Underdiagnosis of Pediatric Obesity During Outpatient Preventive Care Visits

The American Academy of Pediatrics in 2003 recommended that pediatricians screen patients two years of age and older for obesity using body mass index (BMI) calculations and provide guidance to parents regarding diet and exercise for obese patients (BMI ≥ 95%). Furthermore an expert national committee published in 2007 recommendations for use of laboratory tests for screening for the obesity-related comorbid conditions of diabetes and high cholesterol in pediatric patients. Are providers following these recommendations?

Using national survey data on outpatient care, researchers identified obese children and adolescents (ages 2 to 18 years old) coming to physicians for preventive outpatient visits (2005–07).

They found that providers documented a diagnosis of obesity in 18 percent of visits by obese patients. Physicians were less likely to document obesity in younger patients and more likely to document it among patients of non-White race/ethnicity. Physicians offered counseling about diet, exercise or weight reduction in 51 percent of visits by obese patients. They tested cholesterol or glucose in 10 percent of visits.

The researchers found rates of diagnosis “suboptimal” and rates of obesity-related counseling and laboratory testing for comorbid conditions “unsatisfactory.”

These data provide baseline estimates that can be used to track physician improvement in obesity diagnosis and management.

[This research was not funded by the Robert Wood Johnson Foundation.]