Published online December 29, 2008
PEDIATRICS Vol. 123 No. 1 January 2009, pp. e153-e158 (doi:10.1542/peds.2008-1408)
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ARTICLE

Trends in the Diagnosis of Overweight and Obesity in Children and Adolescents: 1999–2007

Lacey Benson, BAa, Heather J. Baer, ScDb,c,d and David C. Kaelber, MD, PhD, MPHa,e

a School of Medicine, Case Western Reserve University, Cleveland, Ohio
b Division of General Medicine and Primary Care, Brigham and Women's Hospital, Boston, Massachusetts
c Harvard Medical School, Boston, Massachusetts
d Harvard School of Public Health, Boston, Massachusetts
e Departments of Internal Medicine, Pediatrics, and Information Services, MetroHealth System, Cleveland, Ohio

OBJECTIVE. Pediatric overweight and obesity are increasingly prevalent problems and have received much attention in recent years, but it is unclear whether this publicity has affected diagnosis by clinicians. We undertook the current study to assess trends in diagnosis rates of overweight and obesity in children.

PATIENTS AND METHODS. We analyzed electronic medical record data from 60711 patients aged 2 through 18 years with at least 1 well-child visit between June 1999 and October 2007 in a large academic medical system in northeast Ohio. Diagnosis of weight problems among children classified as overweight and obese was assessed by using International Classification of Diseases, Ninth Revision codes. Logistic regression was used to examine the impact of patient characteristics on diagnosis and to investigate trends over the study period.

RESULTS. On retrospective review of BMI measurements recorded for patients during the study period, 19% of the children were overweight, 23% were obese, and 8% (33% of the obese patients) were severely obese; among these, 10% of overweight patients, 54% of obese patients, and 76% of severely obese patients had their conditions diagnosed. BMI, age, and number of overweight visits were positively associated with diagnosis. Female patients were more likely to have been diagnosed than male patients. Black and Hispanic patients were more likely to have been diagnosed than white patients. There was a statistically significant trend toward increasing diagnosis during the study period, although the percentage of patients diagnosed per year seemed to plateau or decrease after 2005.

CONCLUSIONS. Although clear BMI definitions of pediatric weight problems exist, a large percentage of overweight and obese patients remain undiagnosed. Diagnosis increased during the study period but remained low among overweight children, for whom early intervention may be more effective. Identification of overweight and obese patients is the first step in addressing this growing epidemic.

Key Words: diagnosis • obesity • weight management • weight status • electronic medical records

Abbreviations: WCV—well-child visit • EMR—electronic medical record • ICD-9—International Classification of Diseases, Ninth Revision • CI—confidence interval

Accepted Oct 8, 2008.


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eLetters:

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Primary prevention as important as secondary prevention to control child overweight epidemic
Isabelle Pitrou, et al.
Pediatrics Online, 7 Jan 2009 [Full text]