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

The University of Texas System (UT)

Status: Completed

Conditions: Overweight; Childhood Obesity

Treatments: Other: Attention to BMI; Other: No attention to high BMI or high-BMI-related medical risk; Other: Attention to high-BMI-related Medical Risk

Study type: Observational

Funder types: Other; NIH

Identifiers

NCT02278705

1K23HL118152-01A1 Aim 1

1K23HL118152-01A1 (U.S. NIH Grant/Contract)

Details and patient eligibility

About

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.

Full 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.

Enrollment: 7,192 patients

Sex: All

Ages: 6 to 12 years old

Volunteers: No Healthy Volunteers

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

Trial design

7,192 participants in 2 patient groups

Weight-status improved

Description:

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).

Treatment:

Other: Attention to high-BMI-related Medical Risk

Other: No attention to high BMI or high-BMI-related medical risk

Other: Attention to BMI

Weight-status unchanged/worse

Description:

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).

Treatment:

Other: Attention to high-BMI-related Medical Risk

Other: No attention to high BMI or high-BMI-related medical risk

Other: Attention to BMI