Table 2 Potential Solutions for obesity management in the primary care setting

Systems level:

Ancillary support in the office, obesity champion, obesity management guidelines, team approach, more training

• “I think making it somebody who is very knowledgeable that’s not necessarily a physician would make more sense. And figure out the compensation model and if there was enough money.”

• “If there was a clinical educator option that would be so awesome because… you could say [to the family] that I think this is really important, it’s a big deal… I’m gonna set you up.”

• “So doing it closer to home would make more sense, in terms of having the follow through, and then the loop back… This is their home office and they feel comfortable coming here.”

• “I’m willing to give [obesity management] the energy if you are willing to actually absorb some of it by being this team with me, but not if I’m in it by myself.”

• “Maybe a conjunction - an MD and a nutritionist would be really good.”

• “I think it would be great to… think of… someone who is in charge of it, like a champion.”

• “I mean… something like an algorithm that could be given to [x person] so that we just had to… (I know we kind of passed the buck here), but… do a referral for obesity, and it goes to [this person]. She looks down the algorithm to where they go and she then sends them over to where the best resource is, opposed to us having to think about it on every single patient, you know, because she is the referral coordinator.”

Work-flow changes:

Develop best practice guidelines, ease of documentation, standardize resources and handouts, gather family-level information

• “[Get] a protocol for when we all have a kid in the office on a well-check…We should have a button saying return in a month or return in two weeks or whatever the return time is. That is when you bring them back and drop down to your obesity smart set with your labs because you have to.”

• “In our checkup one of the things that gets billed for… is what the child’s BMI is… I sometimes won’t label [the child as]… obese, I will say BMI over 95th percentile, and I put it in their problem list because parents get very touchy if they see [obese] in their problem list, and I do not know if that is ok for monitoring…I don’t know what we should put on the problem list.”

• “More help with the documentation part of it and making it easier.”

• “An obesity follow-up note. It might be nice to have a [smart form or obesity template] like that.”

• “The [handouts] need to be in EPIC for our use and also if there’s any other websites.”

• “What if there was like a separate survey that we could give to families…so if they came in and we noticed they were heavy or obese… we would give them a survey that they would maybe bring back to their next [visit]. Like have you tried anything? Do you see this as a problem? Tell me about the foods you eat in your house… Kind of getting a feel for it so they start looking at what we’re looking at, and they could come back with that information, and so it’s something that we could have as an after visit summary thing [in EPIC]. Then we can say, you know what, why don’t you do this?… That way when you come in we’re going to have a really good place to jump off from and we’ll know more.