title: Small steps to health: building sustainable partnerships in pediatric obesity care.
abstract: BACKGROUND
  Given the prevalence of childhood obesity and the limited support for preventing and managing obesity in primary care settings, the Seattle Children's Hospital's Children's Obesity Action Team has partnered with Steps to Health King County to develop a pediatric obesity quality-improvement project.
  
  
  METHODS
  Primary care clinics joined year-long quality-improvement collaboratives to integrate obesity prevention and management into the clinic setting by using the chronic-disease model. Sustainability was enhanced through integration at multiple levels by emphasizing small, consistent behavior changes and self-regulation of eating/feeding practices with children, teenagers, and families; building local community partnerships; and encouraging broader advocacy and policy change. Cultural competency and attention to disparities were integrated into quality-improvement efforts.
  
  
  RESULTS
  . Participating clinics were able to increase BMI measurement and weight classification; integrate management of overweight/obese children and family and self-management support; and grow community collaborations. Over the course of 4 years, this project grew from a local effort involving 3 clinics to a statewide program recently adopted by the Washington State Department of Health.
  
  
  CONCLUSIONS
  This model can be used by other states/regions to develop pediatric obesity quality-improvement programs to support the assessment, prevention, and management of childhood obesity. Furthermore, these health care efforts can be integrated into broader community-wide childhood-obesity action plans.
authors.affiliation: Department of Clinical Nutrition, Seattle Children's Research Institute, Metropolitan Park West, 8th Floor, 1100 Olive Way, Suite 500, Mail Stop 8-1, Seattle, WA 98101, USA.
authors.forename: Mo
authors.initials: M
authors.lastname: Pomietto
authors.forename: Alicia Dixon
authors.initials: AD
authors.lastname: Docter
authors.forename: Nicole
authors.initials: N
authors.lastname: Van Borkulo
authors.forename: Lorrie
authors.initials: L
authors.lastname: Alfonsi
authors.forename: James
authors.initials: J
authors.lastname: Krieger
authors.forename: Lenna L
authors.initials: LL
authors.lastname: Liu
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D019033:Delivery of Health Care, Integrated / Q000458:organization & administration*; D005260:Female; D006266:Health Education / Q000458:organization & administration*; D006776:Hospitals, Pediatric / Q000458:organization & administration; D006801:Humans; D008297:Male; D009765:Obesity / Q000453:epidemiology / Q000517:prevention & control*; D010317:Partnership Practice / Q000458:organization & administration; D010372:Pediatrics / Q000458:organization & administration*; D011320:Primary Health Care / Q000458:organization & administration*; D011322:Primary Prevention / Q000458:organization & administration; D015397:Program Evaluation; D018570:Risk Assessment; D017749:Total Quality Management; D014861:Washington