Aug. 2, 2004 -- Only about half of obese children are recognize
Aug. 2, 2004 -- Only about half of obese children are recognized and treated for their condition by their health care providers, according to a new study that shows childhood obesity is often overlooked by pediatricians.
"Although the prevalence of childhood obesity has reached epidemic proportions, it was underrecognized and undertreated by pediatric health care providers in our study," write researcher Sarah Harvey O'Brian, MD, of the University of Pittsburgh School of Medicine, and colleagues.
"The results of this study are disheartening," write the researchers in the August issue of Pediatrics. "This study highlights the need for increased awareness and identification of obesity in the primary care setting, and especially among younger children and those with mild obesity."
The prevalence of childhood obesity has risen among all age, ethnic, and gender groups in the last two decades. Recent national statistics show that more than one in four children examined by pediatricians is either obese or at high risk of becoming obese.
Childhood Obesity Is Underrecognized
In the study, researchers looked at how often childhood obesity was identified at an academic primary care center serving a largely urban community. In addition, they analyzed what steps were taken by health care providers in the evaluation and management of obesity among children three months to 16 years of age treated at the center.
Researchers defined obesity as a weight of more than 120% of the 50th percentile of weight for height for children under 5 years old and a body mass index exceeding the 95th percentile for age and gender for 5 years old and older.
Of the 2,515 office visits reviewed, a total of 244 children met the researchers' criteria for obesity, which translates to nearly 10% of children meeting the definition of being obese. A nearly equal proportion of girls and boys were considered obese.
Interestingly only about half of those children who met the criteria for obesity were documented as such in their medical records. Recognition of obesity was lowest among preschool children (31%) and highest among adolescents (76%).
Among those children that had obesity listed as a medical diagnosis:
- 69% of their charts contained an adequate dietary history
- 15% of their charts contained a description of the child's activity level or amount of television viewing
- 39% had obesity noted in the physical examination
Undertreated Obesity
Researchers found that even when obesity was documented, many of the health care providers didn't take the recommended steps in addressing the issue. For example:
- Dietary changes were recommended for 71%
- Increased activity was recommended for 33%
- Limits on television viewing were recommended for 5%
The American Academy of Pediatrics recommends recognizing and monitoring changes in obesity-related risk factors such as type 2 diabetes, high blood pressure, and abnormal levels of cholesterol -- all of which are affected by excess weight. They also recommend limiting television and video viewing and promoting increased physical activity.
"Although the majority of providers recommended dietary changes for their obese patients, the important topics of activity level and television viewing were often not discussed with families," write the researchers.
Most providers recommended close follow-up monitoring, and other recommendations included referral to a dietitian, laboratory screening tests (cholesterol, glucose, thyroid function), keeping a food diary, endocrine referral, and preventive cardiology referral.
The study also showed that proper identification of childhood obesity was also related to the degree of obesity with mildly obese children being less likely to be recognized as obese.
Researchers say the medical community is still struggling to develop effective strategies for treating childhood obesity, but timely identification of obesity by pediatric health care providers is a crucial first step.
