Recognition of Childhood Overweight during Health Supervision Visits: Does BMI Help Pediatricians

• Published in: Obesity (Silver Spring, Md.) Vol. 15; no. 1; pp. 225 - 232
• Main Authors: Barlow, Sarah E, Bobra, Sonal R, Elliott, Michael B, Brownson, Ross C, Haire-Joshu, Debra
• Format: Journal Article
• Language: English
• Published: Oxford, UK The North American Association for the Study of Obesity 01.01.2007; Blackwell Publishing Ltd
• Subjects: Adolescent; Body Mass Index; boys; Child; child nutrition; Child Nutrition Disorders; Child Nutrition Disorders - classification; Child Nutrition Disorders - diagnosis; Child Nutrition Disorders - diet therapy; children; Chronic illnesses; classification; Confidence Intervals; Counseling; diagnosis; diet counseling; diet therapy; exercise counseling; Families & family life; Family physicians; Female; girls; growth chart; Health care; Health facilities; health services; Humans; Identification; Male; Missouri; Nutrition research; Obesity; Obesity - classification; Obesity - diagnosis; Obesity - diet therapy; Odds Ratio; Overweight; Patients; pediatricians; Pediatrics; Pediatrics - standards; physician practice behavior; Practice Patterns, Physicians; Practice Patterns, Physicians' - standards; questionnaires; Research methodology; Supervision; Teenagers; Missouri; St Louis Missouri; United States > US
• ISSN: 1930-7381; 1930-739X
• DOI: 10.1038/oby.2007.535

OBJECTIVE: To assess, in diverse pediatric practices, the frequency of overweight/obesity (OW/OB) identification during health supervision visits and its association with BMI curve use. RESEARCH METHODS AND PROCEDURES: Pediatricians in public and private practice in St. Louis, MO, participated in a study of the care of chronic conditions during health supervision visits. Requested information from 30 visits per pediatrician of children 6 to 17 years of age included the visit note, the growth chart, and a one-page questionnaire about patient demographics and visit content. Pediatricians indicated the presence and discussion of common chronic conditions, including OW/OB. Identification was compared with patient BMI category, and associations between identification and patient and visit characteristics, including BMI curve use, were examined. RESULTS: Twenty-one (40%) of contacted pediatricians returned information from 557 visits. Pediatricians identified OW/OB in 27% of children with a BMI at the 85th to 94th percentile and 86% of children with a BMI at or above the 95th percentile. Identification was higher in adolescents but was not associated with patient sex or race, practice setting, insurance type, or visit length. Only 41% of growth charts were current, and 6.1% had BMI plotted. BMI plotting was associated with OW/OB identification when the BMI was at the 85th to 94th percentile but not when the BMI was at or above the 95th percentile. After controlling for BMI percentile, OW/OB identification was significantly associated with diet counseling (odds ratio, 7.46; 95% confidence interval, 3.42 to 16.24) and exercise counseling (odds ratio, 5.57; 95% confidence interval, 2.61 to 11.90). DISCUSSION: Despite low BMI curve use, pediatricians recognized most overweight/obese children with a BMI at or above the 95th percentile. BMI plotting may increase recognition in mildly overweight children.