PC1167: The Healthy Living Visit Pilot: A Primary Care-based Approach to the Management of Childhood Obesity

Background: The Healthy Living Visits pilot aims to improve the primary care management of childhood obesity by offering interested patients with obesity and their families access to a 6-session theme-based primary care intervention aimed to better monitor and treat obesity-related comorbidities, support positive behavior change in five key areas (fruit and vegetable consumption, media use, physical activity, sugary drink consumption, sleep quality and social/emotional wellness), and stabilize or improve BMI percentile.

Methods: Patients are identified and referred to the Healthy Living Visits pilot by their primary pediatrician at well child checks. Participating pediatricians from sites across Children’s Primary Care Medical Group, a large multi-site pediatrics single-specialty group, receive specialized training in delivery and monitoring of the 6 monthly 20-minute theme-based coaching sessions, to be delivered either in person or through video visit. The Healthy Living Visits Pilot consists of a series of 6 theme-based visits addressing 5210, sleep, social/emotional wellness for children with obesity and related comorbidities. The Healthy Living Visits materials are incorporated into an Epic Smartset. Each session uses patient-centered coaching techniques to help patients explore existing behaviors and identify a goal for behavioral change. The visits are coded as obesity and dietary counseling and/or exercise counseling, and by comorbidity, if applicable.

Results: In the first 18 months of the pilot, 36 pediatricians at 16 sites completed Healthy Living Visits training which consisted of 4 hour-long educational sessions. In total, trained clinicians completed 1722 visits, of which 54 percent of patients had Medi-Cal insurance coverage. Seven clinicians received 25pts of MOC 4 credit for completion of training and completing at least 40 Healthy Living Visits. Over 89 percent of participating pediatricians reported increased confidence in managing childhood obesity. The biggest clinician concern was difficulty with follow ups and patient no shows. All visits were covered by insurance.

Conclusion: This MOC-4 approved primary care-based obesity management program based on healthy living principles and behavioral modification is feasible to implement in primary care, offers an approach to improving pediatrician competence and confidence in the management of childhood obesity and financially sustainable.