New digital tool helps pediatric clinics improve care for overweight children

A new electronic health record–based tool is helping pediatric primary care clinics more consistently identify and manage children with overweight and obesity, according to recent findings published in BMC Medical Informatics and Decision Making.

The tool, known as OurPractice Advisory (OPA), is a clinical decision support system designed to prompt healthcare providers to follow evidence-based guidelines when caring for children whose body mass index (BMI) falls above recommended levels. Pediatric overweight is defined as a BMI between the 85th and 94th percentiles for age and sex, while obesity is defined as a BMI at or above the 95th percentile.

Although national guidelines recommend documenting elevated BMI and screening for related health conditions such as diabetes or high cholesterol, these steps are often missed in routine pediatric visits. OPA was created to address this gap by alerting clinicians within the electronic health record (EHR) when a child meets criteria for overweight or obesity and by guiding appropriate next steps.

"Childhood obesity is a health condition that can lead to long-term health risks like diabetes and heart disease later in life," said study lead Dr. Joyce Lee, a CHEAR faculty investigator. "Detecting these risks early is the best way to keep kids healthy."

Researchers analyzed EHR data from 9,621 children and adolescents with overweight or obesity who were seen at 18 different clinics between 2020 and 2023. When the OPA alert was triggered during a visit, the research team assessed whether providers documented elevated BMI on the patient’s problem list and whether they ordered recommended comorbidity screening laboratory tests. Outcomes were examined across age, race and ethnicity, insurance type, and BMI severity.

Statistical process control charts were also used to track changes in care patterns over time and to evaluate the overall impact of the tool.

The results showed notable gains in evidence-based care. Providers documented elevated BMI on the EHR problem list in 44% of eligible visits and ordered comorbidity screening tests in 15% of cases. While these rates suggest room for improvement, trends over time were striking.

Before the tool was introduced, only 9.2% of patients had an elevated BMI diagnosis documented in their problem list. After implementation, that figure rose to 64%. Similarly, the proportion of patients receiving comorbidity screening increased from 7.8% to 32%.

The study also found that providers were more likely to document elevated BMI and order screening tests for older children, non-Hispanic Black children, those with public insurance, and children with higher BMI percentiles.

Lee said the findings highlight the potential of digital tools to improve consistency and quality of care in busy primary care settings.

"By using technology directly in the electronic health record, we ensure that excess weight in children is consistently documented and addressed, ultimately supporting improved long-term health outcomes for children," she said. "This helps providers give proactive, personalized care exactly when it's needed most."

This work was supported by grants from the National Institute of Diabetes and Digestive and Kidney Diseases, and the Elizabeth Weiser Caswell Diabetes Institute at the University of Michigan.