Underdiagnosis of pediatric obesity during outpatient preventive care visits

Acad Pediatr. Nov-Dec 2010;10(6):405-9. doi: 10.1016/j.acap.2010.09.004.

Abstract

Objective: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

MeSH terms

  • Adolescent
  • Child
  • Child, Preschool
  • Diagnostic Errors*
  • Female
  • Guideline Adherence*
  • Humans
  • Logistic Models
  • Male
  • Mass Screening*
  • Metabolic Syndrome / prevention & control
  • Multivariate Analysis
  • Obesity / diagnosis
  • Obesity / prevention & control*
  • Patient Education as Topic
  • Practice Patterns, Physicians'*
  • Primary Health Care
  • United States