{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,21]],"date-time":"2026-08-21T16:56:20Z","timestamp":1787331380046,"version":"build-2736575974"},"reference-count":57,"publisher":"SAGE Publications","issue":"7","license":[{"start":{"date-parts":[[2026,7,20]],"date-time":"2026-07-20T00:00:00Z","timestamp":1784505600000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Childhood Obesity"],"published-print":{"date-parts":[[2026,10,1]]},"abstract":"<jats:sec>\n                    <jats:title>Purpose:<\/jats:title>\n                    <jats:p>Examine existing rural\u2013urban disparities in the utilization of counseling services by pediatric patients with obesity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>Based on 3 years (2017\u20132019) of data from the Merative MarketScan Commercial Claims and Encounters database, we used logistic regression to study rural\u2013urban differences in the likelihood of utilizing counseling services among pediatric patients (aged 2\u201317 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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>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.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>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\u2013urban 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.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/21532176261471297","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T02:41:39Z","timestamp":1784601699000},"page":"447-456","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Existing Geographical Disparities in the Utilization of Counseling Services by Pediatric Patients with Obesity"],"prefix":"10.1177","volume":"22","author":[{"given":"Biplav Babu","family":"Tiwari","sequence":"first","affiliation":[{"name":"Department of Health Policy and Management, College of Public Health, The University of Georgia, Athens, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel B.","family":"Hall","sequence":"additional","affiliation":[{"name":"Department of Statistics, Franklin College of Arts and Sciences, The University of Georgia, Athens, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eunhae","family":"Shin","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, College of Public Health, The University of Georgia, Athens, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sina","family":"Gallo","sequence":"additional","affiliation":[{"name":"Department of Nutrition Sciences, Franklin College of Arts and Sciences, The University of Georgia, Athens, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0468-0387","authenticated-orcid":false,"given":"Janani","family":"Rajbhandari","sequence":"additional","affiliation":[{"name":"Department of Health Policy and Management, College of Public Health, The University of Georgia, Athens, Georgia, USA."}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2026,7,20]]},"reference":[{"issue":"158","key":"e_1_3_4_2_1","article-title":"National Health and Nutrition Examination Survey 2017\u2013March 2020 prepandemic data files development of files and prevalence estimates for selected health outcomes","author":"Stierman B","year":"2021","unstructured":"1.Stierman B, , Afful J, , Carroll MD, et al. National Health and Nutrition Examination Survey 2017\u2013March 2020 prepandemic data files development of files and prevalence estimates for selected health outcomes. Natl Health Stat Report 2021(158); doi: 10.15620\/cdc:106273","journal-title":"Natl Health Stat Report"},{"issue":"20","key":"e_1_3_4_3_1","doi-asserted-by":"crossref","first-page":"337","DOI":"10.15585\/mmwr.mm7420a1","article-title":"Prescriptions for obesity medications among adolescents aged 12\u201317 years with obesity - United States, 2018\u20132023","volume":"74","author":"Kompaniyets L","year":"2025","unstructured":"2.Kompaniyets L, , Pierce SL, , Porter R, et al. Prescriptions for obesity medications among adolescents aged 12\u201317 years with obesity - United States, 2018\u20132023. MMWR Morb Mortal Wkly Rep 2025;74(20):337\u2013344; doi: 10.15585\/mmwr.mm7420a1","journal-title":"MMWR Morb Mortal Wkly