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Improvements in pediatric obesity recognition, treatment needed
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SAN FRANCISCO — Efforts to improve the diagnosis and treatment of obesity must include attention to younger, less obese patients, as well as those with primary diagnoses not directly related to obesity, according to data presented at the AAP National Conference & Exhibition.
The researchers, presenting their findings in San Francisco, concluded that despite obesity’s high prevalence among inpatient youth, it remains under-recognized and rarely addressed by providers.
“Not only is this a beneficial opportunity for patient education, it is also a time for residents to build upon their own education,” Hanna Siddiqui, MD, MPH, of Maimonides Infants and Children’s Hospital of Brooklyn, told Healio Family Medicine.
To determine the prevalence of obesity in hospitalized youth, patterns of obesity documentation among providers, and patient characteristics associated with such documentation and obesity management, Siddiqui and colleagues conducted a retrospective chart review of medical records of 4,680 patients aged 2 to 18 years discharged in 2012 to 2014. They applied World Health Organization standards for identifying outliers in anthropometric data, and used them to exclude charts with biologically implausible BMI.
The researchers reviewed charts of obese patients, defined as those with a BMI among or greater than the 95th percentile, for documentation of obesity. Chi-square and t-tests were used to determine differences between obese patients with documentation and those without.
According to the researchers, 19.8% of inpatient discharges were obese, and of those, 23% had obesity documentation included in their record. In addition, only 5% of discharged patients with obesity received counseling, recommendations or referrals specific to their obesity, the researchers said. Documentation, and documentation of obesity management, were significantly associated with older age and higher BMI z-score in univariate and multivariate analysis. A primary diagnosis of cholelithiasis was significantly associated with a documented obesity plan in univariate analysis, but not after controlling for admission to surgical service with a pediatric consult, the researchers said.
“Quality improvement efforts geared toward resident training on documentation and proper counseling are necessary to increase recognition of obesity in the inpatient setting,” Siddiqui said. “Hopefully, this will lead to less significant health disparities in outcomes linked to obesity over time.” – by Jason Laday
Reference:
Siddiqui H, et al. Obesity among inpatient pediatrics: Prevalence and predictors of provider recognition and management; AAP National Conference & Exhibition, Oct. 21, 2016; San Francisco.
Disclosure: The researchers report no relevant financial disclosures.