Primary Care Clinical Practice Elements and Improving Overweight Children's Weight Status

Study Overview
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Brief Summary
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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
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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.

Official Title
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Primary Care Clinical Practice Elements and Improving Overweight Children's Weight Status

Conditions
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Childhood Obesity, Overweight

Intervention / Treatment
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* Other: Attention to BMI
* Other: Attention to high-BMI-related Medical Risk
* Other: No attention to high BMI or high-BMI-related medical risk


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: 6-12 year-old children with ≥2 visits valid height and weight data at each visit BMI ≥85th percentile at the first visit Exclusion Criteria: children <6 and >12 years old no valid height and weight data at two visits BMI <85th percentile at all 6-12 year-old well child visits

Ages Eligible for Study
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Minimum Age: 6 Years
Maximum Age: 12 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Weight-status improved<br>Cases, termed, weight-status improved, are defined as children whose BMI percent relative to their age/sex-specific BMI at the 95th percentile decreases from one visit to the next; and from one well-child visit to the next well-child (or primary-care visit approximately 9-18 months later). | Other: Attention to BMI<br>* Evidence (using electronic health record data) denoting provider attention to about high BMI.<br>* Other names: BMI;Other: Attention to high-BMI-related Medical Risk<br>* 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.<br>* Other names: Medical Risk;Other: No attention to high BMI or high-BMI-related medical risk<br>* Lack of evidence (using electronic health record data) denoting provider attention to high BMI or high-BMI-related medical risk.<br>* Other names: No BMI/Medical-Risk Attention;|
| Weight-status unchanged/worse<br>Controls are defined as children whose BMI percent relative to their age/sex-specific BMI at the 95th percentile remains unchanged or increases from one visit to the next; and from one well-child visit to the next well-child (or primary-care visit approximately 9-18 months later). | Other: Attention to BMI<br>* Evidence (using electronic health record data) denoting provider attention to about high BMI.<br>* Other names: BMI;Other: Attention to high-BMI-related Medical Risk<br>* 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.<br>* Other names: Medical Risk;Other: No attention to high BMI or high-BMI-related medical risk<br>* Lack of evidence (using electronic health record data) denoting provider attention to high BMI or high-BMI-related medical risk.<br>* Other names: No BMI/Medical-Risk Attention;|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| weight-status improvement | Children with a decrease in BMI percent relative to the age/sex-specific BMI at the 95th percentile | From one visit to the next and from one well-child visit to the next | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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childhood obesity, childhood overweight, primary care, weight management