Identification and assessment of overweight, obesity and hypertension in school based health centers

Given the number of adolescents who are overweight and the associated co-morbidities, Christiana Care School Based Health Centers decided to incorporate the practice of calculating BMIs and obtaining blood pressures on students who seek medical care at the centers to identify, treat and refer overweight students as well as those with hypertension and pre-hypertension. The goal of the project was to increase consistency with incorporating the calculation of BMIs and obtaining blood pressures on students who seek medical care. A letter and information sheet was developed for students and parents giving them feedback on the status of their BMI, blood pressure and facts on hypertension and obesity. An algorithm was developed to refer students who were overweight, or had abnormal BP to the centers' dietitians, center nurse practitioners and/or primary care physicians(PCPs). A letter was also developed for primary care physicians explaining the purpose of the project and providing a brief review of the recommendations for further evaluation. Providers were trained in motivational interviewing techniques to better counsel students about their BMI and BP. A data base was created to collect the data. In the first two years, 3085 students were assessed. As a result of the project, there has been an increase in the number of students referred to the dietitians and to their PCPs. With this project we were able to develop a systematic approach to identify students with an elevated BMI and/or blood pressure and refer them for additional care.