Combatting Pediatric Obesity in Primary Care Facilities
Ravi Saksena, MD
Primary Care Physician
As you may know, our department has received a grant from the New York State Department of Health to improve obesity prevention in pediatric healthcare settings. Lisa Altshuler is the principal investigator of this grant. The objective of the grant is fourfold:
1) Train pediatric healthcare providers and their support staff in the Expert Guidelines for prevention, assessment, treatment of pediatric obesity.
2) Develop systems approaches to ensuring implementation of these guidelines.
3) Create office environment and resources that promotes healthy eating and activity in children from diverse cultural backgrounds.
4) Partner with community agencies to support families’ efforts at a healthy lifestyle.
Though there are several activities happening within the purview of this grant, I would like to describe, in this article, one of the newer elements. This element combines obesity prevention/treatment, resident education, as well as performance improvement. As a part of the grant, it is a requirement that we conduct a "PDSA" project. PDSA stands for "Plan, Do, Study, and Act" and refers to a systematic approach to quality improvement, wherein one first plans an intervention, then does, or implements, the intervention. After a certain time period, a study is done to measure the effectiveness of the intervention. Based on the results, one "acts" by either instituting the intervention or not.
Several of our residents have expressed an interest in partaking in our obesity endeavors. Two in particular, Danielle Fernandes and Puja Kumar, have developed a PDSA project that they are currently rolling out at the 57th Street Primary clinic, where both see their continuity patients. Every Tuesday morning, their patients receive a questionnaire upon registration, that the parents are asked to complete prior to seeing the doctor. The questionnaire consists of 5 simple items that test knowledge of the AAP’s 5-2-1-0 message (5 fruits/vegetables per day, less than 2 hours of screentime per day, 1 or more hours of physical activity per day, and 0 sugar-sweetened beverages per day).
The purpose of this PDSA is to test whether a brief, waiting-room intervention can prompt exam-room conversation about nutrition and exercise, on the doctor's end as well as the patient's. After a study period to test the viability of this project, other primary care providers will introduce the questionnaire to their panels. Danielle and Puja will collect the data and survey providers to see if it did, indeed, lead to the projected changes in practice.
With obesity rates on the rise in children, it is imperative that primary care pediatricians find ways to screen and provide prevention counseling to all families. This PDSA project is an excellent example of how generalists can provide quick and time-effective interventions that can be tested and tweaked, in order to provide the needed education to our families. The idea of PDSA also underscores the importance of never becoming complacent in what we do. In order to provide cutting-edge care to our populations, we need to keep an open mind and constantly change and test novel methods of healthcare delivery to find interventions that are effective, efficient, and up to date.
1. Do you feel your child is:
(a) underweight (b) normal weight (c) overweight (d) obese
2. How many cups (8-ounce) of sugar-sweetened beverages (example: juice, soda) do you think your child should drink in a day?
4 3 2 1 0
3. How many hours of screen time (computer, TV, videogames) do you think your child should have in a day?
4 3 2 1 0
4.How many servings of fruits and vegetables should your child have in a day?
5 4 3 2 1 0
5. How many hours of exercise should your child have in a day?
3 2 1 0