expressed by authors contributing to this journal do not necessarily reflect the opinions of the U.S. Department of Health and Human Services, the Public Health Service, the Centers for Disease Control and Prevention, or the authors’ affiliated institutions.

Page last reviewed: December 21, 2017