Underdiagnosis of Pediatric Obesity during Outpatient Preventive Care Visits

Department of Pediatrics, University of California, San Francisco, Calif 94118, USA.
Academic pediatrics (Impact Factor: 2.01). 11/2010; 10(6):405-9. DOI: 10.1016/j.acap.2010.09.004
Source: PubMed


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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    ABSTRACT: Childhood obesity is a recognized public health crisis. This paper reviews the lessons learned from a voluntary initiative to expand insurance coverage for childhood obesity prevention and treatment services in the United States. In-depth telephone interviews were conducted with key informants from 16 participating health plans and employers in 2010-11. Key informants reported difficulty ensuring that both providers and families were aware of the available services. Participating health plans and employers are beginning new tactics including removing enrollment requirements, piloting enhanced outreach to selected physician practices, and educating providers on effective care coordination and use of obesity-specific billing codes through professional organizations. The voluntary initiative successfully increased private health insurance coverage for obesity services, but the interviews described variability in implementation with both best practices and barriers identified. Increasing utilization of obesity-related health services in the long term will require both family- and provider-focused interventions in partnership with improved health insurance coverage.
    Journal of obesity 04/2013; 2013:379513. DOI:10.1155/2013/379513
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    • "If a lack of reporting mirrors reality, this suggests that for the majority of overweight and obese children, excess bodyweight is not being considered as a priority topic during consultations. Given that the identification of obesity is associated with improved weight management [41,42], further research could usefully be targeted at identifying the barriers to weight management discussions in SB clinics. Reasons for this may include a lack of awareness among clinicians, a lack of confidence to tackle a notoriously sensitive issue or an unwillingness to overburden families who face many challenges already, such as intense therapy schedules [3,55] and socio-economic pressures [11]. "
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    ABSTRACT: Purpose: Children with disabilities are two to three times more likely to become overweight or obese than typically developing children. Children with spina bifida (SB) are at particular risk, yet obesity prevalence and weight management with this population are under-researched. This retrospective chart review explored how weight is assessed and discussed in a children's SB outpatient clinic. Method: Height/weight data were extracted from records of children aged 2-18 with a diagnosis of SB attending an outpatient clinic at least once between June 2009-2011. Body mass index was calculated and classified using Centers for Disease Control and Prevention cut-offs. Notes around weight, diet and physical/sedentary activities were transcribed verbatim and analysed using descriptive thematic analysis. Results: Of 180 eligible patients identified, only 63 records had sufficient data to calculate BMI; 15 patients were overweight (23.81%) and 11 obese (17.46%). Weight and physical activity discussions were typically related to function (e.g. mobility, pain). Diet discussions focused on bowel and bladder function and dietary challenges. Conclusions: Anthropometrics were infrequently recorded, leaving an incomplete picture of weight status in children with SB and suggesting that weight is not prioritised. Bowel/bladder function was highlighted over other benefits of a healthy body weight, indicating that health promotion opportunities are being missed. Implications for Rehabilitation It is important to assess, categorise and record anthropometric data for children and youth with spina bifida as they may be at particular risk of excess weight. Information around weight categorisation should be discussed openly and non-judgmentally with children and their families. Health promotion opportunities may be missed by focusing solely on symptom management or function. Healthcare professionals should emphasise the broad benefits of healthy eating and physical activity, offering strategies to enable the child to incorporate healthy lifestyle behaviours appropriate to their level of ability.
    Disability and Rehabilitation 03/2013; 35(25). DOI:10.3109/09638288.2013.771705 · 1.99 Impact Factor
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    • "Although the causes of obesity are complex, it is widely recognized that poor nutrition and physical inactivity play important roles [5]. For this reason, public health interventions targeting youths frequently focus on health promotion programs in schools [6] [7] [8] [9], as well as calling for nutrition and exercise counseling in the health care setting [10] [11] [12]. "
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    ABSTRACT: Obesity is a serious health threat, particularly among racial/ethnic minorities and those who are uninsured, yet little is known about the implementation of nutrition or exercise counseling or the combination of both among these groups. Trends in counseling by race/ethnicity and types of insurance were examined. Trend analyses were conducted with the California Health Interview Surveys among those ages 12-17 for the period 2003-2009. Race/Ethnicity: Receipt of both counseling methods declined from 2003-2009 for all racial/ethnic groups, except Hispanics and Whites, for whom increases in counseling began after 2007. Hispanics and African Americans generally reported higher levels of nutrition than exercise counseling, while Whites generally reported higher levels of exercise than nutrition counseling for the study period. INSURANCE TYPE: Receipt of both counseling methods appeared to decline from 2003-2009 among all insurance types, although after 2007, a slight increase was observed for the low-cost/free insurance group. Those with private health insurance generally received more exercise counseling than nutrition counseling over the study period. Counseling among all racial/ethnic groups and insurance types is warranted, but particularly needed for African Americans, American Indian/Alaska Natives, and the uninsured as they are at highest risk for developing obesity. Institutional and policy changes in the health care environment will be beneficial in helping to promote obesity-related counseling.
    Journal of Environmental and Public Health 08/2012; 2012:949303. DOI:10.1155/2012/949303
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