Abstract
Objective
To determine the utility of repeated patient-level body mass index (BMI) measurements
among higher-risk patients seen at safety-net clinics as a community-level monitoring
tool for overweight and obesity population trends.
Methods
Data from a network of urban, federally qualified community health centers with computerized
tracking of BMI at sequential outpatient visits were analyzed. We performed a longitudinal
observational study over 8 years (2005–2012) with children stratified by weight status
groups on the basis of BMI. Changes in BMI z-scores were used to estimate population
trends among children 2 to 11 years old, with at least 2 visits (at least 1 year apart),
for whom weight and height were measured.
Results
Among children (n = 33,542), the rate of overweight was 16% and rate of obesity was
18% at their last visit. Children were followed for an average of 3.24 ± 1.76 years
to measure trends and change in weight status from earlier to later childhood. Children
who were obese at first visit had increased odds (adjusted odds ratio 27.8, 95% confidence
interval 25.6–30.2) of being obese by last visit. Mean change in BMI z-score per person-year
of observation was 0.10 ± 0.38, with a differing rate of change based on weight status
category at last visit (not overweight = 0.06 ± 0.39; overweight = 0.17 ± 0.34; obese = 0.19 ± 0.36).
Change in BMI z-score per person-year decreased for 40% of obese children; however,
their weight status group remained unchanged.
Conclusions
Childhood obesity prevalence was high, with substantial progression to overweight
and obesity from first to last visit. Clinically derived BMI z-score per person-year
measures can effectively show population trends not observed using standard weight
status categories.
Keywords
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Article info
Publication history
Accepted:
June 15,
2014
Received:
September 27,
2013
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2014 Academic Pediatric Association. Published by Elsevier Inc. All rights reserved.
