Date Available


Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Judith Daniels

Clinical Mentor

Dr. Stephen Wright

Committee Member

Dr. Debra Hampton


Background: Worldwide, the World Health Organization (2016) estimates that forty-two million children from two to five years of age are overweight or obese. In the United States, Kentucky ranks sixth for the highest rate of overweight youth in the nation (Partnership for Fit Kentucky, 2009). The long term consequences of overweight and obesity are early onset of adult chronic diseases as well as social and psychological issues in childhood and adulthood.

Purpose: The objective of this gap analysis was to assess BMI screening and weight management of children ages two to five who presented for a well-child check (WCC). A primary care office associated with a large medical center was used for this analysis.

Methods: Utilizing a retrospective medical review, the screening and management of childhood overweight and obesity in the two to five year age range was reviewed. This included if a diagnosis was made for a BMI above the 85th percentile. The review included if an assessment and management plan were present for elevated BMI percentile.

Results: Approximately 97% had a current documented BMI percentile. None had a weight diagnosis classification for weight status. No documentation was made for the majority of risk factors, nor any recommendations on specific dietary changes and/or physical activity. Only 6.1% were recommended to follow-up sooner than the next WCC and no follow-up appointments were attended. BMI percentiles increased between WCC.

Conclusion: Although providers did exceptionally well with screening using BMI percentile, there were many missed opportunities for weight management. The electronic medical record can be used to increase adherence to current guideline recommendations for better patient outcomes.