Date of Conferral

8-12-2026

Date of Award

August 2026

Degree

Doctor of Nursing Practice (DNP)

School

Nursing

Advisor

Dr. Susan Huehn

Abstract

Summary This staff education project addressed inconsistent obesity risk assessment practices in an adult primary care setting. Obesity is associated with increased rates of cardiovascular disease, diabetes, hypertension, and other chronic conditions. At the project site, obesity assessment practices relied largely on body mass index (BMI), resulting in inconsistent identification of obesity-related risks and referral needs. The purpose of this project was to educate providers on the Edmonton Obesity Staging System (EOSS) to improve obesity risk identification and referral practices. The project evaluated whether the staff education intervention improved providers' knowledge and use of the Edmonton Obesity Staging System (EOSS) to identify obesity-related risks, improve documentation of obesity-related comorbidities, and guide appropriate referrals. Fifteen providers participated in the project. Preimplementation and postimplementation data were analyzed to assess changes in provider knowledge, obesity risk identification, documentation of obesity-related comorbidities, and referral rates. Findings demonstrated improvements in all measured outcomes following implementation. The project supports evidence-based obesity management, strengthens clinical decision-making, and promotes timely referral to obesity treatment services for patients at risk of obesity-related complications. Background Obesity is associated with increased risk for cardiovascular disease, Type 2 diabetes, hypertension, and other chronic conditions. At the project site, obesity assessment practices relied primarily on body mass index (BMI), resulting in inconsistent identification of obesity-related risks and referral needs. Evidence has indicated that BMI alone may not adequately identify obesity severity or obesity-related complications (Wu et al., 2024). In addition, providers often use inconsistent assessment and referral practices, contributing to missed opportunities for intervention (Al-Saadi et al., 2020). The practice-focused question for this project was as follows: In adult patients seen in primary care and outpatient settings (P), what is the impact of implementing the standardized obesity risk assessment protocol (I), compared with current obesity assessment practices (C), on provider knowledge, obesity risk identification, documentation of obesity-related comorbidities, and referral rates (O)? The purpose of this staff education project was to improve providers' knowledge and use of the Edmonton Obesity Staging System (EOSS) during routine clinical encounters to improve obesity risk identification and referral practices. Evidence supports structured obesity assessment approaches that facilitate comprehensive assessment of obesity-related complications, improve documentation of obesity-related comorbidities, and support appropriate referral decisions (Dobbie et al., 2023; Kushner & Shapiro, 2025). A Level I systematic review found that routine obesity assessments improve consistency of care when integrated into clinical workflows (Atlantis et al., 2022). Collectively, the evidence provided moderate to strong support for implementation of the intervention. Staff Education Project Development The project was implemented in a primary care setting with 15 providers participating in the educational intervention. Training focused on use of the EOSS, limitations of BMI-only screening, identification of obesity-related complications, and referral pathways. Educational materials included a presentation, the EOSS protocol, and a reference guide. The Iowa Model guided implementation. Participants completed pre- and posteducation knowledge assessments. Data collected before and after implementation included provider knowledge scores, obesity risk identification rates, documentation of obesity-related comorbidities, and referral rates. Descriptive statistics, including frequencies and percentages, were used to evaluate project outcomes. Results Fifteen providers completed the educational intervention. Postimplementation findings demonstrated improvements in provider knowledge, obesity risk identification, documentation of obesity-related comorbidities, and referral practices. Table 1 summarizes project outcomes. Table 1 Preimplementation and Postimplementation Project Outcomes Outcome measure Preimplementation Postimplementation Mean provider knowledge score 71% 96% Obesity risk identification rate 45% 84% Documentation of obesity-related comorbidities 40% 81% Referral rate for obesity management services 24% 58% Note. Values represent project outcomes collected before and after implementation of the Edmonton Obesity Staging System (EOSS). Findings demonstrated improved provider knowledge and use of the EOSS, increased obesity risk identification, improved documentation of obesity-related comorbidities, and higher referral rates following completion of the staff education program. These findings indicate greater consistency in obesity assessment, documentation of obesity-related comorbidities, and referral practices after implementation of the educational intervention. The project supported organizational goals related to evidence-based practice and quality improvement. Limitations included the small sample size, single practice setting, and short implementation period. Conclusions Implementation of a staff education program and the EOSS improved provider knowledge, obesity risk identification, documentation of obesity-related comorbidities, and referral practices. Findings support the use of structured obesity assessment processes in primary care settings. Recommendations include continued staff education, integration of assessment tools within the electronic health record, and ongoing monitoring of obesity assessment outcomes. The project supports DNP competencies related to evidence-based practice, quality improvement, and practice change leadership while promoting improved access to obesity treatment services, improving the quality and consistency of obesity care, and supporting earlier identification and management of obesity-related complications.

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