Year of Publication


Degree Name

Doctor of Nursing Practice

Committee Chair

Dr. Sharon Lock

Clinical Mentor

Dr. Linda Wofford

Committee Member

Dr. Lynne Jenson


Background: Pediatric obesity has reached epidemic levels in the United States and the burden of early identification and prevention lies with Primary Care Providers. With this burden comes the responsibility of increased documentation in order for patients to obtain the appropriate counseling, treatment, and referrals.

Objective: The objective of this study is to identify missed opportunities to identify pediatric patients that meet the criteria for overweight or obesity during well-child visits within a primary care practice.

Method: A retrospective chart review of 100 randomly selected patients born between 9/1/2001 and 9/1/2010 that have received a well-child visit between 1/1/2010 and 9/1/2013 was conducted. Nine indicators were recorded: age, gender, height, weight, BMI, BMI percentile ranking for age and gender, diagnosis (ICD-9), counseling, and referrals/treatment. Four of these have been identified as critical indicators for the identification of pediatric overweight and obesity; BMI percentile, diagnosis, counseling, and referrals/treatment. A focus group of providers at the facility was conducted to discuss the findings of the chart review, perceived barriers and facilitators to complete documentation, and treatments.

Findings: A total of 454 well-child visits were reviewed to find the 100 charts that met the inclusion criteria during the study period. Of these well-child visits, 100 children had a BMI percentile ≥ 85th percentile and met the inclusion criteria. During 148 well-child visits, only 24 patients were identified as overweight or obese, resulting in 124 missed opportunities.

Conclusion: Pediatric overweight and obese conditions were identified 16.22% of the time at this facility, leaving room for improvement. A long-term goal of zero missed opportunities to identify overweight and obese conditions needs to be established within all primary care practices, and could be easily be measured with annual chart audits.