Quality Improvement in Childhood Obesity Management

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Overview of the problem and the setting in which the problem or issue occurs

Childhood obesity affects nearly one in every three kids worldwide. In America, childhood obesity has increased almost three times since 1970. The increase is because practically all children spend at least seven to eight hours on screen, thus making them less engaged in activities supporting better lifestyles and feeding habits. Hu & Staiano (2022) reviewed statistics from the Centre for Disease Control (CDC) and observed that data from 2017 to 2020 indicated that 19.7% of children between the ages of 2 years and 19 years were affected by obesity. Further data from the covid pandemic period suggests that childhood obesity has increased by 3% (Hu & Staiano, 2022). Although lack of proper exercise is the main problem with childhood obesity, other factors such as race, income level, education level, and location appear to have also contributed to the increase in childhood obesity.

Besides the chief causes of childhood obesity, including lack of exercise and poor nutrition, genetics, environmental factors, and social and economic status, underlying conditions and stress appear to cause childhood obesity. Obesity not only does it lead to unwanted body weight but also leads to outcomes such as high blood pressure, diabetes, cholesterol, asthma, and fatty liver disease. Apart from the physical and physiological complications, obesity can cause childhood trauma closely related to issues such as bullying, depression, isolation and low self-esteem. 

Why a quality improvement initiative is needed in this area and the expected outcome.

The American Academy of Pediatrician (AAP) usually offer an evidenced-based approach to solving obesity management. However, the recommendation has not been adopted widely by healthcare practitioners. Tee et al. (2020) note that obesity is considered a sex and age body mass index problem, and one is considered obese if one exceeds the 95th percentile body mass index (BMI). The American academy of pediatricians recommends that in the standard care of children, practitioners should look at least measure and record the child's BMI in addition to screening obesity multimorbidity conditions. To assess this condition, the association directs that nurses collect fasting glucose and fasting lipids among children between two and eighteen years to evaluate obesity. Other associations, such as the Endocrine Society, recommend that healthcare workers use hemoglobin AIC to check for obesity-related issues. According to AAP providing medical screening is the first stage, and the second stage involves advising the proper reinforcement of healthy behaviors in a staged approach.

Further, this behavior change approach should be followed by contact behavior treatment at a rate of twenty-six hours per week. Despite these recommendations, it has been found that healthcare workers have not followed and implemented this program consistently. Also, other challenges witnessed was that more pediatricians were likely not going to discuss family-related behavior that contributed to obesity or any other obesity-related ailment. When most pediatricians were interviewed about the reasons for not following the guidelines, they cited lack of training on obesity management and lack of reimbursement on nutritional-related counseling as the main barriers to following and implementing the obesity management guidelines.

How the results of previous research demonstrate support for the quality improvement initiative and its projected outcomes.

Satti et al. (2021) performed a quality improvement assessment on children with obesity management guidelines. Their study highlighted how different factors interacted to limit the provision of quality obesity management programs. In performing the evaluation, they first focused on a few perspectives and later introduced the quality improvement program. To complete the assessment, the team conducted a list review through a chart of about 417 patients who had visited the clinic about six months before. To measure adherence to the program, they measured it as a benchmark against the following; first, patients who had obesity o the hospital problem list. Second, laboratory services, counseling services, time and type of follow-up, and referral to a weight management program. To improve the program, the study first educated health providers about the obesity management guidelines provided by the AAP. Later, they provided recommendations for strengthening obesity-related care systems. Upon implementing the suggestion, the team reported a decline in the number of reported obesity problems; there was an improvement in the number of patients recommended to undertake obesity tests. 

Semlitsch et al. (2019) performed a cross-industry and across-the-world assessment of whether there were globally accepted standards for managing obesity among children and young adults. The idea was to create a widely accepted way to recommend to all practitioners how to improve obesity management. The authors noticed that there were over 711 recommendations and 19 guidelines that outlined how to manage obesity. However, all of these recommendations agreed that obesity should be viewed as a chronic disease and that body mass index (BMI) should be used for diagnosis. To manage obesity, the team should adopt a multifactorial approach that includes reduced calorie intake, improved physical activities, and a measure of behavioral changes between 6 and 12 months. Also, long-term measures for weight control, such as bariatric surgeries, can be explored for people with BMI above 35kg/m2. To perform this assessment, the team performed web scrapping of the database and then completed an exploratory data analysis to determine the level of occurrence of the intervention recommendations.

In their study, Kaufman et al. (2020) suggest that tracking obesity-related healthcare symptoms and the associated problem should move beyond traditional growth charts to using newer electronic health systems. The study suggests that to address the obesity problem in an evidence-based strategy; healthcare workers should begin by assessing the children's weight; however, most discussions around weight have been ignored. Healthcare providers should provide counseling and support and work with patients' families to mitigate these strategies. The study suggests that behavior management is the best approach, unlike focusing on weight loss diets. 

Steps necessary to implement the quality improvement initiative. 

