Date of Publication


Project Team

Rebecca Anne Nagle, University of Vermont


Improving Pediatric Obesity Management in Rural Primary Care

Alyssa Tonks, DNPc, RN; Rebecca Nagle, DNP, PNP-BC, RN

Purpose: Childhood obesity is a major health concern, especially in rural US regions, where children are 26% more likely to develop obesity in comparison to their urban peers. Despite primary care clinicians’ pivotal role in addressing obesity, poor adherence to clinical practice guidelines has impeded effective management. This project addressed this gap by implementing an education module to enhance providers’ understanding and adherence to obesity-related clinical practice guidelines.

Methods: The educational module was implemented at a Federally Qualified Health Center in a rural north-eastern state. Electronic health record analysis assessed diagnosis accuracy (patients correctly assigned a Z68.54 diagnostic code if their BMI ≥ 95th percentile for age) and referral rates before and after the intervention. Post-intervention provider surveys were conducted to evaluate perceived effectiveness.

Results: Pre-intervention data (n= 242) revealed a 56% accuracy rate and a 20% referral rate, while post-intervention data (n=242) showed a 64% accuracy rate and a 29% referral rate. In both datasets, patients meeting BMI criteria for obesity but lacking a Z68.54 code were not referred to specialists. Providers (n=7) reported increased confidence and competence in pediatric obesity management.

Conclusions: The intervention increased provider adherence to clinical practice guidelines and resulted in an 8% increase in the accuracy of obesity diagnosis and an 9% rise in specialty care referrals. Data from provider surveys further underscored effectiveness. Future efforts should focus on widespread dissemination of the educational module and evaluation of long-term implications of follow-up care, specialty referrals, and innovative approaches to care.

Document Type


Available for download on Wednesday, April 08, 2026

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Nursing Commons