Recognition of overweight-obesity in children - are paediatricians missing the opportunity in outpatient clinics?

Abstract

Aims Overweight-obesity is an emerging major health issue in children in the UK. Success of any initiative to address this and mitigate its potential health burden during adulthood relies on proactive engagement of children, parents and professionals. Paediatricians will naturally be at the forefront of such interventions. This study explores if opportunities available in children's outpatient clinics are utilised effectively. Methods This retrospective study looked at 1000 data-sets (routine height and weight) of 2-16 year-old children who attended clinics in the paediatric outpatient department of an inner-city District General Hospital between April 2008 and March 2009. We calculated body mass index (BMI) to identify overweight or obesity as described in the NICE guideline (UK 1990 BMI growth reference chart). Clinic letters from our electronic database were checked to answer three specifi c questions -Was overweight-obesity recognised? Was it discussed with the parent? Was any action initiated to address this issue? Results In this cohort of 1000 children, 231 (23%) were underfi ve; 483 (48%) were 5-11 year-old and 286 (29%) were over-11 to 16 year-old. 583 (58%) were boys. BMI plots revealed that 152 (15%) were obese and 121 (12%) were overweight. 106 (25%) girls and 167 (29%) boys were overweight-obese. Prevalence of overweight-obesity -27.3%-and its distribution among boys (29%) in this cohort correlate with a recent UK-wide survey (2008). Information extracted from clinic letters suggested that only 4 out of 10 overweight-obese children (38%; n=104) were recognised -better if obese (56%; n=84) than overweight (17%; n=20). Documentation of discussion was even less frequent. Specifi c action was initiated only in 43% of obese (n=65) and 10% of overweight (n=12) children.

Obesity Predicts Liver Function Testing and Abnormal Liver Results

“…This is surprising and may represent under‐recognition of obesity in children, which has been reported in up to 83% of children with overweight and 44% of children with obesity . Other studies have also demonstrated under‐recognition of obesity by parents of children with overweight, particularly younger children compared with adolescents and African American parents compared with White parents .…”

Identifying and barriers to intervening in childhood obesity in paediatric outpatient nursing settings using a mixed methods study

“…10 There is also some evidence on practices, attitudes and training needs of Australian primary care nurses surrounding child obesity prevention in the general practice setting. 11 12 In the UK, Gali et al 13 suggested that paediatricians are missing an opportunity in outpatient clinics to identify and intervene in children who are overweight. Their 2011 study reported that 25% of girls and 29% of boys were overweight or obese, but that 83% of overweight children were unrecognised as BMI was not routinely calculated, despite availability of height and weight data.…”