Parents of children with obesity often agonize about how to help their children be healthier. Obesity treatment is especially tricky in children because the approach cannot be overly restrictive without compromising their growth and development. Now a new program, the Working on Wellness (WOW) program, that is part of the Pediatric Clinic at the Texas Tech Physicians of El Paso (TTP El Paso), is doing something about it.
Medical providers have high patient loads, receive limited or no training in nutrition and obesity medicine during medical school, and often have limited success at treating diseases like obesity that require an individualized approach and extensive follow-up. In an effort to make a change, the Paso del Norte Health Foundation provided a grant in 2015 to TTP El Paso in partnership with Centro San Vicente (CSV). CSV provided technical assistance based on their pediatric obesity care model as TTP El Paso’s Pediatric Department created a new system within the Pediatric Clinic called WOW to provide comprehensive medical and nutritional therapy using a family-based behavioral approach. The cornerstone of WOW was the integration of a registered dietitian into the care team to work with young patients who have obesity. WOW is a seven-month-long program with at least one visit per month with either a dietitian or a physician.
Registered dietitian Nydia Orosco (left) helps pediatric patients rethink their eating habits. (Photo: Photo by Chris Espinosa/TTUHSC El Paso)
The WOW dietitian, Nydia Orosco, sets goals with the patient and family using motivational interviewing, a goal-oriented and client-centered counseling style meant to illicit changes in behavior by involving the patient in the decision-making process. The goals may include tracking changes in body composition between appointments, avoiding a sedentary lifestyle, and improving diet. Pediatricians are typically not able to spend extensive amounts of time with each patient, so having regular intensive one-on-one visits with the dietitian and follow-ups every 2-3 months with the pediatric provider has been a positive change for the children and families.
Dr. Blanca Garcia – Photo courtesy of Texas Tech Health Science Center at El Paso
Dr. Blanca Garcia, MD, is the pediatrician who provides medical care to these young patients. She communicates regularly with Ms. Orosco and stays up to date on their goals and progress. In this way, both Dr. Garcia and Ms. Orosco are able to provide consistent messaging to their patients and reinforce what the other is saying. Dr. Garcia also trains future providers in this type of obesity care. Last spring, medical residents completed a quality improvement project focused on WOW and the number of referrals to the program doubled as a result. Dr. Garcia and her team are also working on insurance reimbursement processes to make this system and the additional care for these patients sustainable.
As part of the changes, workflows for these patients have been optimized over the last two years. This included creating a protocol to standardize screening labs to be ordered; setting up a system to track patients’ progress (using the Electronic Medical Record, EMR); purchasing and institutionalizing the use of a body composition device to track changes in body fat and muscle mass in place of simply tracking weight; and setting up a referral process from other providers in the pediatric clinic.
TTP El Paso houses a pediatric department that is a medical home for a large number of children in El Paso and Ciudad Juárez. The clinic’s vision is to be family centered, while offering high quality, developmentally appropriate care and services that are culturally sensitive and promote optimal growth and well-being in their child patients and their families. Its mission is to create a culture of healthy and active lifestyles in El Paso through increased physical activity and nutrition counseling.
Only individuals who are already patients of Texas Tech Physicians of El Paso may join WOW. For more information on Working on Wellness, please contact TTP El Paso:
Central El Paso-Main Campus
Texas Tech Physicians of El Paso
4801 Alberta Avenue
Monday-Friday 8:00 am -10:00 pm
Saturday 10:00 am – 4:00 pm