Promising Practices and Patient-Centered Medical Neighborhoods for Childhood Obesity

Although childhood obesity affects 17 percent of children in the United States, and nearly one-quarter of these children are overweight, only a few centers in the country provide evidence-based care for these patients. The Primary Care Obesity Network (PCON) is a first-of-its-kind network of primary care providers in Central Ohio linked to the Center for Healthy Weight and Nutrition, a tertiary care obesity center at Nationwide Children’s Hospital.

The goal of PCON is to implement evidence-based obesity care by establishing a sustainable multisector collaboration between primary care practices, the tertiary care obesity center at Nationwide Children’s, and community organizations, to address childhood obesity in Central Ohio.

PCON consists of 11 primary care practices from Nationwide Children’s Primary Care Network, eight community private primary care practices, and two practices outside of Central Ohio in Marietta and Bellfontaine. This year, the Nationwide Children’s Hospital’s school-based clinics will become a part of the network and support the nurse practitioner programs to provide obesity care to students.

“Depending on their need, each of the participating primary care practices functions as either a Level 1 PCON clinic – physician only – or a Level 2 PCON clinic – a registered dietician working with the physicians,” says Ihuoma Eneli, MD, director of the Center for Healthy Weight and Nutrition at Nationwide Children’s. “The Center for Healthy Weight and Nutrition provides education and training, resources as well as administrative support.

PCON’s comprehensive care involves the application of an algorithm for the assessment and management of childhood obesity in patients 2 years and older, based on the revised American Heart Association 2007 Expert Committee. The recommendations propose four stages of obesity care, with the first two stages involving counseling by a medical provider that can be delivered in a primary care setting. Subsequent stages are more intensive, requiring more time and resources.

The algorithm outlines that primary care providers should universally assess children for obesity risk to improve early identification of elevated Body Mass Index (BMI), medical risks, and unhealthy eating and physical activity habits. This algorithm uses the current definitions of pediatric overweight (BMI >/= 85^th percentile) and pediatric obesity (BMI >/= 95^th percentile).

BMI should also be calculated and plotted at least annually, and this weight classification should be integrated with other essential information such as growth pattern, family history and presence of comorbidities to assess the child’s overall obesity risk. Recommendations include providing obesity prevention messages for all children and lifestyle interventions for those with excess weight, classified as falling above the 85 percentiles for BMI.

The expert committee recommendations for prevention and treatment include both specific eating and physical activity behaviors, which would promote maintenance of healthy weight, as well as the use of patient-centered counseling techniques such as motivational interviewing.

“Physicians and dieticians within PCON use motivational interviewing to identify patient goals, provide families with educational materials, and create an individual plan to help the patient reach his or her goal of lowering BMI,” says Candace Howell, MD, PCON physician lead for the Primary Care Network at Nationwide Children’s. “Using a combination of electronic health records and data abstraction, PCON also tracks outcomes such as patient weight, height, lifestyle behaviors and utilization rates.”

Importantly, one of the key features of PCON is the integration of the clinic setting with the community, by building sustainable relationships through an initiative called the Patient Centered Medical Neighborhood (PCMN).

“The PCMN links all patients to pertinent resources within their own community through their primary care physician’s office, regardless of whether the patient is overweight or not,” explains Dr. Howell. “These resources include community organizations such as parks, recreation centers, gyms, markets, schools, daycares, as well as policy and leadership building.”

The myriad benefits of participating in the PCMN recognize the significance of social and environmental change to reduce the obesity epidemic, while also identifying methods for health care providers and health care systems to be involved in these broader efforts..

“In summary, PCON offices provide a close-to-home treatment option for children who are at or above the 85^th percentile for BMI,” says Dr. Eneli, who is also a professor of Clinical Pediatrics at The Ohio State University College of Medicine. “The PCON program empowers participating physicians to provide treatment in the early stages of overweight or obesity and addresses population health by integrating the clinical care with community resources.”

References:

1. Barlow SE. Expert Committee Recommendations Regarding the Prevention, Assessment and Treatment of Child and Adolescent Overweight and Obesity: Summary Report. Pediatrics. 2007 Dec;120(4):S164-192.
2. American Academy of Pediatrics Institute for Healthy Childhood Weight (2015). Algorithm for the Assessment and Management of Childhood Obesity in Patients 2 Years and Older.