Paediatric obesity: Documentation, screening, and pharmacotherapy in a national cohort

Abstract

Background: Multiple organizations have published guidelines for the screening and treatment of obesity and related comorbidities in youth, including the use of antiobesity medications (AOM). This study aimed to determine which paediatric patients:(1) receive a diagnostic code for obesity; (2) are most likely to be screened for hyperlipidaemia, non-alcoholic fatty liver disease, and type 2 diabetes mellitus; and (3) are most likely to be prescribed AOM.Methods: A cohort of 35 898 patients 9 years 4 months to 17 years 6 months of age with a BMI > 30 or greater than the 95th% on three separate outpatient encounters was generated using the TriNetX database. Logistic regression models were used to estimate the associations between demographics in the study population and the likelihood of diagnosis of obesity, screening for comorbidities, and prescription of AOMs.Results: Asian, Black, and Hispanic youths had increased odds of having a diagnosis of obesity and being screened for all three comorbidities. Documentation of obesity was associated with increased odds of screening for all comorbidities. Female sex, documentation of obesity, and higher BMIs were associated with increased odds of being prescribed AOMs. Black and Native American races decreased the likelihood of being prescribed AOM.Conclusions: Management of obesity in terms of documentation of disease, screening for comorbidities, and initiation of AOM continues to fall short of the guidelines put forth by multiple organizations. Race/ethnicity, sex, and BMI correlate with differences in care provided to obese paediatric patients. Further research is needed to identify the barriers to and causes of these disparities.

Increasing Screening Rates for Comorbidities in Adolescents with Elevated Body Mass Index in Pediatric Primary Care

“…This exceeded the national rate of 20% for comorbidity screening. 9 We accomplished this by prioritizing the project on a departmental level, committing resources and focus to the project, educating providers on the scope and severity of the problem, and leveraging CDS tools in the EHR. Providing individual feedback and several incentives to providers contributed to the project’s ultimate success.…”

“…In a recent national cohort study, adherence with recommended laboratory screening for comorbid medical conditions associated with obesity was found to be no higher than 65% in pediatric primary care settings, and only one in five children received the complete bundle of recommended screening laboratories for hyperlipidemia, MASLD, and type 2 diabetes. 9 …”