Assessing the Effectiveness of the Healthy Habits Clinic in Improving the Care of Overweight and Obese Pediatric Patients

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Introduction: Obesity affects 10.9% of military dependent youth. Obese adolescents are at high risk of remaining overweight as adults, underscoring the need for effective treatment of childhood obesity. Project Description: In 2011, a multidisciplinary team at the Walter Reed National Military Medical Center started the Healthy Habits Clinic (HHC) to improve the care of overweight and obese children. This family based clinic includes medical evaluation and ten monthly sessions that emphasize physical activity, healthy nutrition, and behavior change. The objective of this project was to determine the effectiveness of the HHC in improving BMI z-score (BMIz) and metabolic parameters in obese and overweight military dependent youth during and after clinic participation. Process: We performed a retrospective review of 189 patients referred to HHC from 2011 to 2016 to evaluate the effect of participation on the care of overweight and obese patients as compared to nonparticipant controls. Records were allocated into groups based on participation level: 59 patients (31.2%) never participated in HHC (No Participation), 91 patients (48.1%) participated in <= 3 sessions (Limited Participation), and 39 patients (20.6%) participated in > 3 sessions (Active Participation). This review of participant data revealed that children referred to HHC showed a small but significant decrease in BMIz from baseline to last available measurement (-0.10 SDs, 95% CI:-0.05 to -0.14, p=0.0005). There was no effect of participation level on BMIz change (p=0.73). Patients who ended with non-obese BMIz had greater reduction in BMIz (-0.41 SDs) when compared to those whose BMIz remained above the 95% (-0.03 SDs, p<0.0001). The children with the greatest BMIz reduction demonstrated less severe obesity at referral (1.65 SDs) than the patients that remained obese (2.22 SDs, p<0.0001). Discussion: Referral to HHC resulted in BMIz reduction even without participation in HHC. Diagnosing obesity and counseling alone may prevent further increase in BMI, and referral to HHC at less severely obese BMIz may lead to improved outcomes. Currently, estimated rates of diagnosis of obesity in military dependent youth are poor. We hope to act on these findings by working to increase the diagnosis of obesity and early referral for intervention to achieve greater BMIz reductions in obese military children.

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