Primary Care Clinician-focused EHR Program Found Effective in Helping Children Achieve Healthy Weight

An electronic health record (EHR) program developed to assist primary care providers in managing children with overweight/obesity was found effective in promoting positive body mass index (BMI) trends, particularly among younger children, according to a new study.

Findings come from a University of Missouri School of Medicine study that examined the effectiveness of the FitTastic EHR-based tool over a mean follow-up period of 4 years.

“Childhood obesity is a growing problem in Missouri and across the country which has been exacerbated by the COVID-19 pandemic,” said principal investigator Amy Braddock, MD, associate professor of clinical family and community medicine, in a university press release. “Over 30% of children in this country meet criteria for obesity or being overweight. Primary care providers have an opportunity to play a pivotal role in providing screening and counseling for obesity, and we wanted to test the long-term effectiveness of FitTastic as a tool to help in this effort.”

FitTastic was developed in 2011 to support primary care clinicians and health care teams in communicating with families/caregivers about the following lifestyle behaviors:

• Aim for at least 1 hour/day of physical activity
• Limit screen time to ≤2 hours/day
• Consume 3 servings/day of low-fat milk or calcium
• Drink at least 4 servings/day of water instead of sugary drinks
• Consume at least 5 servings/day of fruits and vegetables

The FitTastic intervention includes regular assessment of the 5 lifestyle behaviors, an EHR interface that supports clinicians with the behavior and BMI assessment for use in goal-setting with the family, discussion of the FitTastic goals by provider, and goal-matched educational handouts and participation incentives (eg, frisbee, water bottle).

Noting the need for a control comparison and longitudinal outcomes data to better understand the EHR tool’s impact on child BMI long-term, Braddock and colleagues conducted a controlled multiyear effectiveness study of the use of the FitTastic tool compared with usual care on the BMI pattern of 291 children (179 intervention, 112 control) aged 2 to 17 years.

The team used standardized Centers for Disease Control and Prevention algorithms to calculate BMI. Approximately 69% of participants had a healthy BMI percentile (BMI% 5-84th) and 31% had a BMI percentile consistent with overweight or obesity (BMI% ≥85th) at baseline.

“We found a nearly 20% more favorable BMI pattern in the FitTastic group compared to the control group when looking specifically at children who were either overweight or obese,” noted Braddock in the release. “The data was especially favorable for younger children, between the ages of two and five-years-old.”

Per X² analysis, results showed that a greater proportion of children with baseline overweight/obesity at FitTastic sites than control sites had a favorable BMI pattern (32% vs 13%, P=.03). In multivariable adjusted analyses limited to the subsample with overweight/obesity, compared with control children, those in the FitTastic group had 3.8 times the adjusted odds of having a favorable BMI pattern (95% CI, 1.1-13.2).

“The marriage of clinic-based interventions and EHR data assessment offers the opportunity for significant innovation and can be useful for partnering health care teams and families in the important tasks of setting positive, family-centered healthy lifestyle goals,” concluded Braddock. “FitTastic is the first of hopefully many new and exciting technologies to support physicians working with families to promote positive health behaviors. Only by developing creative new approaches that improve the environments that our children live in can we expect to curb the child obesity epidemic.”

Reference: Braddock A, Koopman RJ, Smith J, et al. A longitudinal effectiveness study of a child obesity electronic health record tool. J Am Board Fam Med. 2022;35:742-750. doi:10.3122/jabfm.2022.04.210385