Underdiagnosis of Pediatric Obesity during Outpatient Preventive Care Visits

Department of Pediatrics, University of California, San Francisco, Calif 94118, USA.
Academic pediatrics (Impact Factor: 2.23). 11/2010; 10(6):405-9. DOI: 10.1016/j.acap.2010.09.004
Source: PubMed

ABSTRACT To examine obesity diagnosis, obesity-related counseling, and laboratory testing rates among obese pediatric patients seen in US preventive outpatient visits and to determine patient, provider, and practice-level factors that are associated with obesity diagnosis.
By using 2005-2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data, outpatient preventive visits made by obese (body mass index ≥95%) 2- to 18-year-old patients were examined for frequencies of obesity diagnosis, diet, exercise, or weight reduction counseling, and glucose or cholesterol testing. Multivariable logistic regression was used to examine whether patient-level (gender, age, race/ethnicity, insurance type) and provider/practice-level (geographic region, provider specialty, and practice setting) factors were associated with physician obesity diagnosis.
Physicians documented an obesity diagnosis in 18% (95% confidence interval, 13-23) of visits made by 2- to 18-year-old patients with a body mass index ≥95%. Documentation of an obesity diagnosis was more likely for non-white patients (odds ratio 2.87; 95% confidence interval, 1.3-6.3). Physicians were more likely to provide obesity-related counseling (51% of visits) than to conduct laboratory testing (10% of visits) for obese pediatric patients.
Rates of documented obesity diagnosis, obesity-related counseling, and laboratory testing for comorbid conditions among obese pediatric patients seen in US outpatient preventive visits are suboptimal. Efforts should target enhanced obesity diagnosis as a first step toward improving pediatric obesity management.

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    • "With frequent access and opportunities to engage families , a 2005 Institute of Medicine (IOM) report concluded that physicians, nurses, dietitians, and other clinicians are in a key position to influence children and their parents to adopt healthy lifestyles [9] [10] [11] [12]. Despite these recommendations, a national population-based survey found that obesity was diagnosed at only 18% of well-child visits for children with known obesity, and diet and activity counseling was documented for only 51% of known obese children [13]. One barrier is that few health insurance plans have covered the costs of obesity prevention or treatment, leaving providers with a disincentive to offer the services and families facing significant out-of-pocket expenses if it is offered [14]. "
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