Project Summary

This implementation project is complete.

PCORI implementation projects promote the use of findings from PCORI-funded studies in real-world healthcare and other settings. These projects build toward broad use of evidence to inform healthcare decisions.

This PCORI-funded implementation project is expanding a healthy weight program for children to new clinics to help children with obesity or overweight improve their health.

Childhood obesity or overweight affects millions of children in the United States. Children with obesity may develop health problems in the future, such as heart disease or high blood pressure. They are also at risk for low self-esteem and depression. Recommendations for screening children for obesity and best practices for weight management are not often followed.

What was the goal of this implementation project?

A PCORI-funded research study found that a childhood weight management program offering parents education materials, text message prompts, and other resources helped lower body mass index, or BMI, for children with obesity or overweight. BMI is based on a person’s height and weight.

This project put the program in place in 43 clinics serving diverse low-income communities in Colorado, Massachusetts, and South Carolina.

What did this project do?

At each site, clinicians, such as doctors and nurse practitioners, and medical assistants screened children for obesity during visits. The project team used in-person and online education to train clinicians to deliver weight management counseling. Clinicians could offer local resources on weight loss and educational materials to parents of children with obesity or overweight. Parents could also receive text messages to support behavior change for weight loss.

To support the program, the project team added alerts and guides in the clinics’ electronic health records, or EHRs. The alerts and guides helped clinicians identify children with overweight or obesity and document their diagnosis. The EHR also helped clinicians:

  • Provide recommended care.
  • Refer families to nutrition, weight management, and other community services.
  • Place an order for the text messaging program.
  • Schedule follow-up visits.

As part of the project, the project team also:

  • Adapted program materials and identified community resources for each site.
  • Identified clinic champions and practice coaches at each site to support staff training and use of the program.
  • Provided ongoing coaching and support for staff.
  • Provided clinicians with feedback reports on their use of the EHR tools.

The project team also created a guide to help other clinics adopt the program.

What was the impact of this project?

The project team trained 537 clinical staff, including clinicians and medical assistants, across the 43 sites. After two years, the project evaluation found that:

  • Screening for obesity increased at all sites. More than 19,000 children ages 2–12 were screened and identified as having obesity or overweight.
  • Documentation of BMI in children’s health records increased at all sites. At the Colorado clinics, for example, documentation of BMI for children with overweight increased from 25% to 82%. For children with obesity, it increased from 58% to 90%. 
  • Program uptake varied by site. Across sites, families of 8,718 of the children identified with obesity or overweight received education or resources to help manage weight.
  • BMI didn’t improve for children with overweight or obesity.

In a survey of 800 families, more than 80 percent of parents said that their child’s clinician discussed weight management during their well-child visits. Also, more than 80 percent of parents said they would recommend the program to families or friends. Clinicians said the program was useful for helping patients manage weight.

All sites have continued to use the program. The project team also added information in the Epic EHR Community Library to support future sites with an interest in using the program.

Cost of Implementation

The project team examined the costs associated with implementing the program.

The cost to implement the program in the Colorado and South Carolina health systems was approximately $70,000. The Massachusetts health system assumed additional development expenses for the program, including for the EHR and text messaging supports. The largest cost components included purchasing and maintaining the text messaging system, integrating the program tools in the EHR, and engaging stakeholders to adapt program materials and inform implementation strategies.

For more details, view this project’s Cost of Implementation Report, which will be posted here when available.

PCORI supplemental funding supported project activities to capture and analyze the costs of implementation during this project. PCORI’s goal is to provide decision makers at future sites with information they can use when considering adoption of the intervention that was the focus of this PCORI-funded implementation project.

More about this implementation project:

Stakeholders Involved in This Project

  • Clinic leadership and champions
  • Epic Systems EHR representatives
  • Institutional advisory councils including a Family and Community Advisory Council, Medical Assistant Council, Information Technology Council, and Community Health Board.

Publicly Accessible Project Materials

For more information about these materials, please contact the project team at [email protected]

    Project Achievements

    • Integrated tools, best practice alerts, and resources into the EHR.
    • Trained 537 clinic staff.
    • Screened 19,304 patients for obesity.
    • Provided weight management support for 8,718 pediatric patients with obesity or overweight.
    • High program satisfaction among families and clinicians

    Implementation Strategies

    • Adapted the program to work with sites’ existing resources and workflows, including integrating a text messaging system for families and clinical decision support tools into the EHR.
    • Created and supported implementation teams at sites, including a clinic champion, practice coach, EHR analyst, and project manager.
    • Trained local practice teams using online educational modules and academic detailing.
    • Provided sites with tools to support implementation, including best practice guidance, trainings, and structured note templates in the EHR.
    • Provided educational materials to families, including handouts, after-visit summaries, and community resource guides.
    • Used a phased implementation approach.
    • Provided clinicians with audit and feedback reports on use of the clinical decision support tools.
    • Created a virtual learning collaborative to support use of the program at sites.
    • Identified and prepared clinic champions.
    • Provided technical assistance, including practice facilitation, coaching, and ongoing consultation.
    • Partnered with a national stakeholder organization to promote implementation and dissemination.
    • Developed an implementation guide to support further use of the program at other sites.
    • Offered continuing education credits.

    Evaluation Measures 

    To document implementation:

    • Number of patients screened for obesity
    • Provider documentation of BMI
    • Provider use of EHR tool
    • Number of parents receiving text messages
    • Fidelity of intervention delivery
    • Acceptability of the program to clinicians

    To assess healthcare and health outcomes:

    • Delivery of nutrition and physical activity counseling
    • Parent assessment of care
    • Child BMI-z score

    Project Information

    Elsie Taveras, MD, MPH
    Massachusetts General Hospital
    Dissemination and Implementation of Effective Childhood Obesity Treatment Innovations

    Key Dates

    July 2018
    December 2022

    Study Registration Information

    Initial PCORI-Funded Research Study

    This implementation project focuses on putting findings into practice from this completed PCORI-funded research study: Do Weight Management Programs Involving Health Coaches Improve Body Mass Index and Parent Empowerment for Children with Obesity or Who Are Overweight?


    Project Status
    Health Conditions Health Conditions These are the broad terms we use to categorize our funded research studies; specific diseases or conditions are included within the appropriate larger category. Note: not all of our funded projects focus on a single disease or condition; some touch on multiple diseases or conditions, research methods, or broader health system interventions. Such projects won’t be listed by a primary disease/condition and so won’t appear if you use this filter tool to find them. View Glossary
    State State The state where the project originates, or where the primary institution or organization is located. View Glossary
    Project Details Type
    Last updated: November 2, 2023