Rep"},{"key":"e_1_3_4_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.6450"},{"key":"e_1_3_4_5_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2024.6453"},{"key":"e_1_3_4_6_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2025.0219"},{"key":"e_1_3_4_7_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamapediatrics.2022.2052"},{"key":"e_1_3_4_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.appet.2021.105132"},{"key":"e_1_3_4_9_1","doi-asserted-by":"publisher","DOI":"10.1542\/hpeds.2022-006723"},{"key":"e_1_3_4_10_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060640"},{"key":"e_1_3_4_11_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2022-060642"},{"key":"e_1_3_4_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2018.13022"},{"key":"e_1_3_4_13_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00246-019-02152-w"},{"key":"e_1_3_4_14_1","unstructured":"13.Healthcare.gov. Preventive care benefits for children. Available from: https:\/\/www.healthcare.gov\/preventive-care-children\/ [Last accessed: February13 2023]."},{"key":"e_1_3_4_15_1","unstructured":"14.Medicaid.gov. Prevention. Available from: https:\/\/www.medicaid.gov\/medicaid\/benefits\/prevention\/index.html [Last accessed: May1 2024]."},{"key":"e_1_3_4_16_1","unstructured":"15.KFF. Preventive Services Covered by Private Health Plans under the Affordable Care Act 2024. Available from: https:\/\/www.kff.org\/womens-health-policy\/fact-sheet\/preventive-services-covered-by-private-health-plans\/ [Last accessed: May1 2024]."},{"key":"e_1_3_4_17_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.146.1MA1.85"},{"key":"e_1_3_4_18_1","unstructured":"17.National Council on Aging. Obesity Treatment and Medicare: A Guide to Understanding Coverage 2024. Available from: https:\/\/www.ncoa.org\/article\/obesity-treatment-and-medicare-a-guide-to-understanding-coverage [Last accessed: May1 2024]."},{"key":"e_1_3_4_19_1","doi-asserted-by":"publisher","DOI":"10.1089\/chi.2022.0158"},{"key":"e_1_3_4_20_1","doi-asserted-by":"publisher","DOI":"10.1089\/chi.2014.0085"},{"key":"e_1_3_4_21_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1746-1561.2006.00080.x"},{"key":"e_1_3_4_22_1","unstructured":"21.Rural Health Information Hub. Rural Obesity and Weight Control 2020. Available from: https:\/\/web.archive.org\/web\/20260317233156\/https:\/\/www.ruralhealthinfo.org\/topics\/obesity-and-weight-control [Last accessed: June20 2022]."},{"key":"e_1_3_4_23_1","unstructured":"22.Keisler-Starkey K Bunch LN and Lindstrom RA. Health Insurance Coverage in the United States: 2022. Report no. Current Population Reports P60-281 September 2023. U.S. Government Publishing Office Washington DC: U.S. Census Bureau."},{"key":"e_1_3_4_24_1","unstructured":"23.Eisenstein S Huang X McBride T et al. Health Insurance Coverage in Rural and Urban Areas in the U.S. 2023. 2025. Available from: https:\/\/rupri.public-health.uiowa.edu\/publications\/policybriefs\/2025\/Health_Insurance_Coverage.pdf [Last accessed: May19 2026]."},{"key":"e_1_3_4_25_1","volume-title":"Children\u2019s Uninsured Rate Rises by Largest Annual Jump in More Than a Decade","author":"Alker J","year":"2020","unstructured":"24.Alker J, , Corcoran A. Children\u2019s Uninsured Rate Rises by Largest Annual Jump in More Than a Decade. Georgetown University Center for Children and Families: Washington, DC; 2020."},{"key":"e_1_3_4_26_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2012-0055I"},{"key":"e_1_3_4_27_1","unstructured":"26.United States Census Bureau. Geographic Areas Reference Manual. United States Census Bureau. 1994."},{"key":"e_1_3_4_28_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201800275"},{"key":"e_1_3_4_29_1","doi-asserted-by":"publisher","DOI":"10.1007\/s12325-018-0858-y"},{"key":"e_1_3_4_30_1","doi-asserted-by":"publisher","DOI":"10.1177\/0033354920984155"},{"key":"e_1_3_4_31_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201800473"},{"key":"e_1_3_4_32_1","doi-asserted-by":"publisher","DOI":"10.1002\/pds.5204"},{"key":"e_1_3_4_33_1","unstructured":"32.Truven Health Analytics. Truven Health MarketScan\u00ae Research Databases: Commercial Claims and Encounters Medicare Supplemental 2016. Available from: https:\/\/theclearcenter.org\/wp-content\/uploads\/2020\/01\/IBM-MarketScan-User-Guide.pdf."