Medical Evaluation of Overweight Children and Adolescents: Reports From Pediatricians, Pediatric Nurse Practitioners, and Registered Dietitians
* St Louis University School of Medicine, St Louis, Missouri
Division of Nutrition and Physical Activity, Centers for Disease Control and Prevention, Atlanta, Georgia
Pediatric Gastroenterology, Baylor College of Medicine, Houston, Texas
|| Trowbridge & Associates, Inc, Decatur, Georgia
Objective. The primary aim of this study was to determine how pediatric health care providers identify overweight in children and adolescents and how they evaluate obesity-related medical complications. This information can guide development of programs to help providers improve their evaluation practices. A secondary objective was to examine the association of certain provider characteristics with recommended evaluation practices.
Methods. A random sample of pediatricians, pediatric nurse practitioners (PNPs), and registered dietitians received a questionnaire about their evaluation of overweight children and adolescents. Results were compared with published recommendations. Associations between respondent characteristics and adherence to published recommendations were examined.
Results. A total 940 providers responded (response rate: 19%–33%). Among all 3 groups a majority frequently used clinical impression, weight-for-age percentile, weight-for-height percent, and weight-for-height percentile to assess degree of overweight. Nearly all pediatricians and PNPs routinely evaluated blood pressure, but a minority routinely looked for orthopedic problems, insulin resistance, and sleep disorders. Less than 10% followed all recommendations for history and physical examination. Two thirds of pediatricians and PNPs routinely tested for lipid abnormalities. Most providers asked about family history of overweight, hypertension, cardiovascular disease, and diabetes, but only one third asked about gallbladder disease. In general, the provider’s specialty, years in practice, gender, and body mass index were not associated with adherence to recommended practices.
Conclusions. Medical evaluation of overweight children and adolescents fell short of recommended practices. These results point to the need for educational efforts to increase awareness of medical risks and for tools to facilitate more complete evaluation during office visits.
Key Words: child obesity • adolescent obesity • overweight • medical evaluation
Abbreviations: BMI, body mass index • MCHB, Maternal and Child Health Bureau • HRSA, Health Resources and Services Administration • DHHS, Department of Health and Human Services • PNP, pediatric nurse practitioner • RD, registered dietitian • CDC, Centers for Disease Control and Prevention
Received for publication Jan 28, 2002; Accepted Mar 14, 2002.
CiteULike 
Connotea 
Del.icio.us 
Digg 
Facebook 
Reddit 
Technorati 
Twitter What's this?
This article has been cited by other articles:
|
|
 |
|
  J. Huang, P. Pokala, L. Hill, K. N. Boutelle, C. Wood, K. Becerra, and K. Calfas The Health and Obesity: Prevention and Education (HOPE) Curriculum Project--Curriculum Development Pediatrics, November 1, 2009; 124(5): 1438 - 1446. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Benson, H. J. Baer, and D. C. Kaelber Trends in the Diagnosis of Overweight and Obesity in Children and Adolescents: 1999-2007 Pediatrics, January 1, 2009; 123(1): e153 - e158. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. T. Rattay, M. Ramakrishnan, A. Atkinson, M. Gilson, and V. Drayton Use of an Electronic Medical Record System to Support Primary Care Recommendations to Prevent, Identify, and Manage Childhood Obesity Pediatrics, January 1, 2009; 123(Supplement_2): S100 - S107. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Woolford, S. J. Clark, V. J. Strecher, A. Gebremariam, and M. M. Davis Physicians' Perspectives on Increasing the Use of BMI Charts for Young Children Clinical Pediatrics, July 1, 2008; 47(6): 573 - 577. [Abstract] [PDF]
|
|
|
|
|
|
H. J. Binns, M. M. Mueller, and A. J. Ariza Healthy and Fit for Prevention: The Influence of Clinician Health and Fitness on Promotion of Healthy Lifestyles During Health Supervision Visits Clinical Pediatrics, December 1, 2007; 46(9): 780 - 786. [Abstract] [PDF]
