Existing Geographical Disparities in the Utilization of Counseling Services by Pediatric Patients with Obesity

PURPOSE: Examine existing rural-urban disparities in the utilization of counseling services by pediatric patients with obesity. METHODS: Based on 3 years (2017-2019) of data from the Merative MarketScan Commercial Claims and Encounters database, we used logistic regression to study rural-urban differences in the likelihood of utilizing counseling services among pediatric patients (aged 2-17 years) diagnosed with obesity. Covariates in the model included age, gender, geographic region, health insurance plan type, and the Charlson Comorbidity Index. Second-order effects of these covariates were included as necessary according to a forward stepwise selection procedure based on the Akaike Information Criterion. RESULTS: Only 8.1% of the pediatric enrollees diagnosed with obesity received at least one obesity counseling service. Nutrition counseling was the most common type of counseling service utilized. Further, we observed significantly lower odds among rural participants than their urban counterparts for patients with insurance plan types comprehensive (odds ratio [OR]: 0.123 [0.017, 0.902]), health maintenance organization (OR: 0.703 [0.530, 0.933]), preferred provider organization (OR: 0.459 [0.374, 0.564]), partially capitated point-of-service (OR: 0.062 [0.015, 0.259]), and consumer-driven health plan (OR: 0.655 [0.514, 0.835]). These are all plans under which patients may incur costs for using treatment outside the network. CONCLUSIONS: This study found a geographical disparity in obesity counseling services utilization and suggests that the need to seek services outside the network is a contributing factor to the rural-urban disparity. Health system approaches to address existing disparities are needed to prevent their spillover effect on disparities in access to modern pharmacotherapies such as glucagon-like peptide-1.