Implementation of 2023 Pediatric Obesity Guidelines in a Pediatric Residency Clinic Setting

Introduction/Objectives: Approximately 14.4 million U.S. children are diagnosed with obesity. The prevalence of pediatric obesity in Oklahoma is 29.5%, ranking Oklahoma 18th overall for overweight and obese pediatric patients. Pediatric obesity is associated with multiple serious co-morbidities if left untreated, including cardiovascular disease, diabetes, hyperlipidemia, mental health issues, musculoskeletal disorders, neurological disorders, and sleep apnea. In February 2023, the American Academy of Pediatrics published updated guidelines on the evaluations and treatment of pediatric obesity. New guidelines emphasize enhanced screening and early intervention rather than watchful waiting. Objective for this project was to determine how best to implement the new guidelines in a pediatric residency outpatient clinic training program, with an emphasis on obtaining a comprehensive medical history.

Methods: This project was performed in conjunction with the American Academy of Pediatrics Institute for Healthy Childhood Weight’s “Assessment & Evaluation of Childhood Obesity QI Project.” Four rounds of data collection were performed. In each round, 30 random charts were reviewed (20 from well child checks with a diagnosis code associated with overweight or obesity and 10 from all well child checks). Charts were evaluated for obtaining a complete history, screening for comorbidities, and establishing an appropriate treatment plan. After round one of collection data, a review of electronic health record (EHR) templates for well child checks to determine if inquiry into documenting the five components of a complete history were intuitive. After review of templates, changes were made in attempts to make documenting more efficient.

Results: In the initial round of data collection, it was noted that physicians at the clinic in question obtained a complete history 30% of the time. For example, instead of inquiring about social determinants of health (SDoH), nutrition, physical activity, screen time and sleep; physicians might inquire about only food insecurity and screen time, but not all 5 components. After review and editing of EHR templates, documentation of a complete history improved to 75%.

Conclusions: On initial review of data, it was discovered that physicians within the clinic only obtained a complete history, per the 2023 obesity guidelines, 30% of the time. There was an initial increase then a subsequent decrease in history completion. During this time, senior residents graduated, and a new group of interns came into the practice. After editing EHR templates, complete medical histories were obtained 75% of the time. Making templates more intuitive allowed for more consistent obtaining of comprehensive medical histories. This is particularly important in residency training programs with yearly turnover. Now that comprehensive medical exams are routinely obtained, next steps include increasing initiation of a patient and family centered treatment plan [including Intensive Health Behavior and Lifestyle Treatment (IHBLT)] and improved follow up within 4 weeks of obesity diagnosis.