TUCSON, ARIZ. — Family physicians are failing to diagnose obesity in a substantial number of their overweight pediatric patients.
A review of 100 pediatric charts from two family medicine residency outpatient clinics identified 20% of pediatric patients as overweight and 19% as being at risk for overweight.
Yet only 28% of the cases were correctly identified and documented, Dr. Jennifer Keehbauch and her colleagues reported in a poster at the annual meeting of the North American Primary Care Research Group. It has been reported in previous literature that pediatricians recognize only about 29% of their overweight patient population.
The pilot data were based on 100 charts randomly selected from a computer-generated list of well-child visits. The patients, aged 2–17 years, were identified as Hispanic (36%), white (30%), African American (8%), and other (26%).
Overall, 79% of the overweight children did not have appropriate screening for hyperlipidemia or glucose intolerance, and 21% had blood pressure above the 95th percentile of blood pressure for their sex and age.
It's unclear whether the physicians are failing to recognize obesity or are reluctant to label children as obese, said Dr. Keehbauch, assistant director of family practice residency, Florida Hospital, Orlando. One strategy for better identification of childhood obesity is an upgraded electronic health record (HER) system that generates and plots body mass index percentile for age.
The two clinics in the review use the EHR system from Epic System Corp., which calculates BMI, but plots only height and weight “A BMI of 19 in an adult might be normal, but in a child it might be obese. You have to plot the BMI percentile for age to get the diagnosis,” she said.
Other EMR systems plot BMI percentile for age as well. Evidence supports the use of BMI percentile for age, but less than 15% of pediatricians report using it. The next phase of the study is a follow-up survey to determine awareness and utilization of the BMI percentile by health care providers at both clinics.