Caring Against the Odds: The Role of Patient-Centered Care in Adverse Childhood Environments

Incidence rates of childhood overweight and obesity continue to grow in the United States, threatening children’s health and social development. The aim of this study was to explore how patient-centered care (PCC) at individual and system levels can influence children’s physical, mental, and social well-being. Using the National Survey on Children’s Health (NSCH), data were drawn from 4,045 parents of children aged 6 to 17 who were overweight or obese and had seen a doctor in the past year. Parents reported their child’s adverse childhood experiences (ACEs), difficulty paying medical bills, PCC, system of care, expression of weight concerns, physical activity, forgone mental healthcare, and ability to make friends. Structural equation modeling tested whether PCC mediated the effects of social determinants of health on physical, mental, and social outcomes. Unaffordable medical bills and ACEs significantly worsened children’s mental, physical, and social outcomes. Both system-level and interpersonal PCC mediated these effects. A well-functioning healthcare system predicted greater physical activity, while interpersonal PCC predicted increased use of mental healthcare, improved physical activity, and fewer difficulties making friends. However, provider expression of concern about overweight status was associated with reduced physical activity. PCC and system-level support enhance children’s well-being but cannot fully offset adverse environments. This shows the urgency of addressing broader social determinants. Providers should attend to children’s needs and avoid relying solely on weight-focused messaging, which may inadvertently harm physical activity and social adjustment.