Integrating Obesity Management Into Pediatric Primary Care printable pdf download

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Integrating Obesity Management into Pediatric Primary Care

Childhood obesity affects 12.5 million children in the United States and can lead to a

myriad of health problems. Expert Committee Guidelines (ECG) on the treatment of children

who are overweight or obese, released for use in 2007 are not being adequately utilized. In a

primary care pediatric practice in Southeast Florida, a chart review was undertaken to determine if

children ages 2 to 18 years were being identified as overweight or obese and counseled

appropriately. A review of 100 charts showed that the body mass index (BMI) was calculated

60% of the time and plotted on growth charts 15% of the time. The child’s BMI was assessed

(underweight, normal weight, overweight, or obese) 15% of the time and nutritional counseling

was provided 20% of the time. It was identified that the care given to overweight or obese

children in this practice was not adhering to standards recommended by the ECG. The practice

implemented a quality improvement project focusing on compliance with the 2007 ECG, led by a

nurse practitioner. The project began with education on the ECGs, how to evaluate a child’s

BMI, and a brief introduction on motivational interviewing. Three months later a second review

of 100 charts of children from the ages of 2 – 18 years with a BMI of ≥ 85%, were reviewed for

compliance with the ECG. Study results showed: BMI was plotted on the growth chart 90% of

the time and 44% of the time BMI was assessed. The ECG’s were followed 17% of the time.

As a result of this study, a program began that identified overweight children and referred

them to a nurse practitioner within the practice for a follow-up visit. It is difficult to address all

areas of need during a well child visit and not all providers are comfortable with obesity

counseling. The goal was to improve compliance with the ECGs and ultimately guide these

children to a healthy weight. A counseling visit was designed based on the ECGs that assessed the

child’s BMI, blood pressure, medical diagnoses and co-morbidities, subjective and objective

sequel of obesity, family history, nutrition, and physical activity. Healthy nutrition and activity

teaching is incorporated into the visit and goals for the child are made using motivational

interviewing techniques. Appropriate lab testing and follow-up visits are arranged. These visits

have been well received by providers and families. Chart audits for the effectiveness of these

visits will be completed in the near future.

The childhood obesity epidemic may be plateauing but has not disappeared. While a single

best solution for the treatment of childhood obesity remains elusive, evidence does support the

use of the ECG in the primary care arena. Nurse practitioners working with children in the health

care setting have an opportunity to impact this problem. Healthy lifestyle counseling early in

childhood can begin children and their families on a journey to health that avoids obesity.

Linda Barreras, DNP, FNP-BC, CDE, Nurse Practitioner, Children’s Medical Association,

Plantation, FL

Integrating Obesity Management Into Pediatric Primary Care