Characteristics of Correctly Identified Pediatric Obesity and Overweight Status and Management in an Academic General Pediatric Clinic

Objective: The goals of this study were to identify and characterize the rates of documentation and guideline-based management of overweight and obese children within an academic pediatric clinic.Population/Methods: Overweight, obese, and severely obese children were identified from 7,422 well child visits in 2016 within a primary care clinic that cares for a primarily urban, minority (80% African American), and Medicaid (85%) population until the age of 12. During this 1-year study, there were 79 pediatric residents, 19 attending pediatricians, and 5 nurse practitioners who treated patients. Through a retrospective electronic medical record review, diagnosis and treatment including counseling, referral to a dietician, or referral to a pediatric weight management clinic, were analyzed by the patient’s weight diagnosis, sex, age, and provider training level. Orders for laboratory testing as well as follow up visits were also reviewed. χ 2 analyses were performed to identify whether independent variables such as age of patient, sex, provider level of training, or weight diagnosis affected provider behavior in diagnosis and weight management. Logistic regression was utilized to calculate odds ratio estimates of likelihood of treatment by provider training level, age of patient, weight diagnosis, sex, laboratory testing and follow up.Results. As expected, older and heavier patients were more likely to be diagnosed and to receive weight management. Surprisingly, nurse practitioners and faculty demonstrated lower adherence to pediatric obesity guidelines. The percentages of correctly identified severely obese (90.2%), obese (77.0%), and overweight (42.0%) children were much higher than in previous retrospective chart reviews; however, less than 30% of children were referred for more intensive weight management to a dietician or pediatric obesity weight management program and less than 60% received counseling.Conclusions: Despite progress in the rates of identification of weight status at primary care visits, significant improvement in adherence to intensive pediatric weight management guidelines is needed. Strategic modifications to electronic medical records that automatically offer BMI associated weight diagnoses with a link to treatment pathways and resources are needed to facilitate improved compliance with current pediatric obesity guidelines in the primary care setting.Acknowledgements: The W.T.Gill Fellowship Program funded the research efforts for this study.