Underdiagnosis of Pediatric Obesity during Outpatient Preventive Care Visits

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• 作者：Anisha I. Patel ; MD ; MSPH ; ^{Patela@peds.ucsf.edu} ; Kristine A. Madsen ; MD ; MPH ; Judith H. Maselli ; MSPH ; Michael D. Cabana ; MD ; MPH ; Randall S. Stafford ; MD ; PhD ; Adam L. Hersh ; MD ; PhD
• 关键词：children ; diagnosis ; obesity ; screening ; treatment
• 刊名：Academic Pediatrics
• 出版年：2010
• 出版时间：November-December 2010
• 年：2010
• 卷：10
• 期：6
• 页码：405-409
• 全文大小：84 K

文摘

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?007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data, outpatient preventive visits made by obese (body mass index ?5 % ) 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?3) of visits made by 2- to 18-year-old patients with a body mass index ?5 % . Documentation of an obesity diagnosis was more likely for non-white patients (odds ratio 2.87; 95 % confidence interval, 1.3?.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.