},{"key":"e_1_3_4_34_1","doi-asserted-by":"publisher","DOI":"10.1016\/0167-6296(90)90002-K"},{"key":"e_1_3_4_35_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.focus.2023.100116"},{"key":"e_1_3_4_36_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ypmed.2020.106405"},{"key":"e_1_3_4_37_1","article-title":"Center for Strategic and International Studies","author":"Beaudreault AR","year":"2019","unstructured":"36.Beaudreault AR. Center for Strategic and International Studies. Nutrition and Prosperity 2019.","journal-title":"Nutrition and Prosperity"},{"key":"e_1_3_4_38_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41366-022-01133-z"},{"key":"e_1_3_4_39_1","doi-asserted-by":"publisher","DOI":"10.1177\/21532176251385715"},{"key":"e_1_3_4_40_1","doi-asserted-by":"publisher","DOI":"10.1370\/afm.1040"},{"key":"e_1_3_4_41_1","unstructured":"40.Centers for Medicare & Medicaid Services. Background: The Affordable Care Act\u2019s New Rules on Preventive Care 2010. Available from: https:\/\/www.cms.gov\/CCIIO\/Resources\/Fact-Sheets-and-FAQs\/preventive-care-background [Last accessed: February13 2023]."},{"key":"e_1_3_4_42_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2019.00722"},{"key":"e_1_3_4_43_1","unstructured":"42.Rural Health Information Hub. Physicians per 10 000 People for Metro and Nonmetro Counties 2019. Available from: https:\/\/www.ruralhealthinfo.org\/charts\/109 [Last accessed: April23 2024]."},{"key":"e_1_3_4_44_1","unstructured":"43.US Government Accountability Office. Physician Workforce: Locations and Types of Graduate Training Were Largely Unchanged and Federal Efforts May Not Be Sufficient to Meet Needs. GAO-17-411 2017. Available from: https:\/\/www.gao.gov\/products\/gao-17-411 [Last accessed: April23 2024]."},{"key":"e_1_3_4_45_1","first-page":"71","article-title":"Barriers to the use of preventive health care services for children","volume":"111","author":"Roberta R-M","year":"1996","unstructured":"44.Roberta R-M, , Maija LS-H, , Lenora AR, et al. Barriers to the use of preventive health care services for children. Public Health Reports (1974-). 1996;111:71\u201377.","journal-title":"Public Health Reports (1974-)."},{"key":"e_1_3_4_46_1","unstructured":"45.Federal Register. Coverage of Certain Preventive Services Under the Affordable Care Act In: Internal Revenue Service Department of the Treasury Employee Benefits Security Administration et al. (eds.). 80 FR 41318. 2015."},{"key":"e_1_3_4_47_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12335"},{"key":"e_1_3_4_48_1","doi-asserted-by":"publisher","DOI":"10.1111\/jrh.12222"},{"key":"e_1_3_4_49_1","doi-asserted-by":"publisher","DOI":"10.1097\/jac.0000000000000198"},{"key":"e_1_3_4_50_1","volume-title":"Doctoring Our Diet: Policy Tools to Include Nutrition in US Medical Training","author":"Emily M","year":"2019","unstructured":"49.Emily M, , Leib B. Doctoring Our Diet: Policy Tools to Include Nutrition in US Medical Training. Harvard Law School Food Law and Policy Clinic, 2019."},{"key":"e_1_3_4_51_1","doi-asserted-by":"publisher","DOI":"10.1016\/S2542-5196(19)30171-8"},{"key":"e_1_3_4_52_1","doi-asserted-by":"publisher","DOI":"10.1177\/2382120518763360"},{"key":"e_1_3_4_53_1","doi-asserted-by":"publisher","DOI":"10.3389\/fnut.2023.1178134"},{"key":"e_1_3_4_54_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajmo.2023.100034"},{"key":"e_1_3_4_55_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amepre.2019.12.016"},{"key":"e_1_3_4_56_1","doi-asserted-by":"publisher","DOI":"10.1002\/osp4.450"},{"key":"e_1_3_4_57_1","doi-asserted-by":"publisher","DOI":"10.1111\/dom.14512"},{"key":"e_1_3_4_58_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.juro.2013.04.048"}],"container-title":["Childhood Obesity"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21532176261471297","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/full-xml\/10.1177\/21532176261471297","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/journals.sagepub.com\/doi\/pdf\/10.1177\/21532176261471297","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,12]],"date-time":"2026-08-12T14:33:51Z","timestamp":1786545231000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.sagepub.com\/doi\/10.1177\/21532176261471297"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,20]]},"references-count":57,"journal-issue":{"issue":"7","published-print":{"date-parts":[[2026,10,1]]}},"alternative-id":["10.1177\/21532176261471297"],"URL":"https:\/\/doi.org\/10.1177\/21532176261471297","relation":{},"ISSN":["2153-2168","2153-2176"],"issn-type":[{"value":"2153-2168","type":"print"},{"value":"2153-2176","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,20]]}}}