Published online January 2, 2007
PEDIATRICS Vol. 119 No. 1 January 2007, pp. e148-e155 (doi:10.1542/peds.2005-2867)
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ARTICLE

Identification of Overweight Status Is Associated With Higher Rates of Screening for Comorbidities of Overweight in Pediatric Primary Care Practice

Kimberley J. Dilley, MD, MPHa,b, Lisa A. Martin, MD, MPHa,b, Christine Sullivan, MBA, MSc, Roopa Seshadri, PhDa,b,c, Helen J. Binns, MD, MPHa,b,c for the Pediatric Practice Research Group

a Department of Pediatrics, Children's Memorial Hospital, Chicago, Illinois
b Feinberg School of Medicine, Northwestern University, Chicago, Illinois
c Mary Ann and J. Milburn Smith Child Health Research Program, Children's Memorial Research Center, Chicago, Illinois

OBJECTIVES. The goals were to determine whether primary care provider identification of children as overweight was associated with additional screening or referrals and whether the types and numbers of visits to primary care differed for overweight and nonoverweight children.

METHODS. Sequential parents/guardians at 13 diverse pediatric practices completed an in-office survey addressing health habits and demographic features. Medical records of each child from a sample of families were reviewed. Data were abstracted from the first visit and from all visits in the 14-month period before study enrollment. Analyses were limited to children ≥2 years of age for whom BMI percentile could be calculated.

RESULTS. The analytic sample included 1216 children (mean age: 7.9 years; 51% male) from 777 families (parents were 43% white, 18% black, 34% Hispanic, and 5% other; 49% of families had a child receiving Medicaid/uninsured). Among overweight children (BMI of ≥95th percentile; n = 248), 28% had been identified as such in the record. Screening or referral for evaluation of comorbidities was more likely among overweight children who were identified in the record (54%) than among overweight children who were not identified (17%). Among children at risk of overweight (BMI of 85th to 94th percentile; n = 186), 5% had been identified as such in the record and overall 15% were screened/referred. In logistic regression modeling, the children identified as overweight/at risk of overweight had 6 times greater odds of receiving any management for overweight.

CONCLUSIONS. Low rates of identification of overweight status and evaluation or referrals for comorbidities were found. Identification of overweight status was associated with a greatly increased rate of screening for comorbidities.

Key Words: children • overweight • practice-based research • screening

Abbreviations: AROW—at risk of overweight • ICC—intracluster correlation • LR—logistic regression • OR—odds ratio • HFHC—Healthy Families, Healthy Children: The Pediatrician's Role • CI—confidence interval

Accepted Jul 17, 2006.




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