Diagnosis, evaluation, and treatment of childhood obesity in pediatric practice

Objective: To determine rates of diagnosis and treatment, and types of treatment, among overweight children in clinical practice. Design: Six hundred randomly selected records were reviewed. Setting: Two community-based and 2 hospital-based clinics in New Haven. Participants: Children aged 3 to 17 years with a health maintenance visit from January 1, 1999, to December 31, 2000. Children classified according to body mass index (BMI) (calculated as weight in kilograms divided by the square of height in meters) lower than the 85th percentile were designated as nonoverweight; 85th to 94th percentile, at risk of overweight; and 95th percentile or greater, overweight. Main Outcome Measures: We examined the text of the encounter note for documentation of BMI, corresponding diagnosis regarding overweight, examination for comorbid disease, and treatment for overweight. Results: Among 600 patients, 52.6% were male, 34.5% were black, 35.1% were Latin American, 57.2% were in single-parent households, and 84.0% received Medicaid. Overall, 39.8% were at risk of overweight (n=107; range across sites, 14.7%,20.0%) or were overweight (n=132; range across sites, 18.0%-28.0%). The BMI was documented in 0.5% (n= 3) of medical records. Among the 239 children at risk of overweight or overweight, 20.5% had a documented diagnosis (range, 12%-37%) and 16.9% had documented treatment (range, 6%-34%). The most common strategies among the 41 subjects with documented treatment (overweight and at risk of overweight patients) were diet (74%) and increased activity (49%). Treatment recommendations were often limited to general advice (eg, recommended diet [n =19] or up arrow [increase] exercise [n=16]). Conclusion: Despite a high burden of overweight, routine screening with BMI was not documented and few children received a formal diagnosis or treatment.