Improving Pediatric Obesity Management in Low Income Patients: A Quality Improvement Project

Obesity affects 14.4 million children and has adverse health implications, including both physical and mental symptoms. Children with an elevated body mass index (BMI) are at an increased risk of cardiovascular disease, dyslipidemia, insulin resistance, depression, and low self-esteem. Low socioeconomic status and adverse childhood events can put a child at greater risk for developing obesity. Pediatric patients who fall within this category generally have difficulty obtaining resources to help treat obesity. Motivational interviewing (MI) is cost- effective and has decreased the patient's BMI over time. Local Problem: Pediatric providers at an urban primary care clinic associated with an academic medical center do not have a routine treatment for elevated BMI and have had difficulty providing resources to their patients with obesity because many programs for obesity are not covered by Medicaid insurance and lack Spanish interpretation. This quality improvement project aimed to educate providers on how to perform MI for obesity treatment to implement during patient appointments. Methods: Pre-and post-survey assessed the provider's barriers to addressing obesity during appointments, their comfort level in performing MI, and the usability and feasibility of interventions. A chart review analyzed patient data on treatment utilized pre- and post- implementation. Interventions: Education was presented to providers, including how to implement MI in appointments for patients with a BMI greater than the 85th percentile, an option for a referral, and how to access and utilize the clinic's current BMI smart form tool. A pre-templated phrase was revised for electronic health records (EHR) use. A template for a referral letter was created for providers to use in the EHR if outside expertise was warranted. Results: Chart Review data (N=486) was not statistically significant in the usage of the "readiness for change scale" (p>0.05) to identify if a patient is ready for a behavior change. Increased BMI smart form tool utilization was statistically significant (p<0.05). The pre- intervention survey (N= 15) discovered that providers did not typically feel comfortable providing motivational interviewing (54%) and referrals (73%) for obesity management. In post- intervention surveys (N=8), providers plan to use MI with obesity in future appointments (100%), continue to create individualized goals (100%), and use the BMI smart form (66%). Conclusion: The results showed a statistically significant change in the use of the BMI smart form and creating individualized goals. There was a lack of provider post-implementation response, but based on the data, the usability and feasibility are strong due to providers planning to continue using MI and BMI smart forms in future appointments. The chart review demonstrated that the goals determined post-intervention were individualized and collaborative between patient, family, and provider.