The WELL Clinic: A Telemedicine-based Childhood Obesity Specialty Clinic Rooted in Primary Care

Background: Childhood obesity is a prevalent chronic disease associated with multiple comorbodities that disproprionately impacts children from minority communities of lower socioeconomic status. Many affected children do not have access to high-quality, evidence-informed treatment programs. The COVID 19 pandemic worsened childhood obesity, but transformed the delivery of care at the WELL Clinic at Children's Primary Care Medical Group, which transitioned to a 100% telemedicine-based program, increasing access for patients affected by obesity across San Diego and Riverside Counties.

Methods: The WELL Clinic is a primary-care based specialty clinic at Children's Primary Care Medical Group, a large single-specialty pediatrics group with 35 offices across San Diego and Riverside Counties. When the COVID-19 pandemic began the WELL clinic transitioned to a fully virtual program. The WELL clinic includes 20-minute theme-based telemedicine sessions based on the Wheel of Health which includes nutrition, physical activity, sleep, screen use, and social/emotional wellness. Patients are referred to the WELL clinic from their primary care pediatrician. The visits are held with a specially-trained board-certified pediatrician or nurse practitioner and coded as obesity and any related comorbidities and nutrition and/or exercise counseling. A certified health coach supports patients in scheduling, follow up, and care coordination.

Results: In the year since the WELL clinic transitioned from in-person to video visits, pediatricians submitted 2536 referrals from all sites, of which 48% of patients have Medicaid coverage. The WELL clinic team completed 542 initial visits and 1227 follow up visits. The no-show rate decreased with the telemedicine format. All visits were covered by insurance.

Conclusion: A primary-care based childhood obesity intervention delivered via telemedicine is a clinically and financially feasible approach to improve access to a high quality evidence-informed childhood obesity management program for children of diverse backgrounds.