On the Frontline: Pediatric Obesity in the Emergency Department

Abstract

Obesity among children is rising at an alarming rate. This study examines pediatric emergency department visits for children aged 2 to 17 years to determine the prevalence of normal, overweight, and obesity as well as to characterize discharge diagnosis and level of service among the different groups. The electronic emergency department medical record and billing service data were used in the review process. Body mass index (BMI) and percentiles were calculated using the Centers for Disease Control formulas with overweight being defined as BMI between 85th and 94th sex- and age-specific percentiles and obesity as greater than 95th sex- and age-specific percentile. The study was reviewed and approved by the institutional review board. Of the 596 patients meeting inclusion criteria, there was a predominance of African American and Hispanic patients. Approximately 53% (313) of patients were classified as normal weight, while 46% (272) of patients were either overweight or obese. The percentages of overweight and obesity were similar across racial/ethnic classifications, with a slight predominance of obesity among minority groups (30% and 35%, respectively, in minority groups vs 28% and 25%, respectively, in nonminority groups). There were no statistically significant differences between discharge diagnosis and level of service among the different weight categories. Rates of overweight and obesity in this predominately minority pediatric population were significantly greater than the published national rates. The impact of the epidemic of childhood obesity mandates the need for innovative strategies of weight control and reduction. Emergency departments routinely treat high-risk pediatric populations and can therefore serve as a resource for screening and early referral that has been previously untapped in combating childhood obesity.

Pediatric-Adapted Liking Survey (PALS): A Diet and Activity Screener in Pediatric Care

“…This study had both strengths and weaknesses. The PED can be an acceptable setting to screen health behaviors related to obesity risk and for brief interventions, particularly because it provides health care to high-risk populations, such as low-income, minority families [6,7,8,9]. Additionally, this study utilized the PALS diet and activity screener, which was acceptable to both children and parents, with testing of reliability and validity using multiple statistical techniques and criteria [34,97].…”

“…Obesity prevention requires a multi-sector approach [3], including screening, brief interventions and referrals between clinical and community sectors [4]. As the pediatric emergency department (PED) is utilized for non-urgent care [5], it should be part of this multi-sector approach [6,7,8,9] to reach low-income children who often have unhealthy dietary behaviors and lack access to primary care [6]. Brief obesity interventions have been successfully accomplished in the PED [7].…”

Accuracy of the Weight-for-age Index in Identifying Obese Children in the Emergency Setting

“…(Stettler et al, 2007) The latter implies that there may be some value in using weight-for-age > 95th percentile as a clinical screening tool for obesity in the emergency department. An earlier study out of the United States identified that approximately 30% of children who present to an urban emergency department are obese, (Prendergast et al, 2011) and the reported prevalence in this study's population was approximately 16%. Thus, the emergency setting may be a significant untapped resource in identifying childhood obesity.…”

“…That is, we may have had a higher percentage of children that were shorter and obese with a weightfor-age percentile that did not meet the obesity cut-off. The latter may be relevant in our study since compared to the general population, there is a greater frequency of childhood obesity amongst those who present to emergency departments, (Prendergast et al, 2011) and we may have had on average shorter children given the relatively higher proportion of Southeast Asian participants. Thus, weight-for-age > 95th percentile may have falsely labelled some shorter children as non-obese, thereby compromising the sensitivity of this definition for obesity.…”

“…Emergency departments have been shown to be a key component of the health care system by serving as connectors between acute care and preventative/outpatient management. (Prendergast et al, 2011) Thus, timely referral from the emergency department to a pediatrician and/or specialty clinics focusing on childhood obesity may be an important step in the management of this condition, especially if early intervention has any role in reducing longer-term morbidity. (O'Brien SH et al, 2004) Simultaneously, given the high specificity of the weight-for-age > 95th percentile cut-off, we can avoid erroneous stigmatization of this label and potentially unnecessary treatments or interventions.…”