Adherence With Multiple National Healthy Lifestyle Recommendations in a Large Pediatric Center Electronic Health Record and Reduced Risk of Obesity.

Robin P. Shook, Children's Mercy Hospital
Kelsee Halpin, Children's Mercy Hospital
Jordan A. Carlson, Children's Mercy Hospital
Ann Davis
Kelsey Dean, Children's Mercy Hospital
Amy Papa, Children's Mercy Hospital
Ashley K. Sherman, Children's Mercy Hospital
Janelle R. Noel-Macdonnell PhD, Children's Mercy Hospital
Shelly Summar, Children's Mercy Hospital
Gary Krueger, Children's Mercy Hospital
Deborah Markenson, Children's Mercy Hospital
Sarah Hampl, Children's Mercy Hospital


OBJECTIVE: To evaluate the utility of a routine assessment of lifestyle behaviors incorporated into the electronic health record (EHR) to quantify lifestyle practices and obesity risk at a pediatric primary care center.

PATIENTS AND METHODS: Participants included 24,255 patients aged 2 to 18 years whose parent/caregiver completed a self-report lifestyle assessment during a well-child examination (January 1, 2013, through June 30, 2016). Cross-sectional analyses of age, race/ethnicity, body mass index, and lifestyle assessment responses were performed. Outcome measures included prevalence of patients meeting consensus recommendations for physical activity; screen time; and dairy, water, and fruit/vegetable consumption and the odds of obesity based on reported lifestyle behaviors.

RESULTS: Prevalence of meeting recommendations for lifestyle behaviors was highest for physical activity (84%), followed by screen time (61%) and consumption of water (51%), dairy (27%), and fruits/vegetables (10%). Insufficient physical activity was the strongest predictor of obesity (odds ratio [OR], 1.65; 95% CI, 1.51-1.79), followed by excess screen time (OR, 1.36; 95% CI, 1.27-1.45). Disparities existed across ages, races/ethnicities, and sexes for multiple lifestyle habits. Youth who met 0 or 1 lifestyle recommendation were 1.45 to 1.71 times more likely to have obesity than those meeting all 5 recommendations.

CONCLUSION: Healthy behaviors vary in prevalence, as does their association with obesity. This variation is partially explained by age, sex, and race/ethnicity. Meeting national recommendations for specific behaviors is negatively associated with obesity in a dose-dependent manner. These findings support the assessment of lifestyle behaviors in primary care as one component of multilevel initiatives to prevent childhood obesity.