Communication With Families of Children With Overweight Status or Obesity During Consultation for Tonsillectomy

Children with overweight or obesity experience greater prevalence, severity, and perioperative risk of obstructive sleep-disordered breathing and persistent sleep apnea after tonsillectomy. Yet, little is known about how weight status influences communication between surgeons and families in presurgical consultations.

To evaluate the association between patient weight status with (1) clinician-parent communication and (2) parent ratings of care experience during tonsillectomy consultations.

This cross-sectional study examined encounters occurring between April 2016 and September 2023 at outpatient otolaryngology clinics among English-speaking parents of children aged 2 to 17 years undergoing initial evaluation for tonsillectomy and clinicians (surgeons and advanced practice medical professionals) evaluating patients for tonsillectomy. Data were analyzed from September 2023 to May 2024.

Consultations were audio recorded and coded using the Roter Interaction Analysis System to identify verbal and nonverbal communication behaviors. After consultations, clinicians rated child weight status and parents rated care experiences using items modified from the Consumer Assessment of Healthcare Providers & Systems.

Of 231 encounters in this study, 50 (22%) were with children with overweight. Most children were male (n = 130 [57%]). Children and adolescents were aged 2 to 17 years (hereafter referred to as children; mean [SD] age: no overweight, 5.0 [2.6] years; overweight or obesity, 8.1 [3.3] years). There were no differences between the groups with and without overweight in verbal dominance, patient centeredness, clinician facilitation or activation statements, clinician chit-chat statements, or clinician emotional statements. After adjusting for child's race, parents' education level, and annual household income, the child overweight status was associated with a decrease in cumulative clinician positive global affect levels by standardized β = -0.18 SDs (95% CI, -0.65 to 0.00 SDs). The small effect size observed may have limited the strength of this association. Furthermore, parents of children with overweight were less likely to report that their clinician definitively demonstrated respect relative to parents of children without overweight (odds ratio, 4.56 [95% CI, 1.06-19.99]).

These findings suggest that child weight status was not associated with measured verbal communication behaviors but was associated with lower parent ratings and observer ratings of clinician respectfulness. The small effect size and potential bias from clinician race and ethnicity and sex may have limited this association. These results indicate the need to elucidate and mitigate multilevel determinants that negatively affect quality of care and communication for children with overweight.