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Enhancing Pediatric Obesity Management through Quality Improvement: A Hybrid Approach to Intensive Health Behavior

Emily T Skrocki1,2, Cristian Sarabia1,2, Shengh Xiong1,3

  • 1From the Children's Hospital Colorado, Aurora, Colo.

Pediatric Quality & Safety
|July 29, 2026
PubMed

Insights

Intensive health behavior and lifestyle treatment (IHBLT) for pediatric obesity improved participation and intensity in primary care. A hybrid model enhanced delivery, addressing implementation barriers for better child health outcomes.

Area of Science:

  • Pediatric obesity treatment
  • Primary care quality improvement
  • Health behavior interventions

Background:

  • Intensive health behavior and lifestyle treatment (IHBLT) programs effectively manage pediatric obesity but face limited primary care implementation.
  • Initial assessments revealed low referral rates, poor participation, and insufficient treatment intensity, highlighting significant gaps in IHBLT adoption.

Purpose of the Study:

  • To enhance IHBLT program reach and adoption within a primary care setting.
  • To increase IHBLT referrals, participation, and treatment intensity using a quality improvement framework.

Main Methods:

  • A quality improvement initiative employed iterative plan-do-study-act cycles in an urban academic primary care clinic.
  • Strategies included provider education, culturally tailored materials, and a hybrid in-person/virtual program structure.
  • Process measures (referrals, participation, intensity) were tracked using statistical process control (SPC) charts.

Main Results:

  • SPC analysis confirmed sustained improvements in program participation and intervention intensity, meeting established benchmarks.
  • Referral volume exhibited common-cause variation, indicating stability rather than significant increase.
  • Improvements in participation and intensity were maintained long-term, with stable variation observed.

Conclusions:

  • Iterative system redesign successfully improved the delivery of evidence-based pediatric obesity treatment in primary care.
  • A hybrid IHBLT model demonstrated sustained increases in participation and treatment intensity.
  • This pragmatic approach offers a feasible model for primary care clinics to implement guideline-concordant IHBLT, overcoming logistical and equity challenges.
Abstract

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