Integrating Obesity Management Into Pediatric Primary Care


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


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