Outpatient Specialty Care and Primary Care Clinical Pathway
for BMI-based Evaluation and Management in Children
Child Well Visit ≥ 2 yrs
History and Physical
Obtain weight and height, assess BMI trajectory
Obtain permission from family to discuss weight and growth
Obtain weight and height, assess BMI trajectory
Obtain permission from family to discuss weight and growth
Children with BMI Percentile < 85%
- Continue 5210 Messaging
- Check trend of BMI
- Assess for risk factors
- Evaluate family’s access to healthy foods and exercise
- Reassess at each visit
Children with BMI Percentile ≥ 85%
- Evaluation and Treatment
- Comprehensive History and Physical
- Laboratory Studies
- Based on age and BMI category
- Social Determinants of Health Evaluation
- Mental and Behavioral Health Screening
- Evaluate family’s access to healthy foods and exercise
- Treatment
- Health Behavior and Lifestyle Treatment
- Recommended ≥ 6 yrs
- Consider for < 6 yrs
- Health Behavior and Lifestyle Treatment
- Add appropriate BMI diagnosis to problem list
- Continue 5210 Messaging
- Engage family in one behavioral goal related to 5210 Messaging
- 85th-95th Percentile
- Comorbidities or change in BMI trajectory, consider:
- Healthy Weight Program
- Cardiovascular Risk Assessment Clinic
- ≥ 95th Percentile
- Consider referral to:
- Healthy Weight Program
- Cardiovascular Risk Assessment Clinic
- Adolescent Bariatric Program
- BMI ≥ 120% of the 95th percentile and comorbidities
- or
- BMI ≥ 140% of the 95th percentile
- Consider weight loss pharmacotherapy
- ≥ 12 yrs
Determine Family’s Interest in More Frequent Visits
Interested
Not Interested
Nurse educator, if available, and/or referral to registered dietician for additional nutrition counseling
- Weight check every 3-6 mos
- Evaluate family’s access to healthy foods and exercise
- Reassess interest in more
frequent visits
Evidence
- Clinical Practice Guideline for the Evaluation and Treatment of Children and Adolescents with Obesity
- Pediatric Metabolic and Bariatric Surgery: Evidence, Barriers, and Best Practices
- Stigma Experienced by Children and Adolescents with Obesity
- The Role of the Pediatrician in Primary Prevention of Obesity
- Preventing Obesity and Eating Disorders in Adolescents
- ASMBS Pediatric Metabolic and Bariatric Surgery Guidelines, 2018
- Severe Obesity in Children and Adolescents: Identification, Associated Health Risks, and Treatment Approaches: a Scientific Statement from the American Heart Association
- Expert Panel on Integrated Guidelines for Cardiovascular Health and Risk Reduction in Children and Adolescents: Summary Report
- Pediatric Obesity—Assessment, Treatment, and Prevention: An Endocrine Society Clinical Practice Guideline
- NICHQ — National Initiative for Children’s Healthcare Quality
- Additional Evidence
CHOP Programs
- Adolescent Bariatric Program
- Cardiovascular Risk
Assessment Clinic - Healthy Weight Program
- Clinical Nutrition
Media
Related Links