Clinical practice and variation in care for childhood obesity at seven clinics in California

Qual Prim Care. 2012;20(5):335-44.


Background: The Healthy Eating Active Living TeleHealth Community of Practice is a virtual quality-improvement learning network of seven rural clinics in California. The goal of this network is to improve childhood obesity prevention and management practices at participating clinics.

Aim: Our objective is to describe clinical practices regarding weight assessment and nutrition and physical activity counselling at participating clinics before implementation of the quality improvement intervention.

Methods: Participants were 2-11 year old children seen for well-child care in 2010. Telephone surveys of English and Spanish-speaking parents were conducted within three days of their child's well-child visit to determine the content of counselling during the visit regarding nutrition and physical activity. Medical record reviews were conducted to determine clinicians' assessment of weight status.

Findings: Twenty-seven clinicians conducted 144 well-child visits included in the study. Body mass index (BMI) was documented in 71% of medical records. Fewer than 10% of medical records had documentation of weight category. Sixty-nine percent of parents received counselling on physical activity and 62% reported receiving counselling on fruit and vegetable intake. Parents were counselled less frequently on breakfast intake, sweetened beverages, television and family meals. Parents of overweight/obese children did not receive more counselling than parents of children with a healthy BMI. Clinician-level effects accounted for moderately large amount of variation in counselling, but accounted for smaller variation in documentation of BMI and weight category. There was high between-clinic variation in documentation practices, with 54% of the total variance for documentation attributable to clinic-level effects.

Conclusions: Rural clinicians, like those elsewhere, do not uniformly assess BMI percentile or counsel families on behavioural risk factors for paediatric obesity. There exists considerable clinician-level variation in counselling practices and clinic-site level correlation in documentation practices related to BMI percentile and weight category.

Publication types

  • Research Support, U.S. Gov't, P.H.S.

MeSH terms

  • Body Mass Index
  • California
  • Child
  • Child, Preschool
  • Counseling / methods*
  • Counseling / statistics & numerical data
  • Cross-Sectional Studies
  • Diet
  • Female
  • Health Care Surveys
  • Health Promotion / methods*
  • Health Promotion / statistics & numerical data
  • Humans
  • Male
  • Motor Activity
  • Multivariate Analysis
  • Obesity / prevention & control*
  • Obesity / therapy
  • Practice Patterns, Physicians' / standards*
  • Practice Patterns, Physicians' / statistics & numerical data
  • Professional-Family Relations
  • Rural Health Services
  • Workforce