587 - Barriers to the Identification and Treatment of Rural Children with Overweight or Obesity

Publication Number: 4575.587

Paul M. Darden, University of Oklahoma College of Medicine, Oklahoma City, OK, United States; Sarah E.. Hampl, Children's Mercy Hospitals and Clinics, Kansas City, MO, United States; James Roberts, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Ellen Kerns, University of Nebraska Medical Center, Omaha, NE, United States; Russell J. McCulloh, University of Nebraska Medical Center, Omaha, NE, United States; Ashley Weedn, University of Oklahoma College of Medicine, Edmond, OK, United States; Missy McCullough, OPHIC/ University of Oklahoma, Skiatook, OK, United States; Cortney Cherry, University of Oklahoma College of Medicine, Broken Arrow, OK, United States; Shannon Cabaniss, Medical University of South Carolina College of Medicine, Charleston, SC, United States; Megan Olalde, University of Kansas Medical Center, Kansas City, KS, United States; Emily Frankel, University of Nebraska College of Medicine, Omaha, NE, United States; Ann M. Davis, Center for Children's Healthy Lifestyles & Nutrition; University of Kansas Medical Center, Kansas City, KS, United States

Background: Overweight and obesity disproportionately affect children living in rural America. Treatment for overweight and obesity depends upon recognition and tracking over time. A key tool is BMI percentile (BMI%ile) growth charts; the CDC BMI%ile growth charts for children released in 2000 (CDC 2000) do not provide the data needed for classification and tracking of most children with obesity.

Objective: To identify processes and experience in diagnosing and treating rural children with overweight and obesity in primary care clinics.

Design/Methods: In an obesity related clinical trial in 4 states (Kansas, Nebraska, Oklahoma and South Carolina) and 16 clinics that care for rural children, we interviewed the clinic manager about obesity related resources, billing and practices. We audited a random sample of medical records, goal of 80, in each of 13 clinics for two time periods (1/2 in each period) July to December 2024 and January to June 2025 based on a visit within the last month of that period. Charts were eligible for review if the child was 6-11 years, BMI%ile ≥ 85, rural and followed in that clinic for ≥ 1 year and had a visit in the last month of the time period. We only reviewed the most recent well check or obesity related visit, if present, within that 6 months. Statistical testing used Chi-Square.

Results: All 16 clinics reported using BMI%ile growth charts with 12 (80%) using CDC BMI%ile growth charts from 2000 (CDC 2000). Four (25%) reported no billing issues, 1 (6%) reported multiple, 2 (13%) did not bill obesity related codes and 8 (50%), clinics from all states, reported that obesity related ICD10 codes were not reimbursed. We reviewed 919 eligible medical records from 13 clinics, 841 (92%) had a growth chart present, with 66% a CDC 2000, 558 (61%) had a diagnosis of well child and/or obesity in the last 6 months; 234 (42%) well child only, 75 (13%) obesity only and 249 (45%) both well child and obesity. Of 386 patients with an obesity diagnosis 83% had only a Z code, 11% had an E code and 5% had both E and Z codes. Only 46 (8%) patients had a planned follow-up ordered for overweight or obesity. Patients with a follow-up for overweight or obesity were more likely to have a diagnosis of obesity (87% (N=40) versus 13% (N=6), P<.01).

Conclusion(s): Multiple related issues impede recognition and treatment of rural children with overweight and obesity. Areas for improvement include updating EHRs with new extended BMI-for-age growth charts, provider training and insurer recognition of recommended ICD-10 codes for obesity and provider support for implementing guideline-based treatment.