Weight Assessment and Counseling for Nutrition and Physical Activity for Children/Adolescents

Percentage of patients 3-17 years of age who had an outpatient visit with a primary care physician (PCP) or obstetrician/gynecologist (OB/GYN) and who had evidence of the following during the measurement period.

 - Percentage of patients with height, weight, and body mass index (BMI) percentile documentation
 - Percentage of patients with counseling for nutrition
 - Percentage of patients with counseling for physical activity

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Report a total score, and each of the following strata:
Stratum 1 - Patients age 3-11 years at the end of the measurement period
Stratum 2 - Patients age 12-17 years at the end of the measurement period

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Over the last four decades, childhood obesity has more than tripled in children and adolescents 2 to 19 years of age (from a rate of approximately 5 percent to 18.5 percent) (Fryar, Carroll, & Ogden, 2014; Hales et al., 2017). Non-Hispanic black and Hispanic youth are more likely to be obese than their non-Hispanic white and non-Hispanic Asian counterparts. In 2015-2016, approximately 22 percent of non-Hispanic black and 26 percent of Hispanic youth were obese compared to approximately 14 percent of non-Hispanic white and 11 percent of non-Hispanic Asian youth (Hales et al., 2017). 

Childhood obesity has both immediate and long-term effects on health and well-being. Children who are obese have higher rates of physical health conditions, such as risk factors for cardiovascular disease (like high blood pressure and high cholesterol), type 2 diabetes, asthma, sleep apnea, and joint problems. There is also a correlation between childhood obesity and mental health conditions, such as anxiety and depression (Centers for Disease Control and Prevention, 2016). In addition, children who are obese are more likely to be obese as adults and are therefore at risk for adult health problems, such as heart disease, type 2 diabetes, and several types of cancer (Centers for Disease Control and Prevention, 2016). 

The direct medical costs associated with childhood obesity total about $19,000 per child, contributing to the $14 billion spent on care related to childhood obesity in the United States (Finkelstein, Graham, & Malhotra, 2014). 

Because obesity can become a lifelong health issue, it is important to screen for obesity in children and adolescents, and to provide interventions that promote weight loss (U.S. Preventive Services Task Force, 2017).

U.S. Preventive Services Task Force (2017) - The Task Force recommends that clinicians screen for obesity in children and adolescents 6 years and older and offer or refer them to comprehensive, intensive behavioral interventions to promote improvements in weight status. (B recommendation)
 
American Academy of Pediatrics – Bright Futures (Hagan, Shaw, & Duncan, 2017)

- Plot and assess BMI percentiles routinely for early recognition of overweight and obesity. 
- Assess barriers to healthy eating and physical activity. 
- Provide anticipatory guidance for nutrition and physical activity.

Higher score indicates better quality

Reference Type: CITATION

Reference Text: 'Centers for Disease Control and Prevention. (2016). Childhood Obesity Causes & Consequences. Retrieved from https://www.cdc.gov/obesity/childhood/causes.html'

Reference Type: CITATION

Reference Text: 'Finkelstein, E. A., Graham, W. C. K., & Malhotra, R. (2014). Lifetime Direct Medical Costs of Childhood Obesity. Pediatrics, 133(5), 854-862.'

Reference Type: CITATION

Reference Text: 'Fryar, C. D., Carroll, M. D., & Ogden, C. L. (2014). Prevalence of Overweight and Obesity Among Children and Adolescents: United States, 1963-1965 through 2011-2012. Health E-Stats. Retrieved from https://www.cdc.gov/nchs/data/hestat/obesity_child_11_12/obesity_child_11_12.htm'

Reference Type: CITATION

Reference Text: 'Hagan, J. F., Shaw, J. S., & Duncan, P. M. (eds.). (2017). Bright Futures: Guidelines for Health Supervision of Infants, Children, and Adolescents, 4th ed. Elk Grove Village, IL: American Academy of Pediatrics.'

Reference Type: CITATION

Reference Text: 'Hales, C.M., Carroll, M.D., Fryar C.D., et al. (2017). Prevalence of Obesity Among Adults and Youth: United States, 2015-2016. NCHS Data Brief. Retrieved from https://www.cdc.gov/nchs/data/databriefs/db288.pdf'

Reference Type: CITATION

Reference Text: 'U.S. Preventive Services Task Force. (2017). Screening and interventions for overweight in children and adolescents: Recommendation statement. Rockville, MD: Agency for Healthcare Research and Quality.  https://www.uspreventiveservicestaskforce.org/Page/Document/UpdateSummaryFinal/obesity-in-children-and-adolescents-screening1?ds=1&s=obesity'

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The visit must be performed by a PCP or OB/GYN. 
Because BMI norms for youth vary with age and sex, this measure evaluates whether BMI percentile, rather than an absolute BMI value, is assessed.

This eCQM is a patient-based measure.

This version of the eCQM uses QDM version 5.6.  Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM.

TBD

Patients 3-17 years of age by the end of the measurement period, with at least one outpatient visit with a primary care physician (PCP) or an obstetrician/gynecologist (OB/GYN) during the measurement period

Equals Initial Population

Patients who have a diagnosis of pregnancy during the measurement period.

Exclude patients who are in hospice care for any part of the measurement period.

Numerator 1: Patients who had a height, weight and body mass index (BMI) percentile recorded during the measurement period
Numerator 2: Patients who had counseling for nutrition during the measurement period
Numerator 3: Patients who had counseling for physical activity during the measurement period

Not Applicable

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For every patient evaluated by this measure also identify payer, race, ethnicity and sex

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