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July 2005

Diagnosis, Evaluation, and Treatment of Childhood Obesity in Pediatric Practice

Author Affiliations

Author Affiliations: Departments of Pediatrics (Dr Dorsey) and Internal Medicine (Drs Krumholz and Concato) and Robert Wood Johnson Clinical Scholars Program (Ms Wells and Drs Krumholz and Concato), Yale University School of Medicine, and Investigative Medicine Program, Yale University School of Medicine, Mentored Clinical Research Award Program (Dr Dorsey), New Haven, Conn; and Clinical Epidemiology Research Center, VA Connecticut Healthcare System, West Haven, Conn (Ms Wells and Dr Concato).

Arch Pediatr Adolesc Med. 2005;159(7):632-638. doi:10.1001/archpedi.159.7.632

Objective  To determine rates of diagnosis and treatment, and types of treatment, among overweight children in clinical practice.

Design  Six hundred randomly selected records were reviewed.

Setting  Two community-based and 2 hospital-based clinics in New Haven.

Participants  Children aged 3 to 17 years with a health maintenance visit from January 1, 1999, to December 31, 2000. Children classified according to body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) lower than the 85th percentile were designated as nonoverweight; 85th to 94th percentile, at risk of overweight; and 95th percentile or greater, overweight.

Main Outcome Measures  We examined the text of the encounter note for documentation of BMI, corresponding diagnosis regarding overweight, examination for comorbid disease, and treatment for overweight.

Results  Among 600 patients, 52.6% were male, 34.5% were black, 35.1% were Latin American, 57.2% were in single-parent households, and 84.0% received Medicaid. Overall, 39.8% were at risk of overweight (n = 107; range across sites, 14.7%-20.0%) or were overweight (n = 132; range across sites, 18.0%-28.0%). The BMI was documented in 0.5% (n = 3) of medical records. Among the 239 children at risk of overweight or overweight, 20.5% had a documented diagnosis (range, 12%-37%) and 16.9% had documented treatment (range, 6%-34%). The most common strategies among the 41 subjects with documented treatment (overweight and at risk of overweight patients) were diet (74%) and increased activity (49%). Treatment recommendations were often limited to general advice (eg, “recommended diet” [n = 19] or “↑ [increase] exercise” [n = 16]).

Conclusion  Despite a high burden of overweight, routine screening with BMI was not documented and few children received a formal diagnosis or treatment.