Suboptimal Clinical Documentation in Young Children with Severe Obesity at Tertiary Care Centers

Abstract

Background and Objectives. The prevalence of severe obesity in children has doubled in the past decade. The objective of this study is to identify the clinical documentation of obesity in young children with a BMI ≥ 99th percentile at two large tertiary care pediatric hospitals. Methods. We used a standardized algorithm utilizing data from electronic health records to identify children with severe early onset obesity (BMI ≥ 99th percentile at age <6 years). We extracted descriptive terms and ICD-9 codes to evaluate documentation of obesity at Boston Children's Hospital and Cincinnati Children's Hospital and Medical Center between 2007 and 2014. Results. A total of 9887 visit records of 2588 children with severe early onset obesity were identified. Based on predefined criteria for documentation of obesity, 21.5% of children (13.5% of visits) had positive documentation, which varied by institution. Documentation in children first seen under 2 years of age was lower than in older children (15% versus 26%). Documentation was significantly higher in girls (29% versus 17%, p < 0.001), African American children (27% versus 19% in whites, p < 0.001), and the obesity focused specialty clinics (70% versus 15% in primary care and 9% in other subspecialty clinics, p < 0.001). Conclusions. There is significant opportunity for improvement in documentation of obesity in young children, even years after the 2007 AAP guidelines for management of obesity.

Management of childhood obesity: An audit of clinical practice in secondary care

“…Results also suggest that females are more likely to receive intervention. This has been found in many previous studies . Our population suggests that obesity is more common in males in secondary care yet less likely to be addressed for them, presenting a disparity.…”

“…A truer reflection may come from the 17.2% who received a formal diagnosis, which would be clinically coded. These rates are largely not dissimilar to those in the literature . This is disappointingly low, leaving a huge gap for improvement.…”

“…Whether this is due to lack of clinical recognition, communication difficulties or some other barrier remains unclear. Of note, in American studies, children of Black and Hispanic ethnicity, who also have higher rates of obesity, were more likely to receive clinical management . There remains a lack of specific clinical research regarding the Maori and Pacific Island child population despite their high clinical need, and this is likely needed before this issue can truly be addressed.…”

“…Unfortunately, the literature suggests that opportunities to address this issue are often being missed. Five separate American studies found the diagnosis of childhood obesity to vary between 18 and 54% and one in tertiary paediatric care 21.5% . Clinical management was universally less common in younger children and males and more common in Black and Hispanic children .…”

“…Five separate American studies found the diagnosis of childhood obesity to vary between 18 and 54% and one in tertiary paediatric care 21.5% . Clinical management was universally less common in younger children and males and more common in Black and Hispanic children . One Australian study found that 1 in 58 children had obesity addressed, while another found that one third received a diagnosis of obesity .…”