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Can't chalk it up to 'baby fat'

December 30, 2008

Doctors not properly diagnosing overweight and obesity in children

Despite recent widespread media attention given to studies that have indicated one-third of American children have a weight problem, a new study shows just one-third of children who are overweight or obese actually receive that diagnosis by a pediatrician. The study, led by researchers at The MetroHealth System and Case Western Reserve University School of Medicine in Cleveland, also stresses that this failure to diagnose appears to mostly impact children who may most greatly benefit from early intervention. The study is published in the January issue of the journal Pediatrics.

Using electronic medical records (EMR), researchers reviewed BMI measurements recorded for 60,711 2-18 year olds who had at least one well-child visit between June 1999 and October 2007 at MetroHealth. The BMI measurement showed that 19% (11,277) of the children were overweight, 23% (14,105) obese, and 8% (4,670) severely obese. Researchers discovered that increasing BMI percentile increased the likelihood of a diagnosis. While 76% of severely obese children and 54% of obese children were diagnosed - just 10% of overweight patients received a proper diagnosis. (Overweight is defined as a BMI between the 85th-95th percentile. Obesity is defined as a BMI greater than 95th percentile. And severely obese is a BMI equal or greater to the 99th percentile.)

"Despite having set pediatric BMI guidelines, this is a bit of a wake-up call to pediatricians that as many as 90% of overweight children are not being properly diagnosed," said David C. Kaelber, M.D., Ph.D., M.P.H., lead author of the study, as well as an internist and pediatrician and chief informatics officer at MetroHealth and assistant professor of internal medicine and pediatrics at Case Western Reserve University School of Medicine. "Better identification of this group of children who have just crossed into the 'unhealthy' weight category is essential for early intervention which will hopefully prevent not only a childhood of increased health problems, but also what now often becomes an ongoing battle through adulthood with life-long issues."

The researchers, which included an investigator from the Harvard Medical School, the Harvard School of Public Health, and Brigham and Women's Hospital in Boston, also found that although the percentage of patients whose condition was diagnosed increased steadily over the study period until 2005, the diagnosis rate plateaued in 2006 and 2007, implying the impact of publicity regarding weight problems may be reaching its peak. And despite adding an abnormal BMI flag in the EMR system from 2004-2007, there was no evidence of increased diagnosis in that time period.

"While early and accurate diagnosis of pediatric weight issues is an essential first step in identifying the problem, we must also look at possible solutions," says Dr. Kaelber. "For example, as the role of EMR grows, new methods such as automatic electronic alerts being sent to pediatricians and parents about a child's weight status and automatic referrals to special pediatric weight-management programs are some innovative ideas in using technology to help improve our children's health."

Case Western Reserve University