Children and adolescents should be screened at least annually for body mass index (BMI), according to the U.S. Preventive Services Task Force. Patients with a high or increasing BMI should be counseled on nutrition and physical activity to encourage healthy weight.

BMI Assessment & Nutrition/Physical Activity Counseling Case Examples

Providers from one Connecticut SBHC conduct BMI screenings during each initial patient visit and provide nutrition and physical activity counseling to everyone. They offer a subsequent weight management and nutrition visit to any clients with a BMI greater than 85%. Based on the client’s responses to questions about readiness for change, providers schedule an additional follow-up appointment. To be able to document, track, and report this work, the sponsoring organization developed an EHR template with discrete fields so they could extract BMI data (including nutrition and physical activity counseling).

Staff at one Colorado SBHC developed these standard recommendations for each weight category:

  • BMI <5%: “Your child has a BMI of <5 percentile. Your child should gain weight. Offer three whole milk servings per day. Encourage your child to eat higher calorie foods through three meals and two healthy snacks per day. Make sure to follow-up as planned.”
  • BMI 5-85%: “All children need five servings of fruit and vegetables per day, four servings of water, and three servings of dairy. They should have one hour or more of daily activity, 8-10 hours of sleep, and less than two hours of screen time per day.”
  • BMI 85%-95%: “Your child’s BMI is between the 85th and 95th percentile. They will either need to maintain their weight as they grow, or lose weight if they are no longer growing. Children need 60 minutes of active play every day and should keep screen time to no more than two hours per day. Drinks should be limited to 24 oz. of 1% milk, four servings of water, and no more than 4 oz. of juice each day. Limit soda to 0-1 each week and eating in restaurants 0-1 each week. To help keep your child healthy, encourage them to eat five servings of fruits and vegetables every day in addition to breakfast each morning.”
  • BMI >95%: “Your child’s BMI is over the 95th percentile and we recommended they lose weight for their health and well-being. Children need 60 minutes of active play every day and should keep screen time to no more than two hours per day. Drinks should be limited to 24 oz. of 1% milk, four servings of water, and no more than 4 oz. of juice each day. Limit soda to 0-1 each week and eating in restaurants 0-1 each week. To help keep your child healthy, encourage them to eat five servings of fruits and vegetables every day in addition to breakfast each morning.”

Other Resources

Do you have a promising strategy or resource you believe would be helpful to other SBHCs working to increase the number of SBHC clients with a well child visit? Share it with us by sending an email to info@sbh4all.org and we’ll post it here!

Frequently Asked Questions

  • Conduct a BMI screening at every new patient visit, then annually thereafter.
  • Use motivational interviewing to counsel youth — it’s client-centered, collaborative, and offers tools to change behavior. For example, you may want to implement youth-centered care plans for students who are identified as overweight or obese or distribute free access passes to community recreational facilities.
  • Find community partners that offer after school physical activity programs and collaborate with them!
  • Use discrete ICD-10 codes to track counseling provided: If you are entering the nutrition or physical activity counseling as a note, narrative, or comment field in your EHR, convert those to discrete fields so you can extract that data more easily. Make sure that each provider enters data into the EHR in the same way.
  • Address both nutrition and physical activity: Make sure to track nutrition counseling and physical activity counseling as separate codes to note that patients received both services.
  • If your WCV or risk assessment includes a BMI assessment, count those visits toward the number of students with a BMI assessment.
  • You can create a discrete field to note that you completed a BMI assessment as a separate service from the WCV or risk assessment, and another discrete field in your EHR to track the BMI assessment results.

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