|
|
|
|
|
|
M. J. Gilbert and M. F. Fleming Use of Enhanced Body Mass Index Charts During the Pediatric Health Supervision Visit Increases Physician Recognition of Overweight Patients Clinical Pediatrics, October 1, 2007; 46(8): 689 - 697. [Abstract] [PDF]
|
|
|
|
|
|
C. L. Carroll, P. Stoltz, N. Raykov, S. R. Smith, and A. R. Zucker Childhood Overweight Increases Hospital Admission Rates for Asthma Pediatrics, October 1, 2007; 120(4): 734 - 740. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Y. Kubik, M. Story, and G. Rieland Developing School-Based BMI Screening and Parent Notification Programs: Findings From Focus Groups With Parents of Elementary School Students Health Educ Behav, August 1, 2007; 34(4): 622 - 633. [Abstract] [PDF]
|
|
|
|
|
|
E. T. Rhodes, C. B. Ebbeling, A. F. Meyers, C. T. Bayerl, W. L. Ooi, M. F. Bettencourt, and D. S. Ludwig Pediatric Obesity Management: Variation by Specialty and Awareness of Guidelines Clinical Pediatrics, July 1, 2007; 46(6): 491 - 504. [Abstract] [PDF]
|
|
|
|
 |
|
 P. M. Minihan, S. N. Fitch, and A. Must What Does the Epidemic of Childhood Obesity Mean for Children with Special Health Care Needs? J. Law Med. Ethics, March 1, 2007; 35(1): 61 - 77. [PDF]
|
|
|
|
 |
|
 L. M. Bell, S. Byrne, A. Thompson, N. Ratnam, E. Blair, M. Bulsara, T. W. Jones, and E. A. Davis Increasing Body Mass Index z-Score Is Continuously Associated with Complications of Overweight in Children, Even in the Healthy Weight Range J. Clin. Endocrinol. Metab., February 1, 2007; 92(2): 517 - 522. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J J Reilly Tackling the obesity epidemic: new approaches. Arch. Dis. Child., September 1, 2006; 91(9): 724 - 726. [Full Text] [PDF]
|
|
|
|
|
|
A. A. Meyer, G. Kundt, M. Steiner, P. Schuff-Werner, and W. Kienast Impaired Flow-Mediated Vasodilation, Carotid Artery Intima-Media Thickening, and Elevated Endothelial Plasma Markers in Obese Children: The Impact of Cardiovascular Risk Factors Pediatrics, May 1, 2006; 117(5): 1560 - 1567. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. N. Robinson Obesity Prevention in Primary Care Arch Pediatr Adolesc Med, February 1, 2006; 160(2): 217 - 218. [Full Text] [PDF]
|
|
|
|
|
|
M. Satchell and S. Pati Insurance Gaps Among Vulnerable Children in the United States, 1999-2001 Pediatrics, November 1, 2005; 116(5): 1155 - 1161. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. B. Dorsey, C. Wells, H. M. Krumholz, and J. C. Concato Diagnosis, Evaluation, and Treatment of Childhood Obesity in Pediatric Practice Arch Pediatr Adolesc Med, July 1, 2005; 159(7): 632 - 638. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Cook, M. Weitzman, P. Auinger, and S. E. Barlow Screening and Counseling Associated With Obesity Diagnosis in a National Survey of Ambulatory Pediatric Visits Pediatrics, July 1, 2005; 116(1): 112 - 116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. R. Mabry, S. J. Clark, A. Kemper, K. Fraser, S. Kileny, and M. D. Cabana Variation in Establishing a Diagnosis of Obesity in Children Clinical Pediatrics, April 1, 2005; 44(3): 221 - 227. [Abstract] [PDF]
|
|
|
|
|
|
M. V. Louthan, M. J. Lafferty-Oza, E. R. Smith, C. A. Hornung, S. Franco, and J. A. Theriot Diagnosis and Treatment Frequency for Overweight Children and Adolescents at Well Child Visits Clinical Pediatrics, January 1, 2005; 44(1): 57 - 61. [Abstract] [PDF]
|
|
|
|
|
|
D. Dougherty and L. A. Simpson Measuring the Quality of Children's Health Care: A Prerequisite to Action Pediatrics, January 1, 2004; 113(1/S1): 185 - 198. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. E Temple, K. I Koranyi, and M. C Nahata Lipodystrophy in HIV-Infected Pediatric Patients Receiving Protease Inhibitors Ann. Pharmacother., September 1, 2003; 37(9): 1214 - 1218. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. E. Barlow and W. H. Dietz Management of Child and Adolescent Obesity: Summary and Recommendations Based on Reports From Pediatricians, Pediatric Nurse Practitioners, and Registered Dietitians Pediatrics, July 1, 2002; 110(1): 236 - 238. [Full Text] [PDF]
|
|
