BMI-based Evaluation and Management in Children — Targeted Primary Care — Clinical Pathway: Outpatient Specialty Care and Primary Care

BMI-based Evaluation and Management in Children Clinical Pathway — Outpatient Specialty Care and Primary Care

Targeted Primary Care

Structured weight management with specific goal-setting and weight checks every 1-2 months for 6 months

  • Continue to set goals related to 5210 after initial primary care management visit, using a simple tracking sheet
    • Initially, develop only one goal related to eating, drinking, physical activity, or sedentary behavior
  • Brainstorm with family to develop a specific plan for setting and achieving goals
    • For example: "Will exercise on Mon., Wed., and Fri. from 5-6 p.m."
  • Depending on age of patient, have parent, child, or parent and child together track their progress toward specified goal using a log/tracking sheet
  • Use planned reinforcement for achieving targeted behaviors
  • Alternatively, refer to a registered dietitian (RD) for additional targeted follow up care
    • Visit frequency: every 1-2 months for 6 months
    • RD can reassess need for additional referral to Healthy Weight Program or continued follow up by Primary Care

Note: If at any point provider feels patient needs multidisciplinary management (e.g. BMI ≥ 99th percentile, rapid increase in BMI, comorbidities) refer to Healthy Weight Program.

Weight Loss Goals by Age and BMI Percentile Categories

Age 85th - < 95th percentile 95th - < 120% of 95th percentile 120% > 95th percentile
2-5 Years Weight maintenance 1-2 lbs/month 1-2 lbs/month
6-11 Years Weight maintenance 1-2 lbs/month 1-2 lbs/week
12-18 Years Weight maintenance 1-2 lbs/week 1-2 lbs/week

Readiness to Change Questions/Motivational Interviewing

  • Review lifestyle assessment and gauge the patient’s/family’s understanding of need for change
  • Which (if any) of these behaviors does the patient/family think they can change?
    • "On a scale from 1 to 10, how important is it to you to change [the target behavior] where 1 is not at all important, and a 10 is extremely important?"
    • "And why are you at ___and not__ [a lower number than stated]?"
    • "What might happen that could move you from ___to [a higher number]?"
    • Does the patient/family feel they can start making changes within the next 30 days?
    • "How confident are you that you could make the change if you decided to do it?"

Motivational Interviewing: Moving from Why to How with Autonomy Support.