397 - Weight Trajectories in Infants & Children Served by Community Health Centers: The Evidence and Realities of Clinical Practice

Poster Number: 397
Publication Number: 397.145

Alyson Goodman, CDC, United States; Rashmi Narayan, AllianceChicago, Oakland, CA, United States; Ta-Yun Yang, AllianceChicago, Chicago, IL, United States; Abbey Ekong, AllianceChicago, Chicago, Il, IL, United States; Nivedita Mohanty, Alliance Chicago and Northwestern University The Feinberg School of Medicine, Chicago, IL, United States

Background: Clinicians are advised to assess for excess or rapid weight gain in early life because of correlation with later elevated BMI, but further guidance is not well-established. In a query of AllianceChicago’s (AC) shared electronic health record (EHR) platform, an average of 12,320 children less than 2 had assessment of weight and length annually since 2015. 7-9% each year were given a diagnosis of “Abnormal weight gain” or “Encounter for rapid growth”. Despite conventional acceptance that rapid/excess weight gain in infancy is a risk factor for obesity, lack of clear parameters to define or manage it leads to variation in practice and hinders the promotion of healthy weight.

Objective: To synthesize existing evidence on early excess weight gain and understand how the diagnosis is applied in practice, as well as to understand how clinician diagnosis compares to more established definitions of rapid weight gain in terms of future risk for excess weight at age of school entry.

Design/Methods: Utilizing data from 23 qualifying community health centers in AC’s health center-controlled network, a quantitative analysis of data from 2010-2022 was conducted to look at weight trajectories in the 0-2 age range and correlate them with BMI through age 5-6. Ongoing chart review of 100 kids under 2 who received the diagnoses of “Abnormal weight gain” or “Encounter for rapid growth” will inform qualitative analysis of the parameters used as well as management and counseling provided. Growth since infancy will be analyzed in multiple ways (e.g. BMI-for-age, weight-for-age Z-score, BMI-z-score, weight velocity) and compared to understand weight trajectories and implications at age 5-6.

Results: Of patients less than 2 years old with clinician-diagnosis of “Abnormal weight gain” or “Encounter for rapid growth”, 32% had a BMI≥85th percentile at age 2-3 years (20% had a BMI ≥95th percentile). However, of patients aged 5-6 with an elevated BMI and records since infancy, < 4% had a documented diagnosis of excess weight gain before age 2. The prevalence of 5 to 6 year-old children with overweight BMI at these clinics in 2021 was 46%.

Conclusion(s): Clinicians document concerning weight trends in early life but more guidance is needed on the definition and management of notable trajectories and their relation to future elevated BMI. Understanding how the diagnosis of excess weight gain under age 2 is made and resulting actions is important for evidence-based practice improvement. The high rate of children with overweight and obesity seen in safety-net clinics makes effective prevention starting in early childhood imperative.