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Underdiagnosis of Pediatric Obesity during Outpatient Preventive Care Visits

  • Anisha I. Patel
    Correspondence
    Address correspondence to Anisha I. Patel, MD, MSPH, MSHS, Assistant Professor, Department of Pediatrics, University of California at San Francisco, 3333 California Street, Suite 245, Mailbox 0503, San Francisco, California 94118.
    Affiliations
    Department of Pediatrics, University of California, San Francisco, Calif (Dr Patel, Dr Madsen, Dr Cabana, and Dr Hersh); Philip R. Lee Institute for Health Policy Studies, San Francisco, Calif (Dr Patel, Dr Cabana, and Dr Hersh); Department of Medicine, University of California, San Francisco, Calif (Dr Maselli); Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif (Dr Cabana); and Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif (Dr Stafford)
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  • Kristine A. Madsen
    Affiliations
    Department of Pediatrics, University of California, San Francisco, Calif (Dr Patel, Dr Madsen, Dr Cabana, and Dr Hersh); Philip R. Lee Institute for Health Policy Studies, San Francisco, Calif (Dr Patel, Dr Cabana, and Dr Hersh); Department of Medicine, University of California, San Francisco, Calif (Dr Maselli); Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif (Dr Cabana); and Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif (Dr Stafford)
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  • Judith H. Maselli
    Affiliations
    Department of Pediatrics, University of California, San Francisco, Calif (Dr Patel, Dr Madsen, Dr Cabana, and Dr Hersh); Philip R. Lee Institute for Health Policy Studies, San Francisco, Calif (Dr Patel, Dr Cabana, and Dr Hersh); Department of Medicine, University of California, San Francisco, Calif (Dr Maselli); Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif (Dr Cabana); and Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif (Dr Stafford)
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  • Michael D. Cabana
    Affiliations
    Department of Pediatrics, University of California, San Francisco, Calif (Dr Patel, Dr Madsen, Dr Cabana, and Dr Hersh); Philip R. Lee Institute for Health Policy Studies, San Francisco, Calif (Dr Patel, Dr Cabana, and Dr Hersh); Department of Medicine, University of California, San Francisco, Calif (Dr Maselli); Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif (Dr Cabana); and Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif (Dr Stafford)
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  • Randall S. Stafford
    Affiliations
    Department of Pediatrics, University of California, San Francisco, Calif (Dr Patel, Dr Madsen, Dr Cabana, and Dr Hersh); Philip R. Lee Institute for Health Policy Studies, San Francisco, Calif (Dr Patel, Dr Cabana, and Dr Hersh); Department of Medicine, University of California, San Francisco, Calif (Dr Maselli); Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif (Dr Cabana); and Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif (Dr Stafford)
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  • Adam L. Hersh
    Affiliations
    Department of Pediatrics, University of California, San Francisco, Calif (Dr Patel, Dr Madsen, Dr Cabana, and Dr Hersh); Philip R. Lee Institute for Health Policy Studies, San Francisco, Calif (Dr Patel, Dr Cabana, and Dr Hersh); Department of Medicine, University of California, San Francisco, Calif (Dr Maselli); Department of Epidemiology and Biostatistics, University of California, San Francisco, Calif (Dr Cabana); and Program on Prevention Outcomes and Practices, Stanford Prevention Research Center, Stanford University School of Medicine, Stanford, Calif (Dr Stafford)
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      Abstract

      Objective

      To examine obesity diagnosis, obesity-related counseling, and laboratory testing rates among obese pediatric patients seen in US preventive outpatient visits and to determine patient, provider, and practice-level factors that are associated with obesity diagnosis.

      Methods

      By using 2005–2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data, outpatient preventive visits made by obese (body mass index ≥95%) 2- to 18-year-old patients were examined for frequencies of obesity diagnosis, diet, exercise, or weight reduction counseling, and glucose or cholesterol testing. Multivariable logistic regression was used to examine whether patient-level (gender, age, race/ethnicity, insurance type) and provider/practice-level (geographic region, provider specialty, and practice setting) factors were associated with physician obesity diagnosis.

      Results

      Physicians documented an obesity diagnosis in 18% (95% confidence interval, 13–23) of visits made by 2- to 18-year-old patients with a body mass index ≥95%. Documentation of an obesity diagnosis was more likely for non-white patients (odds ratio 2.87; 95% confidence interval, 1.3–6.3). Physicians were more likely to provide obesity-related counseling (51% of visits) than to conduct laboratory testing (10% of visits) for obese pediatric patients.

      Conclusion

      Rates of documented obesity diagnosis, obesity-related counseling, and laboratory testing for comorbid conditions among obese pediatric patients seen in US outpatient preventive visits are suboptimal. Efforts should target enhanced obesity diagnosis as a first step toward improving pediatric obesity management.

      Keywords

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