Among children hospitalized for acute problems, comorbid obesity is commonly unaddressed. The objective was to improve identification and initial management of obesity among hospitalized children. In collaboration with nurses and dietitians, pediatric hospitalists of 2 children’s hospitals conducted a quality improvement project to improve body mass index (BMI) documentation, obesity diagnosis, diet, and nutrition consultation through clinician education, development of computerized clinical decision-support system tools, and workflow modifications. Participants received monthly performance feedback. Among those with elevated BMI, diagnosis rose to 70.2%; a documented obesity diagnosis was associated with being 35 times more likely (P < .001) to receive at least 1 intervention while hospitalized. Participants reported an increase in skill in (27%), comfort with (27%), and knowledge of (33%) obesity management. Improvement in health care provider recognition and management of obesity in the inpatient setting is achievable. Additional work is needed to identify how best to sustain desired practice patterns.
YoungKLDemeuleMStuhlsatzK, et al. Identification and treatment of obesity as a standard of care for all patients in children’s hospitals. Pediatrics. 2011;128(suppl 2):S47-S50.
HoweEEWrightSMLandisRKisuuleF.Addressing obesity in the hospitalized patient: a needs assessment. South Med J. 2010;103:500-504.
6.
McLeanKWakeMMcCallumZ.Overweight in medical paediatric inpatients: detection and parent expectations. J Paediatr Child Health. 2007;43:256-261.
7.
O’ConnorJYoudeLSAllenJRBaurLA.Obesity and under-nutrition in a tertiary paediatric hospital. J Paediatr Child Health. 2004;40:299-304.
8.
WooJGZellerMHWilsonKIngeT.Obesity identified by discharge ICD-9 codes underestimates the true prevalence of obesity in hospitalized children. J Pediatr. 2009;154:327-331.
9.
JelalianEBoergersJAldayCSFrankR.Survey of physician attitudes and practices related to pediatric obesity. Clin Pediatr (Phila). 2003;42:235-245.
10.
StoryMTNeumark-StzainerDRSherwoodNE, et al. Management of child and adolescent obesity: attitudes, barriers, skills, and training needs among health care professionals. Pediatrics. 2002;110(1, pt 2):210-214.
11.
HesslerKSiegristM.Nurse practitioner attitudes and treatment practices for childhood overweight: how do rural and urban practitioners differ?J Am Acad Nurse Pract. 2012;24:97-106.
12.
SehgalNLWachterRM.The expanding role of hospitalists in the United States. Swiss Med Wkly. 2006;136:591-596.
13.
KisuuleFMinter-JordanMZenilmanJWrightSM.Expanding the roles of hospitalist physicians to include public health. J Hosp Med. 2007;2:93-101.
14.
Institute of Medicine. Recommendations from the future of public health. In: The Future of the Public’s Health. Washington, DC: National Academies Press; 2003:411-420.
15.
SleeperEJArizaAJBinnsHJ.Do hospitalized pediatric patients have weight and blood pressure concerns identified?J Pediatr. 2009;154:213-217.
16.
KatzowMHomelPRheeK.Factors associated with documentation of obesity in the inpatient setting. Hosp Pediatr. 2017;7:731-738.
17.
TurerCBBarlowSEMontañoSFloresG.Discrepancies in communication versus documentation of weight-management benchmarks: analysis of recorded visits with Latino children and associated health-record documentation. Glob Pediatr Health. 2017;4:2333794X16685190.
18.
van der Baan-SlootwegOBenningaMABeelenA, et al. Inpatient treatment of children and adolescents with severe obesity in the Netherlands: a randomized clinical trial. JAMA Pediatr. 2014;168:807-814.
19.
HoMGarnettSPBaurL, et al. Effectiveness of lifestyle interventions in child obesity: systematic review with meta-analysis. Pediatrics. 2012;130(6):e1647-e1671.
20.
HuangJSChunSCheungCPoonLTerronesL.The nutritional value of food service meals ordered by hospitalized children. Clin Nutr ESPEN. 2016;15:122-125.
21.
BradfordKKihlstromMPointerISkinnerACSlivkaPPerrinEM.Parental attitudes toward obesity and overweight screening and communication for hospitalized children. Hosp Pediatr. 2012;2:126-132.
22.
HernandezRGChengTLSerwintJR.Parents’ healthy weight perceptions and preferences regarding obesity counseling in preschoolers: pediatricians matter. Clin Pediatr (Phila). 2010;49:790-798.
23.
WilfleyDEKassAEKolkoRP.Counseling and behavior change in pediatric obesity. Pediatr Clin North Am. 2011;58:1403-1424.
24.
SavinonCTaylorJSCanty-MitchellJBlood-SiegfriedJ.Childhood obesity: can electronic medical records customized with clinical practice guidelines improve screening and diagnosis?J Am Acad Nurse Pract. 2012;24:463-471.
25.
RattayKTRamakrishnanMAtkinsonAGilsonMDraytonV.Use of an electronic medical record system to support primary care recommendations to prevent, identify, and manage childhood obesity. Pediatrics. 2009;123(suppl 2):S100-S107.
26.
DrydenEMHardinJMcDonaldJTaverasEMHackerK.Provider perspectives on electronic decision supports for obesity prevention. Clin Pediatr (Phila). 2012;51:490-497.
27.
BordowitzRMorlandKReichD.The use of an electronic medical record to improve documentation and treatment of obesity. Fam Med. 2007;39:274-279.
28.
AdhikariPDParkerLABinnsHJArizaAJ.Influence of electronic health records and in-office weight management support resources on childhood obesity care. Clin Pediatr (Phila). 2012;51:788-792.
