Usual Care Protocols to Manage and Prevent Childhood Obesity at Community Centers in Los Angeles County

Background: The pediatric primary care team is well positioned to provide effective protocols to manage and prevent obesity among families of young children. Well child visits occur at least annually from ages 2 through 6 years and additional problem-oriented visits provide other opportunities to develop a relationship with the child and family. The continuity of the relationship between pediatricians and families, embodied in the concept of both “team based care” and the “medical home,” promotes receptivity to suggestions for changes in health related behaviors.  This paper examines the usual care protocols to manage and prevent childhood obesity in large community health centers in Los Angeles County.   

Methods: Choose Health LA Clinic Program is a partnership between the LA County Department of Public Health (LAC DPH) and 30 community health centers to provide clinical quality improvement training and technical assistance to enhance screening and management of pediatric obesity.  LAC DPH staff help clinics to establish formal clinical practice protocols, improve protocol implementation using the Plan Do Study Act (PDSA) method and utilize data to guide quality improvement efforts.  Prior to program implementation,  LAC DPH staff systematically documented childhood obesity usual care protocols among the pediatric and family medicine health providers and their respective care teams. 

Results: Early stages of planning showed that most, but not all,  providers screened and documented BMI at every well child and problem-oriented visit.   At those health centers that provided pediatric obesity health education programs, most reported low patient turn-out rates and very few provided a patient-centered motivational interviewing approach.  Most of the health centers did not have a co-located specialist (nutritionist or dietician) as part of the care teams, and as a result, these centers had to refer out for these services.   

Conclusions: Early baseline data shows the need that community health centers have for quality improvement training and technical assistance to enhance screening and management of pediatric obesity protocols.