search text   Advanced Search

This Article Full Text Full Text (PDF) P3Rs: Submit a response Alert me when this article is cited Alert me when P3Rs are posted Alert me if a correction is posted Citation Map Services E-mail this article to a friend Similar articles in this journal Similar articles in ISI Web of Science Similar articles in PubMed Alert me to new issues of the journal Add to My File Cabinet Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via CrossRef Citing Articles via ISI Web of Science (16) Citing Articles via Google Scholar Google Scholar Articles by Cook, S. Articles by Barlow, S. E. Search for Related Content PubMed PubMed Citation Articles by Cook, S. Articles by Barlow, S. E. Related Collections Nutrition & Metabolism

Screening and Counseling Associated With Obesity Diagnosis in a National Survey of Ambulatory Pediatric Visits

Stephen Cook, MD^*,, Michael Weitzman, MD^*,, Peggy Auinger, MS^*, and Sarah E. Barlow, MD, MPH

^* Strong Children's Research Center, Department of Pediatrics, University of Rochester School of Medicine and Dentistry, Rochester, New York
American Academy of Pediatrics Center for Child Health Research, Rochester, New York
Division of Gastroenterology and Hepatology, St Louis University School of Medicine, St Louis, Missouri

Objective. To examine clinician-reported diagnosis of obesity and frequency of blood pressure assessment and diet and exercise counseling during ambulatory visits made by children and adolescents.

Methods. The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey 1997 to 2000 were combined for visits to clinicians of 2- to 18-year-olds. Well-child visits (WCVs) were examined for frequencies of obesity diagnosis, blood pressure screening, and diet and exercise counseling in relation to patient and clinician characteristics. Multivariate models examined the relationship of patient and visit characteristics with diet and exercise counseling.

Results. Of the 32 930 ambulatory visits made by 2- to 18-year-olds in 1997–2000, obesity was diagnosed at 0.78% of all visits and 0.93% of WCVs. Blood pressure assessment was reported in 61.1% of WCVs with obesity diagnosis compared with 43.9% of WCVs without obesity diagnosis. WCVs with obesity diagnosis had higher diet counseling rates (88.4% vs 35.7%) and higher exercise counseling rates (69.2% vs 18.6%). Diet counseling was reported for 88.4% and exercise counseling was reported for 69.2% of visits with an obesity diagnosis compared with 35.7% and 18.6% during WCVs without a diagnosis of obesity. In multivariate analyses, factors associated with diet counseling at WCVs were diagnosis of obesity (odds ratio [OR]: 12.9; 95% confidence interval [CI]: 3.0–55.3), being seen by pediatricians (OR: 2.5; 95% CI: 1.6–3.9), 2- to 5-year-olds compared with 12- to 18-year-olds (OR: 0.7; 95% CI: 0.5–1.0), and self-pay compared with private insurance visits (OR: 0.6; 95% CI: 0.4–0.9). Associations with exercise counseling were similar to those for diet counseling, but exercise counseling occurred less frequently in visits by black youths compared with white youths (OR: 0.5; 95% CI: 0.3–0.8).

Conclusions. Clinicians may overlook obesity during WCVs. Programs to increase obesity diagnosis could improve diet and exercise counseling rates, but even with diagnosis of obesity, significant opportunities for screening and intervention are missed.

Key Words: nutrition • exercise • obesity • physician practice patterns • survey

Abbreviations: WCV, well-child visit • NAMCS, National Ambulatory Medical Care Survey • NHAMCS, National Hospital Ambulatory Medical Care Survey • ICD-9, International Classification of Diseases, Ninth Revision • OR, odds ratio • CI, confidence interval

This article has been cited by other articles:

				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]

				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]

				A. S. Kong, R. L. Williams, M. Smith, A. L. Sussman, B. Skipper, A. C. Hsi, R. L. Rhyne, and On behalf of RIOS Net Clinicians Acanthosis Nigricans and Diabetes Risk Factors: Prevalence in Young Persons Seen in Southwestern US Primary Care Practices Ann. Fam. Med, May 1, 2007; 5(3): 202 - 208. [Abstract] [Full Text] [PDF]

				A. K. Choudhary, L. F. Donnelly, J. M. Racadio, and J. L. Strife Diseases Associated with Childhood Obesity Am. J. Roentgenol., April 1, 2007; 188(4): 1118 - 1130. [Abstract] [Full Text] [PDF]

				K. J. Dilley, L. A. Martin, C. Sullivan, R. Seshadri, H. J. Binns, and for the Pediatric Practice Research Group Identification of Overweight Status Is Associated With Higher Rates of Screening for Comorbidities of Overweight in Pediatric Primary Care Practice Pediatrics, January 1, 2007; 119(1): e148 - e155. [Abstract] [Full Text] [PDF]

				I. Eneli and H. D. Davies Screening and Counseling for Obesity in the Ambulatory Care Setting Pediatrics, March 1, 2006; 117(3): 984 - 984. [Full Text] [PDF]

				S. Cook, P. Auinger, M. Weitzman, and S. Barlow Screening and Counseling for Obesity in the Ambulatory Care Setting: In Reply Pediatrics, March 1, 2006; 117(3): 984 - 985. [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]

	Home | My Pediatrics | Journal Information | Current Issue | Past Issues | Subscriptions & Services | Contact Us Click here for faster international access © 2005 American Academy of Pediatrics. All rights reserved.