Childhood obesity is a major public health issue in the US, yet many interventions to improve body mass index in children have been found to be ineffective. However, a new study has suggested that an intervention program utilizing computerized health records could lead to positive results.
Childhood obesity rates have increased in recent years, with nearly a fifth of children and adolescents in the US now affected. The study, published in JAMA Pediatrics, was conducted to find out to what extent clinical decision support (CDS) for pediatric clinicians helped to improve the body mass index (BMI) and quality of care of obese children.
It appears as though there is room for improvement when it comes to dealing with childhood obesity. According to the Centers for Disease Control and Prevention (CDC), 17% of all children and adolescents in the US are affected by obesity – three times as many as were affected one generation ago.
“Despite the availability of obesity management guidelines, interventions to improve BMI in children have not proved effective in the context of primary care, and pediatric clinicians have been slow to adopt recommended screening and management practices,” write the authors.
They suggest that reliable clinical information systems could help to improve obesity management. “The use of electronic health records offers the potential for improving the quality of care for obese children and for accelerating the use of evidence on obesity screening and management by primary care clinicians,” the authors state.
Dr. Elsie Taveras of Massachusetts General Hospital for Children, Boston, and colleagues set out to trial child obesity interventions in a randomized three-arm clinical trial. A total of 549 obese children aged 6-12 from 14 primary care practices were enrolled and tracked from October 2011 to June 2012.
For one arm of the trial, five practices (194 children) had access to modified electronic health records that alerted pediatric clinicians to children with high BMIs and provided links to obesity screening guidelines, growth charts and information on weight management programs.
Pediatric clinicians also provided additional educational materials and emphasized the importance of behavioral changes during follow-up visits, such as reducing consumption of sugar-sweetened beverages and getting more exercise.
For the second arm of the trial, another five practices (171 children) gave this level of support but also assigned a health coach to work with the families of obese children by telephone, text message and email.
Finally, the remaining four practices (184 children) gave standard levels of care, with no additional CDS tools for treating obesity.
Faithful adherence to the interventions led to success
The researchers found that the children whose families and pediatricians adhered most faithfully to the intervention utilizing both CDS tools and health coaching experienced the greatest reductions in BMI, in comparison with the participants that received standard care.
Participants that were not completely faithful to the interventions did not experience improvements to their BMI.
Although the intervention that included individual coaching resulted in the greatest reductions in BMI among the most faithful participants, the researchers found that overall, BMI increased less among children receiving the intervention that used CDS tools without health coaching.
“The number of coaching sessions or their frequency or content might have been insufficient to produce greater effects than the CDS and self-guided intervention,” the authors suggest. “Future studies should determine what minimal amount of coaching is necessary to achieve improvement in childhood obesity interventions.”
The authors acknowledge that the study may be limited by the fact that the biggest improvements to BMI among the children in the highest-fidelity group could potentially be due to differences in motivation for this group rather than due to the intervention being more effective.
“We found that an intervention that leveraged efficient health information technology to provide CDS for pediatric clinicians and that provided an intervention for self-guided behavior change by families resulted in improvements in the children’s BMI,” the authors conclude.
Previously, Medical News Today reported on a study conducted in the UK that found that many parents may not be aware that their children have a weight problem unless they are extremely obese.
Last updated: 21 April 2015. By James McIntosh
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