Clinical

Our clinical team has a depth and breadth of expertise that spans clinical care, advocacy, education, quality improvement and research. Highlights for this year include many national presentations, continued clinical excellence meeting Children’s Mercy’s metrics, leadership in regional and national obesity organizations, 17 journal articles, ongoing clinical research, new clinical research grants and continued leadership and excellence in quality improvement. We have also had changes in staff with the addition of a second Nurse Practitioner who is now seeing patients independently since January 2025. We continue to see a very high volume of referrals (2689 new referrals in 2024) so that despite increased capacity, at the end of 2024 we still had over 4000 new referrals waiting for appointments. In addition to seeking more clinicians, we have continued education of the local, regional and national workforce in obesity medicine best practices to meet these needs. We have also implemented a formal transition program to safely allow patients to continue their current advanced weight management therapies as they transition out of pediatric weight management into adult care. Over time we have also continued to build the experience for residents and endocrine fellows rotating with us. Every pediatric resident is spending at least a day with us, other residents choose to spend 2-4 weeks on a rotation, and endocrine fellows spend multiple days over their fellowship in weight management. We continue involving medical students in our research projects and quality improvement, and teaching providers throughout the state through our ECHO program and the REACH grant funded by the CDC (see advocacy report). 

With the advent of highly effective obesity medications, we have continued to learn and grow ourselves, and to share that knowledge far and wide.  Consistent with our expertise in medical management of the 1319 patients seen in 3795 visits in weight management in 2024 (an increase from 1144 and 3192 in 2023), we manage 721 children or teens (55%) on weight management medications including 3 pre and post heart transplant, and 38 teens (3%) who had a gastric sleeve in 2023 or 2024. Our surgical patients are also complex, including 2 children with genetic syndromes, one combined liver transplant/gastric sleeve, and one on dialysis. 

Improvements in clinical processes this year have focused around improving safety and efficacy in prescribing obesity medications. In collaboration with pharmacy, we added a shared pharmacist and full-time pharmacy technician to our team. They have increased efficiency and success in prior authorizations, developed titration and monitoring processes to allow patients to continue medication more effectively and titrate doses between clinic visits. Our dietitians developed an evidence-based handout for counseling patients on obesity medications, specifically GLP-1 Receptor Agonists, to assure adequate fluid, protein and vitamin intake, as well as optimized effectiveness with healthy routines and minimizing and addressing side effects when they occur. 

Our net promoter score is 93.3%, an increase of 8.6% from previous CY year and our comments in NRC increased from 19 to 80 between 2023 to 2024 showing increased engagement and satisfaction in care as we make these changes.

“I was nervous for this appointment and didn't want my son to feel bad about his weight. They were unbelievably great at easing my nerves and making him very comfortable as well. A very positive experience.” Parent of a 9-year-old

We continue disseminating the information learned from our quality improvement projects nationally, presenting four of them at The Obesity Society this year. Two medical students and one of our dietitians joined us to present. Eating disorder screening and treatment efforts are now nationally recognized, and Dr. Fernandez presented nationally in two combined workshops.  The results of the post-surgery hydration and our short nutrition screen quality improvement work were presented at The Obesity Society annual conference. We have just begun a new project to trial our new biological impedance scale to measure fat and fat free mass in our patients for monitoring muscle mass over time, especially in our children on GLP-1 medications and pre and post bariatric surgery.

We continue to improve on our family-based behavioral group offerings, keeping up with changes in the field of Obesity Medicine and the advent of highly effective obesity medications. With funding from the CDC, we are testing a new package of family-based behavioral treatment designed to match the new MO Medicaid benefit – Sarah Hampl MD and Meredith Dreyer Gillette PhD are leading this effort. Our ability to offer these robust intensive health behavior and lifestyle treatment options aligns with the AAP clinical practice guideline and is vital to comprehensive treatment given the scarcity of these types of programs nationally.  Our program goes beyond traditional education about nutrition and physical activity to include individual skill-building, parenting skills training, improving the shared home environment, increasing support from social networks, and fostering positive self-esteem and body image, among other goals. Drs. Shook, Hampl, Dreyer Gillette and Laroche have a REACH grant from the CDC in partnership with investigators at UMKC that includes further cultural adaptation of our family-based behavioral treatment and training providers to implement this program at Swope Health Center (a federally qualified health center).  Dr. Laroche has an R01 testing a combination of this family-based treatment with community health workers to improve engagement, retention and outcomes and examine parent bandwidth.

Clinical research has continued and expanded this year.  Dr. Laroche critically evaluates CHLN and external proposed studies desiring to recruit from our clinics. In 2024 we completed recruitment for the Stay in Treatment NIH funded trial looking at retention in weight management which began year 5 (SIT: Dr. Hampl, Site PI), Family-based Approach to Healthy Lifestyles funded by the CDC (RYSE: Dr. Hampl, Site PI) and Rare Genetic Disorders of Obesity (RGDO: Dr. Sweeney, Site PI) . We continue to recruit for the special needs weight management clinic registry (SNWM: Dr. Dreyer Gillette, PI) and a randomized clinical trial of setmelanotide for rare genetic disorders of obesity (EMANATE: Dr. Sweeney, Site PI), and will soon start recruitment for a Phenotyping study (Sweeney, site PI) and muscle changes for patients on GLP1 Receptor Agonists pilot (Shook, PI). In addition, we continue to collaborate with other areas, assist other Children’s Mercy researchers recruiting from our population, and see continued staff and patient satisfaction with our training and processes implemented in 2023, with research assistants recruiting in clinic. Our research assistants and clinical trial coordinators are integrated into the clinical team, sharing in clinic huddles, as well as team celebrations.  Our clinical staff has continued to grow as a highly functioning team, allowing us to excel in direct service, while continuing to be national leaders in improving care for children with obesity through advocacy, education and research.