Physicians and Physician Trainees Rarely Identify or Address Overweight/Obesity in Hospitalized Children

Abstract

Objectives To determine how frequently physicians identify and address overweight/obesity in hospitalized children and to compare physician documentation across training level (medical student, intern, resident, attending). Study design We conducted a retrospective chart review. Using an administrative database, Centers for Disease Control and Prevention body mass index calculator, and random sampling technique, we identified a study population of 300 children aged 2–18 years with overweight/obesity hospitalized on the general medical service of a tertiary care pediatric hospital. We reviewed admission, progress, and discharge notes to determine how frequently physicians and physician trainees identified (documented in history, physical exam, or assessment) and addressed (documented in hospital or discharge plan) overweight/obesity. Results Physicians and physician trainees identified overweight/obesity in 8.3% (n = 25) and addressed it in 4% (n = 12) of 300 hospitalized children with overweight/obesity. Interns were most likely to document overweight/obesity in history (8.3% of the 266 patients they followed). Attendings were most likely to document overweight/obesity in physical examination (8.3%), assessment (4%), and plan (4%) of the 300 patients they followed. Medical students were least likely to document overweight/obesity including it in the assessment (0.4%) and plan (0.4%) of the 244 hospitalized children with overweight/obesity they followed. Conclusions Physicians and physician trainees rarely identify or address overweight/obesity in hospitalized children. This represents a missed opportunity for both patient care and physician trainee education.

Lack of Recognition, Diagnosis, and Treatment of Overweight/Obesity in Children Hospitalized for Asthma

“…27,33,45 Some studies indicate error or inaccuracy in overweight and obesity coding 14 ; however, others, as in our study, demonstrate lack of provider diagnosis. 27,45 There could be many reasons for lack of diagnosis. Provider and patient sensitivity and bias have been shown to influence provider diagnosis and treatment of overweight and obesity.…”

“…21 Identifying, plotting, and monitoring BMI percentile are essential steps in the algorithm 22 and are recommended for all hospitalized children by the National Association of Children' s Hospitals and Related Institutions, 23 but studies have shown that providers in both primary care and inpatient settings are failing to measure and monitor BMI percentile. [24][25][26] A recent study by King et al 27 described lack of identification and treatment of overweight and obesity in hospitalized children; however, only a small number of patients with asthma were included, and results specific to the patients with asthma were not described.…”

Factors Associated With Documentation of Obesity in the Inpatient Setting

“…18,19 However, it is difficult to interpret these results, specifically because the documentation and coding of obesity occurs even less frequently in the hospital than in primary care. Rates of obesity documentation or diagnosis in the hospital range from 8% to 18% in single-center studies, [20][21][22][23] with obesity more often identified in girls, children of color, and older children. 20 To better understand the factors driving inpatient provider documentation of obesity, we conducted a retrospective chart review to identify patient characteristics associated with the documentation of weight status and related obesity management recommendations.…”

Outcome of nutritional screening in the acute paediatric setting

“…The risks of obesity in childhood are well documented; however, there is a paucity of evidence regarding the impact of short-term nutritional management and periods of deficit in overweight/obese children and the subsequent impact on length of stay, morbidity or mortality. A recent study in the USA found that physicians and their trainees rarely identified or addressed overweight/obesity in hospitalised children26 and this therefore needs addressing. Although STAMP and PYMS tools are designed to identify those who are undernourished, we included those who were overweight/obese into the at-risk group for analysis as these children are, although slightly different, still are at nutritional risk.…”