BMI-based Evaluation and Management in Children Clinical Pathway — Outpatient Specialty Care and Primary Care

Clinical Pathways Home Emergency ICU Inpatient Outpatient Specialty Care Primary Care

Child Well Visit ≥ 2 yrs

History and Physical
Obtain weight and height, assess BMI trajectory
Obtain permission from family to discuss weight and growth

Stratify by BMI Percentile

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
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

Targeted Primary Care

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

Posted: July 2014
Revised: October 2023

Authors:
- E. Parks Prout, MD;
- J. Michel, MD;
- M. O’Byrne, MD;
- E. Coover, RD;
- A. Dayno, MD;
- D. Villalta, MD

Editors: Clinical Pathways Team

Evidence

CHOP Programs

Media

Primary Care Perspectives: Podcast for Pediatricians Episode 4: Food Insecurity

Related Links

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.

Outpatient Specialty Care and Primary Care Clinical Pathway for BMI-based Evaluation and Management in Children

Evidence

CHOP Programs

Media

Related Links

Outpatient Specialty Care and Primary Care Clinical Pathway
for BMI-based Evaluation and Management in Children