Children whose families and pediatricians were most faithful to an obesity intervention program that included computerized clinical decision support for physicians and health coaching for families experienced the greatest improvements in body mass index (BMI), according to an article published online by JAMA Pediatrics.
The prevalence of childhood obesity in the United States remains at historically high levels. Clinical approaches that are cost-effective and scalable for obesity reduction in children are a public health priority. However, interventions to improve BMI in children have not proven effective in the context of primary care, according to the study background.
Elsie M. Taveras, M.D., M.P.H., of Massachusetts General Hospital for Children, Boston, and coauthors conducted a three-arm clinical trial that enrolled 549 children (ages 6 to 12) with BMIs at the 95 percent percentile or higher from 14 primary care practices from October 2011 through June 2012.
Five practices (194 children) were assigned to receive clinical decision support (CDS) tools where the existing electronic health record was modified to alert pediatricians to a child with a high BMI and provide links to growth charts, obesity screening guidelines and referrals for weight management programs. To support behavior change in families, pediatricians also provided educational materials and follow-up visits focused on behaviors changes, including decreasing screen time, less consumption of sugar-sweetened beverages, more exercise and sleep.
In five additional practices (171 children), the intervention included CDS tools plus a health coach was assigned to work with the families via telephone, text message and email support. The remaining four practices (184 children) were assigned to usual care, which was the standard care offered by the current pediatric office with no CDS tool for obesity.
The study found that children who had the greatest improvement in BMI were those whose families and pediatricians participated in, and were most faithful to, the intervention that included CDS tools in pediatric practices and health coaching for the family.
Results indicate that compared with participants who received usual care, participants who were the most faithful to the CDS plus coaching intervention had the greatest improvements in BMI (reduction of 0.53). Participants less faithful to the intervention did not improve their BMI.
Overall, BMI increased less in children in the CDS intervention during one year (a reduction of 0.51) and the CDS plus health coaching intervention resulted in a smaller magnitude of BMI improvement (reduction of 0.34) compared with usual care. However, at one year, no differences were found among the study groups in follow-up visits for weight management, according to the study.
“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 study concludes.
(JAMA Pediatr. Published online April 20, 2015. doi:10.1001/jamapediatrics.2015.0182.