North Carolina First Step Program: Improving Provider Assessment of Childhood Obesity

The United States' worsening prevalence of childhood overweight/obesity has stimulated substantial attention from the medical community. Several medical organizations have acknowledged that one of the most important steps in addressing the problem is early detection. Yearly overweight/obesity screening with Body Mass Index (BMI) for all children is standard of care, however, many practitioners are non-compliant with these guidelines. As a result, overweight/obese children are being underdiagnosed, causing missed opportunities for secondary prevention and early treatment. The North Carolina (N.C.) First Step Program is an intervention aimed at helping providers assess pediatric weight status more accurately and consistently. The program incorporates changes in multiple levels of the patient encounter and is designed to be both cost-effective and time-efficient. This Master's paper describes the planning and evaluation of the N.C. First Step Program.Master of Public Healt

Prevention and Treatment of Childhood Obesity: Care Received by a State Medicaid Population

Based on chart review for a representative cluster sample of North Carolina Medicaid enrollees aged 3 to 5 years (n = 1951) and 13 to 16 years (n = 1922) years, this study describes prevalence, practice patterns, and comorbidities related to overweight/obese immediately prior to 2007 Expert Recommendations. In total, 16% of children in both age groups were overweight, and 20% (ages 3–5 years) and 25% (ages 13–16 years) were obese. For 3- to 5-year-olds, body mass index percentile was infrequently recorded (22%) or plotted on growth charts (24%), and weight status category was rarely documented (10%). Results were similar for adolescents (21%, 20%, and 12%, respectively). In both groups, documentation of counseling in nutrition or physical activity was rare (16% for ages 3–5 years; 7% for ages 13–16 years). In adolescents, approximately 20% received recommended laboratory screening and overweight/obesity was significantly associated with chart-documented asthma, back pain, prediabetes, gastroesophageal reflux disease, hypertension, and sleep apnea. Whether improvements in documentation of care followed these new guidelines deserves further research