529 - Obesity Counseling is Associated with Improved BMI Trajectories in an Urban Primary Care Practice Serving High-Risk Youth.

Poster Number: 529
Publication Number: 529.239

Eugene Dinkevich, SUNY Downstate Health Sciences University, Mount Vernon, NY, United States; Christopher Ramirez, Rutgers, Robert Wood Johnson Medical School, New brunswick, NJ, United States; Molly Schneider, State University of New York Downstate Medical Center College of Medicine, Brooklyn, NY, United States; Lily Lee, SUNY Downstate College of Medicine/School of Public Health, Brooklyn, NY, United States

Background: AAP guidelines recommend a stepwise approach to obesity prevention and treatment that starts with primary care pediatricians (PCPs). Prevention and Prevention plus (PPP) involves monthly office visits for 6 months to 1 year followed by referral to Structured Weight Management if the problem persists. The latter may not be available in under-resourced settings. While PPP has shown some efficacy, questions remain about its effectiveness in settings serving high-risk children.

Objective: To investigate associations between Prevention and Prevention Plus (PPP) for obesity and child BMI trajectories in an urban pediatric practice serving high-risk youth.

Design/Methods: Charts from 639 consecutive visits by PCPs over 6 months in 2016 were reviewed. BMIs were classified using CDC definitions as normal, overweight (OV) or obese (OB). OV/OB patients who received PPP were included in the analysis. Criteria for PPP included documentation of 1) OV/OB ICD (billing) code and 2) language consistent with provision of obesity counseling. Patients' BMI growth trajectories were visually inspected. Age and BMI were noted at PPP initiation, decrease in BMI trajectory for at least 6 months (DCT), visit before DCT (pre-DCT), and BMI rebound (BMI greater than at Pre-DCT). BMIs were converted to Z-scores using CDC criteria. Primary analyses were conducted using paired sample t-tests.

Results: Of 280 OV/OB patients (51% male; 91% Black; 52% Medicaid), 238 (85%) received PPP. Chronic conditions excluded 59 patients, leaving 179 for analysis. Mean age at PPP was 6.3 y, 92% had DCT during 7.7 y of follow up. Mean BMI z-score decrease from pre-DCT to DCT was 0.31 (p < .0001). No change in BMI category was seen in 64.6% of patients, but 34.8% changed from OB to OV. An average of 2.9 visits were needed to reach DCT from PPP over 19.2 months (38.4% took 12 months and 32.7%, 24 months). No BMI rebound was seen in 19.6% of children, while 37.0%, 32.0% and 11.4% maintained BMI below DCT for 12, 24 and 36 months respectively.Conclusion(s): In this study PPP was associated with DCT for most children. Onset of DCT took almost two years and 3 visits. One half of children had a clinically significant decrease in BMI z-score, one third decreased one BMI category, and half experienced no rebound for two years. While one weakness of this study is lack of a control group, its strengths include 1) examination of AAP-recommended PPP in a high-risk primary care setting, and 2) long follow up. These results support PPP with fewer visits over longer time than current AAP guidelines, especially because of its ready availability and relatively low cost.
BMI Growth Chart with Time Points Labeled