Published online March 1, 2006
PEDIATRICS Vol. 117 No. 3 March 2006, pp. 984 (doi:10.1542/peds.2005-2966)
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Screening and Counseling for Obesity in the Ambulatory Care Setting

Ihuoma Eneli, MD, MS
H. Dele Davies, MD, MSc
Department of Pediatrics/Human Development
Michigan State University
East Lansing, MI 48824

To the Editor.—

We read with interest the Pediatrics article by Cook et al1 on screening and counseling associated with a diagnosis of obesity in the ambulatory care setting. Although this article addresses an important topic, we have concerns on whether its conclusions can be reliably drawn from the National Ambulatory Medical Care Survey and the outpatient component of the National Hospital Ambulatory Medical Care Survey surveillance databases. The low rate of identification (0.7%) is so far from the US national estimates of 16% of overweight children that it is unlikely that the results reflect how physicians care for overweight children. Second, the rates of counseling are derived from self-report and may represent overestimates of actual counseling rates. It is probable that providers inflate their reported diet and physical activity counseling because it is socially desirable to provide these services. Finally, the National Center for Health Statistics recommends a minimum of at least 30 unweighted cases and a relative standard error of <30% as the reliability criteria to ensure that the sample estimates approximate the population estimates.2,3 In reviewing the results (eg, their Table 1), it is likely that some of the estimates violate this reliability criteria. Thus, we do not believe that all the reported results can be generalized to the national population.

REFERENCES

  1. Cook S, Weitzman M, Auinger P, Barlow SE. Screening and counseling associated with obesity diagnosis in a national survey of ambulatory pediatric visits. Pediatrics. 2005;116 :112 –116[Abstract/Free Full Text]
  2. National Center for Health Statistics. Public Use Data Tape Documentation: 1997–2000 National Ambulatory Medical Care Survey. Hyattsville, MD: National Center for Health Statistics, US Public Health Service; 2000
  3. Schappert SM, Cherry DK. NAMCS/NHAMCS workshop. Division of Health Statistics, National Center for Health Statistics. Available at: www.cdc.gov/nchs/about/major/ahcd/ahcd1.htm. Accessed November 20, 2005
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics

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Screening and Counseling for Obesity in the Ambulatory Care Setting: In Reply
Stephen Cook, Peggy Auinger, Michael Weitzman, and Sarah Barlow
Pediatrics 2006 117: 984-985. [Extract] [Full Text]  




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