Addressing Obesity in Pediatric Primary Care: Development of Institutional Algorithms and Management Tools Utilizing a Multidisciplinary Approach and Community Collaborations

Background: Obesity is a chronic multifactorial disease affecting 1 in 5 youth, with rates increasing in both youth and adults. The AAP 2007 Expert Committee Guidelines recommends screening for obesity based on BMI at age 2 and above. These 2007 guidelines also include recommendations for screening for common obesity related co-morbidities, along with frequent visits to support weight management. In addition, the 2010 United States Preventative Task Force (USPTF) recommendations highlighted the significant role that intensive behavioral interventions, >26 contact hours over 6-12 months, may have in addressing obesity. These intensive interventions often are family centered and take place in community settings, taking advantage of ancillary resources that are often not centralized in clinical practices. The pediatrician's role and responsibility in addressing weight management is clear, but many clinicians describe lacking the skills, knowledge, or time to tackle the multifactorial nature of obesity and its related co-morbidities. The primary objective of our project was to assess the barriers primary care pediatricians identify in the management of obesity and develop effective tools that streamline clinical recommendations and strengthen clinical-community partnerships to better address obesity and its related co-morbidities.

Methods: A mixed methods study was conducted by distributing a survey to 380 pediatric providers in Washington, DC and its surrounding metropolitan areas through a large pediatric health network listserv. A subgroup of primary care providers was identified, and three focus groups were conducted to further explore findings from cross sectional analysis. A comprehensive literature review was completed to explore the most up to date evidence-based recommendations for the diagnosis and management of obesity and its related comorbidities in children. Pediatric sub-specialists across Children’s National Hospital participated in an iterative process to develop a comprehensive clinical algorithm.

Results: 81 pediatric providers completed the survey, and each focus group contained 4-10 clinicians. Six primary themes emerged regarding clinical barriers to addressing obesity in the primary care setting including 1) limited time, 2) clinician perceived familial resistance, 3) challenges with cultural competency, 4) perceived environmental barriers, 5) limited knowledge of community resources, and 6) inadequate collaborative support (Table 1). Based on these results, an institutional algorithm was developed with 9 pediatric pathways to address obesity and its related co-morbidities. In addition, 7 patient education handouts and a patient navigator network to assist families in connecting to local community resources were developed.

Conclusion: Pediatric providers continue to endorse significant challenges in addressing obesity in primary care. Novel and tailored evidence-based resources bridging individual institutions and communities may serve as a supportive mechanism to improve clinician practices in future management.