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

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.

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