TOP 14 - Plotting Progress: Improving Recognition and Education for Patients with Elevated BMI admitted to the Pediatric Hospital Medicine Service

Publication Number: 3742.TOP 14

Caitlin I. Toney, UC San Diego/Rady Children's Hospital, Encinitas, CA, United States; Chloe Kupelian, Rady Children's Hospital San Diego, San Diego, CA, United States; Amy Z. Chong, UC San Diego/Rady Children's Health San Diego, Boston, CA, United States; Heather Pierce, Rady Children's Hospital/UCSD, San Diego, CA, United States

Background: Nationally, children with body mass index (BMI) ≥ 95th% have tripled over the last three decades. Children with elevated BMI may be at risk for chronic health problems, adverse psychosocial effects, and increased healthcare utilization (~$14 billion/year). Prior studies have shown suboptimal recognition of elevated BMI. In a retrospective multicenter study, only 13.2% of hospitalized children who had clinical obesity (19.5%) received an appropriate obesity diagnosis.

Objective: To increase the percentage of non-tube fed patients on the pediatric hospital medicine service (PHM) with BMI >85% to have the diagnosis added to problem list, receive standardized discharge education, and evidence-based follow-up plan communicated to the primary care physician (PCP) from 0% to 80% by 5/31/2026.

Design/Methods: Stakeholders from PHM, primary care and specialty groups completed an Ishikawa Diagram (Figure 1) to identify barriers in education for patients with elevated BMI and Key Driver Diagram (Figure 2) outlining project drivers. Measures include percentage of patients with 1) elevated BMI added to problem list, 2) written discharge education with resources, and 3) communication of follow-up plan to PCP. Balancing measures include increased Nutrition referral burden. Interventions include: 1) Our Practice Advisory (OPA) in the EHR to improve identification of elevated BMI; 2) DC education packet using patient-inclusive language; 3) DC Summary template providing PCP guidance using AAP Obesity Clinical Practice Guidelines (CPG). Baseline data assessed utilization of current Our Practice Advisory (OPA) prior to interventions (Figure 3b). Our baseline is 0% for all outcome measures. Reviewing baseline data from November 2024 to September 2025, the prior OPA had baseline 70% for adding "obesity" or "overweight" to the problem list (Figure 3). Eligible patients ranged from 34-58 per month. Nutrition consults were placed 14% at baseline for "overweight/obesity". The revised OPA (Figure 3b) ensures diagnoses on the hospital problem list align with updated obesity classifications outlined in CPG. We collaborated with specialists from multiple disciplines to create a standardized DC education packet. The EHR DC summary template incorporates recommendations from the CPG relayed to the PCP. Data collection is underway and reviewed monthly. In the coming months, we aim to show improvement in identifying patients admitted to the PHM service with elevated BMI, provide standardized weight-inclusive education to patients and families, and communicate evidence-based recommendations for follow-up to the PCP.

Figure 1. Ishikawa Diagram
Identifying Barriers in Providing Education for Patients with Elevated BMI

Figure 2. Key Driver Diagram
SMART Aim, Key Drivers, and Interventions

Figure 3. Our Practice Advisory: Baseline Data and Examples
Figure 3a_3b.pdfFigure 3a. Elevated BMI Added to the Hospital Problem List Using Current OPA/Figure 3b. Baseline OPA vs Intervention OPA Revision with BMI classifications