Pediatricians can help reduce childhood obesity in a step-wise approach that reflects the recommendations of the AAP. The step-wise approach includes; child weight management through chart recording or electronic data recording, focusing on child factors such as sedentary activity, family factors such as nutritional knowledge, and community factors such as social and economic status and ethnicity. Childhood obesity can be managed in the following ways;

First, they can perform screening and early obesity identification. At this step, routine and systematic screening of all growth parameters should be conducted. Height and weight assessments can be undertaken to understand the relationship to BMI. Further classification of these measurements can help categorize children into different obesity classes, thus aiding in monitoring other health-related conditions that may arise. The second step is to support children with obesity while mitigating bias and stigma. Primary caregivers must offer these families that they are their first line of support in providing understanding and solutions and being nonjudgmental while discussing care and weight loss. These caregivers must first familiarize themselves with the code of conduct for handling weight and the biases associated so that they can have an all-inclusive approach when helping families and their patients to cope with weight loss discussions. The third step is to train families on behavior change. Families should be instructed on maintaining proper family nutrition plans and physical and mental health. Aspects such as mental state like temper affect the ability to gain weight, and also, in most cases, people who had lost weight regain weight between six and twelve months due to changes in nutrition programs. This training on weight loss should be accompanied by motivational interviewing, where families are made to list goals for losing weight and encourage them to lose weight. The last step is adopting weight loss interventions through bariatric surgery or programs. Furthermore, this weight loss program can also be accompanied by medication. Introduction to medication such as metformin helps to promote weight loss, especially among children with impaired glucose tolerance.

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How the quality improvement initiative will be evaluated to determine whether there was an improvement.

To determine if there was an improvement in adherence to obesity management guidelines. The two guidelines we will check performance against are improvement in training and education sessions by clinic staff on patients. To check compliance, we will focus on the number of training performed. Also, we will assess the progress of delivering quality behavioral change advice and training through the pediatric tool kit and the growth chat. To evaluate the improvement, we will adopt a sample of 100 patients. Fifty patients will be pre-intervention, while the other 50 will be post-intervention. The pre-implementation patients will be those with a recorded BMI greater than 85 percentiles. These will form the baseline of our assessment. For the post-implementation patients, we expect the implementation to have an impact. Therefore the level of BMI we will implement will be different in that we will adopt patients with a BMI range between 25 and 85 with the age bracket between 2 and 18 years until we attain a total of 50 charts. Other than BMI, we might consider different demographics in the evaluation, including age, race or ethnicity, gender, and progress reports.

Support your explanation by identifying the variables, hypothesis, and statistical tests.

We adopted descriptive statistics to evaluate basic demographics' percentage, mean, median and standard deviation. Percentage and comparison mean will be used to document all variables' pre and post-intervention. The three objectives of the quality improvement guidelines will be to achieve the following objectives: first, to improve the attendance of educational training sessions. Second to show improvement in behavior and care process, and third to show progress in identifying and managing childhood obesity. For variables such as weight, age, gender, height, and body mass index percentiles, statistics such as frequency, mean, and central tendency measures will be analyzed. There are datasets such as risk factors, diagnosis, and related health conditions that will be used to meet the objectives and appear as ordinal or nominal data; therefore, descriptive statistics will be employed to describe aspects such as frequency and mean.  

 References

Getman, A. I., Goryunov, M. N., Matskevich, A. G., & Rybolovlev, D. A. (2021). Methodology for collecting a training dataset for an intrusion detection model. Proceedings of the Institute for System Programming of the RAS, 33(5), 83–104. https://doi.org/10.15514/ispras-2021-33(5)-5 

Hu, K., & Staiano, A. E. (2022). Trends in obesity prevalence among children and adolescents aged 2 to 19 years in the US from 2011 to 2020. JAMA Pediatrics, 176(10), 1037. https://doi.org/10.1001/jamapediatrics.2022.2052 

Kaufman, T. K., Lynch, B. A., & Wilkinson, J. M. (2020). Childhood obesity: An evidence-based approach to family-centered advice and support. Journal of Primary Care & Community Health, 11, 215013272092627. https://doi.org/10.1177/2150132720926279 

Satti, K. F., Tanski, S. E., Jiang, Y., & McClure, A. (2021). Improving care for childhood obesity: A Quality Improvement initiative. Pediatric Quality & Safety, 6(3). https://doi.org/10.1097/pq9.0000000000000412 

Semlitsch, T., Stigler, F. L., Jeitler, K., Horvath, K., & Siebenhofer, A. (2019). Management of overweight and obesity in primary care—a systematic overview of international evidence‐based guidelines. Obesity Reviews, 20(9), 1218–1230. https://doi.org/10.1111/obr.12889 

Tee, J. Y., Gan, W. Y., & Lim, P. Y. (2020). Comparisons of body mass index, waist circumference, waist-to-height ratio and a body shape index (ABSI) in predicting high blood pressure among Malaysian adolescents: A cross-sectional study. BMJ Open, 10(1). https://doi.org/10.1136/bmjopen-2019-032874