O1030: Implementing the 2023 Clinical Practice Guideline for the Assessment and Treatment of Pediatric Obesity in a busy Residency Practice

Purpose/Objectives: Obesity is a complex, multifactorial, public health issue affecting 26% of US adolescents. Guidelines recently published by the AAP provide a much needed update on the evaluation and management of obesity in children and adolescents. But can these guidelines be incorporated in a busy residency practice with 80+ providers? The Academic General Pediatric (AGP) Resident Clinic HDVCH participated in a national QI project with the American Academy of Pediatrics Institute for Healthy Childhood Weight. Our aim was to improve adaption of evidence based guidelines; this QI project specifically focused on the identification and evaluation of obesity and overweight status.

Design/Methods: Our outpatient residency clinic collected data across 4 cycles in a 25-week collaborative period for comparison. In each cycle, data was obtained from 15 random well child visits and 20 charts classified as overweight or obese, ages 2-18 years. Charts were evaluated for documentation and classification of BMI percentiles, assessment of lifestyle behaviors, social determinants of health, and preventative counseling. We noted if providers evaluated for comorbidities including hypertension, dyslipidemia, and diabetes, how often comprehensive histories and physicals were performed, including evaluation for sleep apnea, polycystic ovarian syndrome, depression, musculoskeletal disease, idiopathic intracranial hypertension, and nonalcoholic fatty liver disease, and whether or not a targeted weight treatment plan was created with the patient. We ran many educational events for the residents, including a grand rounds on the new guidelines, a skills day in motivational interviewing and morning report discussing algorithms for when laboratory assessments are indicated.

Results: AGP clinic reviewed 4 cycles of data and noted an increased rate at which severe obesity was identified at well child visits from 0 to 66%. When lipid screening was indicated, the clinic successfully obtained labs 70% of the time during cycle 4, compared to 12.5% in cycle 1. When indicated, liver function tests were ordered more frequently with a steady increase to 50% by the 4th cycle. There was a slight increase in cycle 2 in the evaluation for hypertension in overweight and obese patients. Providers in the clinic also showed an increase from 20 to 70% in how often they developed a treatment plan with patients with overweight and obesity.

Conclusion/Discussion: The 2023 American Academy of Pediatrics clinical practice guideline for the evaluation and treatment of pediatric obesity is a tool designed to screen patients early and initiate prompt treatment of this complex chronic disease. With appropriate education for primary care providers on the classification of obesity, motivational interviewing, comorbidities and laboratory assessments required for screening, primary care providers can make improvements to ensure the well child exam is designed to improve outcomes. We were able to increase adaption of the AAP guidelines within a busy residency practice.