Underdiagnosis of Pediatric Obesity during Outpatient Preventive Care Visits

ArticleinAcademic pediatrics 10(6):405-9 · November 2010with12 Reads
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.
    • "A Canadian study linking a population-based survey with physician billing data showed that only 10% of children aged 10–11 years with a BMI, based on measured height and weight, that identified them as having obesity received an ICD code diagnosis of obesity during the same year, with a quarter of children with obesity that did not have an obesity diagnosis having a BMI between 28.5 and 44.0 kg/m 2 (Kuhle et al., 2011 ). According to US studies, documentation of a diagnosis of obesity on the charts ranged from 18 to 66% of children who were identified with obesity based on their measured BMI (O'Brien, Holubkov & Reis, 2004; Dorsey et al., 2010; Dilley et al., 2007; Patel et al., 2010). There is also a need to consider whether an additional step be included, given that there is increasing evidence that parents may not accurately perceive the weight status of their child(ren). "
    [Show abstract] [Hide abstract] ABSTRACT: The management of a child presenting with obesity in a primary care setting can be viewed as a multi-step behavioral process with many perceived and actual barriers for families and primary care providers. In order to achieve the goal of behavior change and, ultimately, clinically meaningful weight management outcomes in a child who is considered obese, all steps in this process should ideally be completed. We sought to review the evidence for completing each step, and to estimate the population effect of secondary prevention of childhood obesity in Canada. Methods. Data from the 2009/2010 Canadian Community Health Survey and from a review of the literature were used to estimate the probabilities for completion of each step. A flow chart based on these probabilities was used to determine the proportion of children with obesity that would undergo and achieve clinically meaningful weight management outcomes each year in Canada. Results. We estimated that the probability of a child in Canada who presents with obesity achieving clinically meaningful weight management outcomes through secondary prevention in primary care is around 0.6% per year, with a range from 0.01% to 7.2% per year. The lack of accessible and effective weight management programs appeared to be the most important bottleneck in the process. Conclusions. In order to make progress towards supporting effective pediatric obesity management, efforts should focus on population-based primary prevention and a systems approach to change our obesogenic society, alongside the allocation of resources toward weight management approaches that are comprehensively offered, equitably distributed and robustly evaluated.
    Full-text · Article · Oct 2015
    • "However , the subjective nature of self-report data (as used in this current study) also needs consideration, as selfreport has been shown to over-estimate the rates of both individual and centre-wide clinical practices [49], including the assessment of weight and height of chil- dren [40]. Current literature suggests that identification of obesity is associated with improved weight manage- ment [50], which highlights the need to identify best practices related to assessing, identifying, and managing overweight and obesity in children. However, for children with spina bifida, even when weight is assessed , the options for monitoring and classification are currently limited; in this survey, only 41% of respondents felt that currently available tools such as growth charts were appropriate. "
    [Show abstract] [Hide abstract] ABSTRACT: Childhood obesity is a global health concern, but children with spina bifida in particular have unique interacting risk factors for increased weight. PURPOSE: To identify and explore current clinical practices around weight assessment and management in paediatric spina bifida clinics. METHODS: An online, self-report survey of healthcare professionals (HCPs) was conducted in all paediatric spina bifida clinics across Canada (15 clinics). Summary and descriptive statistics were calculated and descriptive thematic analysis was performed on free text responses. RESULTS: 52 responses across all 15 clinics indicated that weight and height were assessed and recorded most of the time using a wide variety of methods, although some HCPs questioned their suitability for children with spina bifida. Weight and height information was not routinely communicated to patients and their families and HCPS identified considerable barriers to discussing weight-related information in consultations. CONCLUSION: Despite weight and height reportedly being measured regularly, HCPs expressed concern over the lack of appropriate assessment and classification tools. Communication across multi-disciplinary team members is required to ensure that children with weight-related issues do not inadvertently get overlooked. Specific skill training around weight-related issues and optimizing consultation time should be explored further for HCPs working with this population.
    Full-text · Article · Sep 2014
    • "Diastolic blood pressure was related to increasing adiposity for black boys, but not black girls (b). have found generally that the use of BMI-for-age reference values is suboptimal47484950. Advocates of the WHtR must address problems associated with the available protocols for measuring waist size. "
    [Show abstract] [Hide abstract] ABSTRACT: Convention defines pediatric adiposity by the body mass index z-score (BMIz) referenced to normative growth charts. Waist-to-height ratio (WHtR) does not depend on sex-and-age references. In the HEALTHY Study enrollment sample, we compared BMIz with WHtR for ability to identify adverse cardiometabolic risk. Among 5,482 sixth-grade students from 42 middle schools, we estimated explanatory variations (R (2)) and standardized beta coefficients of BMIz or WHtR for cardiometabolic risk factors: insulin resistance (HOMA-IR), lipids, blood pressures, and glucose. For each risk outcome variable, we prepared adjusted regression models for four subpopulations stratified by sex and high versus lower fatness. For HOMA-IR, R (2) attributed to BMIz or WHtR was 19%-28% among high-fatness and 8%-13% among lower-fatness students. R (2) for lipid variables was 4%-9% among high-fatness and 2%-7% among lower-fatness students. In the lower-fatness subpopulations, the standardized coefficients for total cholesterol/HDL cholesterol and triglycerides tended to be weaker for BMIz (0.13-0.20) than for WHtR (0.17-0.28). Among high-fatness students, BMIz and WHtR correlated with blood pressures for Hispanics and whites, but not black boys (systolic) or girls (systolic and diastolic). In 11-12 year olds, assessments by WHtR can provide cardiometabolic risk estimates similar to conventional BMIz without requiring reference to a normative growth chart.
    Full-text · Article · Aug 2014
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