P2.K201: Optimizing Infant and Toddler Feeding for Obesity Prevention

Purpose/Objectives: Obesity prevalence in U.S. children between 6-11 years old has more than tripled from 4% to 15% between 1963-2000 and subsequently rising to 19% from 2017-2020. Despite a deceleration in obesity prevalence in children younger than 6 years of age, there have been continued increases among certain populations, including adolescents, lower socioeconomic status, and non-Hispanic Black and Mexican-American. Obesity originating early in life is predictive of obesity in adulthood. However, early healthy and active-living patterns beginning from preconception through 2 years of age influence the development of a children’s future risk for obesity. Therefore, in collaboration with the American Academy of Pediatrics (AAP), a team at the University of New Mexico set out to implement interventions beginning from the pre- and peri-natal period that foster healthy behaviors and healthy weight in children from birth to 2 years including nutrition, supportive environments, and responsive relationships.

Design/Methods: Using quality improvement (QI) methodology from January to September 2023, the QI team conducted retrospective medical record reviews to collect de-identified data elements from birth to age 2-year well-child visits as determined by the AAP. Baseline and ongoing data collection identified gaps from the AAP pre-determined benchmarks and informed Plan, Do, Study, Act (PDSA) cycles targeting improvements. PDSA cycles 1 and 2 occurred from February to May 2023. The sustainability maintenance period started in May 2023 through September 2023.

Results: Baseline data from 15 pediatric primary care providers indicated the greatest gaps from the AAP benchmarks were in the pre- and peri-natal risk factor screening and social determinants of health (SDH) screening and education categories (see Table 1). Pre- and peri-natal risk factor screening progressively increased from baseline (0%) to cycle 2 (25%) and increased during the sustainability monitoring period (median 38%), but never reached the AAP benchmark (70%). SDH screening increased from baseline (85%) and cycle 1 (85%) to cycle 2 (90%). SDH education increased from baseline (5%) to cycle 1 (23%) to cycle 2 (44%). Both SDH screening (median 80%) and education (median 73%) remained consistently above the AAP benchmark (50%) during the sustainability monitoring period (see Figure 1).

Conclusion/Discussion: Supporting early obesity prevention is critical to promote healthy weight trajectories and overall wellbeing. Participation in this project offered opportunities for identifying risks and developing interventions that have potential for a positive life-long impact on childhood weight. Ongoing data monitoring and workflow process revisiting was necessary to maintain sustainability. However, interoperability hardwired in the electronic medical record prompting providers holds more promise for long term sustainability.