WIP 55 - Best Practices for Improving Adolescent Obesity and Comorbidity Screenings

Publication Number: WIP 55.7361

Michelle Y. Mandeville, Uniformed Services University of the Health Sciences F. Edward Hebert School of Medicine, Norfolk, VA, United States; Arek Hidirsah, United States Air Force, Chesapeake, VA, United States

Background: Childhood obesity is linked to numerous comorbidities and poor health outcomes. The American Academy of Pediatrics recommends screening obesity and associated comorbidities, yet, obesity rates continue to rise. Screening with body mass index (BMI) can reduce obesity rates and prevent development of comorbidities. However, obesity and related comorbidities are underrecognized. In one study with national data from 2017 to 2020, obesity was coded in only 55.8% of all patients with obesity and comorbid conditions were only screened completely in 21.2% (1). Knowing these gaps in practice, we hope to improve obesity screening and management in adolescence.

1. Hidirsah A et al. Paediatric obesity: Documentation, screening, and pharmacotherapy in a national cohort. Pediatr Obes. 2023 Jul;18(7):e13032. doi: 10.1111/ijpo.13032. Epub 2023 Apr 5. PMID: 37017271

Objective: This is a quality improvement project that aimed to see if our intervention bundles can improve screening obesity and related comorbidities during well child visits in the Pediatric Residency Clinic at Naval Medical Center Portsmouth

Design/Methods: Our project has been reviewed by the IRB and deemed exempt

We are implementing the following to prompt appropriate screening:
- Obesity/Blood pressure posters in clinic rooms to encourage families to inquire
- Blood pressure cards on vitals monitors with expected range for age
- Corpsmen training to alert provider of BMI >95%tile and blood pressures above the range indicated on the cards and flag findings on intake forms

We will compare background data to data collected after the proposed intervention. We plan to collect data for 2 rounds of 20 patients, with anticipated completion by February 2025. Specifically, we will compare the proportion of appropriately documented obesity diagnosis, elevated blood pressure, and correctly ordered screening labs (lipid, CMP, HA1c). In this way, we aim to identify if our interventions will change the screening and electronic medical record documentation practices of providers seeing adolescents with obesity for their Well Child Visits