Primary Care Clinical Practice Elements and Improving Overweight Children's Weight Status
Condition: Overweight; Childhood Obesity
MeSH terms: Overweight; Pediatric Obesity
Study type: Observational

Summary: 
      The purpose of this study is to identify whether specific clinical practices-including
      attention to body-mass-index (BMI) screening/overweight/obesity, medical risk (from
      conditions associated with overweight/obesity such as high blood pressure), and following up
      to reassess progress-will improve the weight status of overweight school-age children.
    

Detailed description: 
      The aim of this study is to identify specific clinical practice elements in pediatric primary
      care that predict improvement in weight status among overweight school-age children.
      Pediatricians are well-suited to regularly assess and treat school-age children who are
      overweight. Well-child visits present an important opportunity to assess and treat overweight
      children. Strategies are needed to maximize the effectiveness of this opportunity. Although
      the American Academy of Pediatrics endorses recommendations by the United States Preventive
      Services Task Force that clinicians screen for overweight, assess medical/behavior risk, and
      use a staged treatment approach that includes frequent reassessment, it is unclear whether
      these practices, when used in primary care, impact whether children make lifestyle changes or
      improve their weight status. It is essential to identify specific clinical practice elements
      and communication strategies associated with weight-status improvement in overweight
      children, to maximize the effectiveness of primary-care weight-management interventions. The
      investigators hypothesize that, during primary-care visits with overweight 6-12-year-old
      children, attention to high BMI, medical risk (from weight-related comorbidities such as high
      blood pressure), and reassessing progress (defined as having a primary-care visit with
      evidence of attention to BMI or completing a referral to a weight-management specialist or
      nutritionist) will be associated with improvement in weight status (assessed as decrease in
      percent overweight (percentage above the age/sex-specific 95th BMI percentile) at follow-up.
    

Intervention name(s): Attention to BMI; Attention to high-BMI-related Medical Risk; No attention to high BMI or high-BMI-related medical risk
Intervention type(s): Other; Other; Other
Intervention description(s): Evidence (using electronic health record data) denoting provider attention to about high BMI.; Evidence (using electronic health record data) denoting provider attention to high-BMI-related medical risk, including from high blood pressure/hypertension, cholesterol/dyslipidemia, blood sugar/diabetes, liver enzymes/fatty liver, and low vitamin D/vitamin-D deficiency.; Lack of evidence (using electronic health record data) denoting provider attention to high BMI or high-BMI-related medical risk.
Other intervention name(s): BMI; Medical Risk; No BMI/Medical-Risk Attention
Observational model: Case-Control
Time perspective: Retrospective
Sampling method: Probability Sample
Study population: 
        Overweight 6-12 year-old children followed by pediatricians at community-based and academic
        primary-care clinics. A random sample of controls will be matched to cases by age, gender,
        race/ethnicity, BMI-percentile category, and clinic site.
      
Keywords: childhood obesity; childhood overweight; primary care; weight management