Taking Youth Obesity Seriously
Can electronic records help doctors give heavy kids better care?
Elsie Taveras, MD, MPH
Assistant Professor of Population Medicine and of Pediatrics, Harvard Medical School
|ADA Research Funding
Clinical Translational Award
Childhood obesity is a growing problem, in more ways than one. According to the American Academy of Pediatrics, the number of obese children and adolescents has more than tripled in the past 30 years. Today, 17 percent of American children between the ages of 2 and 17 are considered obese.
The numbers represent a serious public-health issue. "Pretty significant evidence shows childhood obesity is of consequence, not just for adult health but for the child," says Elsie Taveras, MD, MPH, a pediatrician and epidemiologist at Harvard Pilgrim Health Care in Boston as well as an assistant professor at Harvard Medical School. "Young children can suffer from high blood sugars, insulin resistance, high cholesterol, hypertension, and, of course, higher rates of type 2 diabetes."
The battle against childhood obesity is being fought on many fronts, from school cafeterias and supermarket aisles to playgrounds and TV screens. But Taveras has her sights set on an unlikely place she says could use some improvement: the pediatrician's office.
Taveras says that ideally, pediatric obesity should be a simple thing to diagnose and deal with, unlike conditions that might rely on a more subjective diagnosis. "This is different from ADHD," or attention-deficit hyperactivity disorder, she says. "If a child is overweight or obese, there's no ambiguity."
The problem, Taveras says, is that some pediatricians aren't sure how to handle obese and overweight patients during checkups and other office visits. And many doctors don't see obesity as a serious medical problem, or don't recognize obesity when they see it. Keeping up with the latest research is a challenge even for full-time researchers. For doctors struggling to care for patients on a daily basis, it's a near impossibility. "We don't make it easy for clinicians to adopt these recommendations. We leave a lot up to the clinicians to do on their own and take continuing education classes."
As a result, patients don't always benefit from the latest in medical knowledge. To find a solution, Taveras has turned to electronic health records, computerized systems that are increasingly replacing traditional paper charts in doctor's offices and hospitals across the country. Stored on computer networks, the digital records make it easy to track a patient's weight from visit to visit, for example, or automatically prompt a doctor to order a specific test or procedure.
Working with 14 practices in the Boston area, including hundreds of individual physicians in all, Taveras has created an alert that automatically pops up on a doctor's computer when an obese child is being examined.
Here's how it works: Children come in for an office visit and are weighed and measured by a medical technician. The numbers are plugged into the computer, which automatically calculates the patients' BMI, or body mass index, a ratio of weight to height that correlates highly with body fat. BMI scores over a certain percentile are flagged. "When the physician comes in, a pop-up window comes up that alerts them and gives them a list of expert recommendations on what to do at that visit, and how to follow up," Taveras says.
The intervention goes beyond the doctor's office. In the days before a parent comes in with a child for an appointment, trained educators will call to talk with the parent about what to expect and how to get the most out of the visit. "We are really interested in how to 'activate' the parent," Taveras says.
The experiment divides the doctors in the study into two groups: Half of the doctors in the study see the alert, which also walks them through the different tests an obese child might need as well as subjects to cover with parents, and half don't. When the experiment is over, Taveras will again use the digital records to check hundreds of "charts" and see if the kids cared for by doctors who got the electronic prompts are healthier than their peers who got standard care.
By testing the potential of electronic health records (also known as electronic medical records, or EMRs), Taveras is tapping into a trend she says will become more and more common in the years to come. "It's shortsighted to not be designing interventions based on EMRs, because that's the wave of where we're headed," she says. "It's going to change the way we do medical research." By improving care all along the line, EMRs might be a tool to help doctors turn the tide of childhood obesity—and reduce the number of people living with type 2 diabetes.
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