Use of Electronic Health Records for Addressing Overweight and Obesity in Primary Care

Overweight and obesity are significant clinical and public health problems. Over 35 percent of U.S. adults are obese and another 33 percent are overweight. Overweight and obesity are associated with many serious health conditions, including type 2 diabetes, cardiovascular disease, and some cancers. Clinical practice guidelines urge providers to screen for these problems and recommend appropriate treatment options, as even small amounts of weight loss can lead to significant health benefits. However, primary care providers often fail to do so.

Electronic health records (EHRs) have the potential to improve management and treatment of obesity by primary care clinicians, though few tools have been developed or evaluated for this purpose. The objectives of this research study were to develop and evaluate EHR-based tools such as reminders and clinical decision support (CDS) for identification, diagnosis, and treatment of overweight and obese patients.

The specific aims of the project were as follows:

• Develop EHR-based tools to help primary care clinicians identify, evaluate, and treat patients who are overweight or obese. 
• Conduct a cluster-randomized controlled trial to assess the effectiveness of EHR-based tools for the identification, evaluation, and treatment of overweight and obesity in primary care. 

Researchers developed and incorporated new obesity CDS elements into EHRs used by primary care practices at Brigham and Women’s Hospital (BWH). These elements included reminders about measuring height and weight, an alert to add overweight or obesity to the problem list, patient-specific management recommendations for primary care providers, a feature to calculate a weight loss goal, an automatic email referral function, and links to handouts and resources for patients. They then conducted a cluster-randomized controlled trial in 12 BWH primary care practices. The study randomized 23 clinical teams within the practices to intervention or control groups. The new features were activated for clinics in the intervention group and were not activated for clinics in the control group.

Study findings suggested that tools can lead to substantial improvements in the diagnosis of overweight and obesity, although there were no significant differences in management outcomes or weight change between patients in the intervention and control groups. Researchers concluded that future studies should focus on creating and evaluating other scalable, low-cost solutions to help address overweight and obesity in the primary care setting.