Racial and Ethnic Disparities in Pediatric Counseling on Nutrition, Lifestyle, and Weight
Authors: Moonseong Heo, Corinna J. Rea, Tammy M. Brady, David G. Bundy, Ezinne Sylvia Melikam, Kelly Orringer, Beth A. Tarini, Kimberly Giuliano, Katherine Twombley, Beatrice Goilav, Peterkaye Kelly, Myles S. Faith, Angelo Pietrobelli, Michael L. Rinke
Journal: JAMA Network Open (2025)

Importance Pediatric obesity and hypertension are highly correlated. To mitigate both conditions, provision of counseling on nutrition, lifestyle, and weight to children with high blood pressure (BP) measurements is recommended. Objective To examine racial and ethnic disparities in receipt of nutrition, lifestyle, and weight counseling among patients with high BP at pediatric primary care visits stratified by patients’ weight status. Design, Setting, and Participants This was a post hoc secondary analysis of the BP-CATCH study, a matched, stepped-wedge cluster randomized clinical trial investigating the best methods to screen children with high BP measurements and manage their care. Urban, suburban, and rural pediatric primary care practices across the US with a multidisciplinary team of at least 1 physician, 1 nurse and another practice associate, and a hypertension specialist for their practice group submitted baseline data from clinical encounters documented between November 2018 and January 2019. Practices identified the first 17 eligible patients with high BP measurements each month. This analysis was conducted from October 2023 to July 2024. Exposures Race and ethnicity (Black, Hispanic, White, and other [Asian, multiracial, other races, and unknown race]) and weight status (with or without obesity). Main Outcomes and Measures Primary outcomes were receipt of counseling on nutrition, lifestyle, and weight during primary care visits. Baseline measures extracted from medical records included demographics, anthropometric measures, and systolic and diastolic BP. Results Of 2677 participants from 59 practices, 1516 (56.6%) were male; mean (SD) age was 10.8 (5.2) years. A total of 593 (21.1%) were Black; 414 (15.5%), Hispanic; 1111 (41.5%), White; and 559 (20.9%), 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, and 46.4% (n = 1142 of 2461) for all counseling topics. Compared with the other 3 groups, Hispanic participants 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. There were no significant differences in rates of receiving weight counseling between any pairs of groups. These findings were consistent in general among participants without obesity, and no significant pairwise differences were noted among participants 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). Conclusions and Relevance This secondary analysis of the BP-CATCH trial found that among children with high BP measurements, racial and ethnic disparities in receiving nutrition, lifestyle, and all 3 counseling topics were significant, although no significant disparities in receipt of weight counseling were noted. Racial disparities in receipt of counseling were not observed in participants with and without obesity. Trial Registration ClinicalTrials.gov Identifier: NCT03783650