The assessment of weight status in children and young people attending a spina bifida outpatient clinic: a retrospective medical record review

Abstract

PurposeChildren with disabilities are two to three times more likely to become overweight or obese than typically developing children. Children with spina bifida (SB) are at particular risk, yet obesity prevalence and weight management with this population are under-researched. This retrospective chart review explored how weight is assessed and discussed in a children’s SB outpatient clinic.MethodHeight/weight data were extracted from records of children aged 2–18 with a diagnosis of SB attending an outpatient clinic at least once between June 2009–2011. Body mass index was calculated and classified using Centers for Disease Control and Prevention cut-offs. Notes around weight, diet and physical/sedentary activities were transcribed verbatim and analysed using descriptive thematic analysis.ResultsOf 180 eligible patients identified, only 63 records had sufficient data to calculate BMI; 15 patients were overweight (23.81%) and 11 obese (17.46%). Weight and physical activity discussions were typically related to function (e.g. mobility, pain). Diet discussions focused on bowel and bladder function and dietary challenges.ConclusionsAnthropometrics were infrequently recorded, leaving an incomplete picture of weight status in children with SB and suggesting that weight is not prioritised. Bowel/bladder function was highlighted over other benefits of a healthy body weight, indicating that health promotion opportunities are being missed.Implications for RehabilitationIt is important to assess, categorise and record anthropometric data for children and youth with spina bifida as they may be at particular risk of excess weight.Information around weight categorisation should be discussed openly and non-judgmentally with children and their families.Health promotion opportunities may be missed by focusing solely on symptom management or function.Healthcare professionals should emphasise the broad benefits of healthy eating and physical activity, offering strategies to enable the child to incorporate healthy lifestyle behaviours appropriate to their level of ability.

Factors Associated with Mobility Outcomes in a National Spina Bifida Patient Registry

“…Unfortunately, obesity in the SB population is difficult to measure for several reasons. 26–28 The legs are often proportionally shorter than the arms, which creates a potential in biased body mass index (BMI) calculations. Although suggestions have been made for ways to calculate a modified BMI taking into account anthropometric data, this practice has not been adopted by all clinics.…”

“Fat is really a four‐letter word”: Exploring weight‐related communication best practices in children with and without disabilities and their caregivers

“…HCPs, but literature suggests that weight-related discussions still happen infrequently (McPherson et al, 2013;.…”

“…There may be additional barriers when HCPs work with specialized populations, such as children with disabilities. Despite evidence of increased risks of obesity in children with physical and developmental disabilities (2-3 times that of typically developing children ;Neter et al, 2011), the topic is seldom addressed in clinical consultations (McPherson, Swift, Yung, Lyons, & Church, 2013). The long-standing relationships developed with families in rehabilitation care and complex nature of many disabilities can deter HCPs from addressing weight-related topics in this population (Jachyra et al, Under review;.…”

Obesity Prevention for Children with Developmental Disabilities

“…BMI assessment is known to vary widely among healthcare professionals [143, 144], and limited evidence suggests that routine recording of weight and height and guidance on nutrition, physical activity, and sedentary activity may not be complete in compliance with these recommendations for children with DD, in particular [145]. Practitioners also need to be aware of and screen for genetically-based syndromes that are associated with both ID and obesity such as Prader Willi, Bardet Biedl, Alstrom syndromes, and others.…”