Implementation of a Childhood Obesity Toolkit to Improve Provider Knowledge and Adherence to Clinical Practice Guidelines in Pediatric Primary Care

In the United States, 14.7 million children and adolescents fall into the obese category, making obesity one of the most common chronic childhood diseases (Karas et al., 2024). More alarmingly, in North Carolina (NC), 17.3% of children ages 10 to 17 are considered obese, ranking North Carolina 33 of 50 states for highest obesity rates from the years 2021 to 2022 (Robert Wood Johnson Foundation, 2022). Common risk factors associated with developing childhood obesity include parental obesity, low income, maternal weight gain during pregnancy, increased intake of calorie-dense foods, increased screen time before 2 years of age, and sedentary behavior (Jimenez & Littlejohn, 2023). In 2023, the American Academy of Pediatrics (AAP) released their first clinical practice guideline (CPG) focused on evidence-based management of children and adolescents with overweight and obesity (Hampl et al., 2023). For many years, primary care providers have been recognized as playing an important role in the prevention and management of childhood obesity (Patel et al., 2021). However, management of childhood obesity and implementation of associated CPGs varies greatly between providers, leading to a large variation in patient care and poor patient outcomes (Snyder et al., 2024). The selected intervention for the quality improvement project was implementation of an evidence-based provider toolkit to improve provider knowledge and adherence to clinical practice guidelines for the management of childhood obesity at a pediatric primary care clinic in Wilson, North Carolina. Provider knowledge was measured through a pre and post-intervention provider survey. From strongly agree (5) to strongly disagree (1), self-reported provider knowledge on current clinical practice guidelines for diagnosing childhood obesity increased from 4.6 pre-intervention to 4.8 post-intervention, and increased from 4.3 to 4.7 for the management of childhood obesity. Provider adherence to clinical practice guidelines was measured through toolkit use and the documentation of ICD-10 Z codes for nutrition and physical activity counseling and BMI-for-age percentiles. Results showed an increase in toolkit use from 0% to 95%, an increase in nutrition and physical activity Z code documentation from 0% to 64%, and an increase in BMI-for-age percentile Z code documentation from 88% to 92%.