According to a study led by a Saint Louis University pediatric hospitalist, titled, “Physicians and Physician Trainees Rarely Identify or Address Overweight/Obesity in Hospitalized Children” currently published in The Journal of Pediatrics, physicians and trainees are not able to appropriately identify or attend to cases of overweight and obesity in more than 90% of children admitted to hospitals.
According to Marta King, MD, MEd, her study’s findings present an unaddressed issue that concerns both quality of patient care and physician training.
“Overweight/obesity is the most common chronic pediatric disease in the United States,” said King, who is also a SLUCare Physician Group pediatrician. “Physicians who recognize overweight/obesity can provide healthy weight counseling, inpatient consultations and outpatient referrals and thereby have the opportunity to improve outcomes for children with this severe and potentially life-threatening disease.”
The study was conducted at Primary Children’s Hospital, an affiliate of the University of Utah School of Medicine. Dr. King and her colleagues drew initial data from the facility’s administrative database, and made use of the Centers for Disease Control BMI calculator and a random sampling technique. They were able to draw a sample of 300 hospitalized pediatric patients, aged 2-18 years old, who were either overweight or obese. Dr. King then led the team in analyzing each patient’s admission and discharge notes, which were documented by medical students, interns, senior residents and physicians.
“The children were hospitalized on the general medical service for a variety of reasons,” King said. “Common diagnoses included asthma, pneumonia and cellulitis.”
The study revealed overweight and obesity were only identified in 8.3% of patients, and addressed in only 4%. Medical students were found to be least likely to identify the condition, while attending physicians would only make a note of it during a physical assessment.
“We were very liberal in our definition of identifying and addressing overweight/obesity,” King said. “Physicians received credit for identifying overweight/obesity risk factors if they documented any questions about a child’s diet, physical activity, screen time or family history of overweight/obesity. That meant if a single member of the physician team asked a single question about the number of soft drinks a child drinks, frequency of eating meals out or any sports the child might be involved in, it would be counted as identifying overweight/obesity risk factors.”
In 2003, the American Academy of Pediatrics released a recommendation for BMI calculations and screening for overweight/obesity during children’s preventive visits. In 2007, a committee of specialists released further recommendations on screening for comorbidities and appropriate interventions in outpatient settings. However, there has yet to be a release of updated guidelines for pediatric patients in inpatient settings or in follow-up appointments.
