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
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Academic PediatricsAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Prevalence of Obesity and Trend in Body Mass Index among US Children and Adolescents, 1999–2010.JAMA. 2012; 307: 483-490
- Identifying risk for obesity in early childhood.Pediatrics. 2006; 118: e594-e601
- A changing pattern of childhood BMI growth during the 20th century: 70 y of data from the Fels Longitudinal Study.Am J Clin Nutr. 2012; 95: 1136-1143
- Prevalence of childhood and adult obesity in the United States, 2011–2012.JAMA. 2014; 311: 806-814
Learn the Facts. Lets Move. Available at: http://www.letsmove.gov/learn-facts/epidemic-childhood-obesity. Accessed November 7, 2012.
- Predicting obesity in young adulthood from childhood and parental obesity.N Engl J Med. 1997; 337: 869-873
- The consequences of childhood overweight and obesity.Future Child. 2006; 16: 47-67
US Centers for Disease Control and Prevention; US Department of Health and Human Services. Healthy People 2020: nutrition and weight status. Available at: http://healthypeople.gov/2020/topicsobjectives2020/objectiveslist.aspx?topicId=29. Accessed November 08, 2012.
Centers for Medicare and Medicaid Services. EHR incentive programs, 2010. Available at: http://www.cms.gov/Regulations-and-Guidance/Legislation/EHRIncentivePrograms/index.html. Accessed July 15, 2014.
- Developmental trajectories of overweight during childhood: role of early life factors.Obesity. 2007; 15: 760-771
- 2000 CDC growth charts for the United States: methods and development.Vital Health Stat. 2002; 246: 1-190
- Expert Committee. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report.Pediatrics. 2007; 120: S164
- Incidence of childhood obesity in the United States.N Engl J Med. 2014; 370: 403-411
Institute of Education Sciences, National Center for Education Statistics. Early Childhood Longitudinal Program, Kindergarten class of 1998–99 (ECLS-K) kindergarten through eighth grade full sample public-use data and documentation. US Department of Education National Center for Education Statistics. Available at: http://nces.ed.gov/pubsearch/pubsinfo.asp?pubid=2009005. Accessed July 11, 2014.
- The public health impact of socioeconomic status on adolescent depression and obesity.Am J Public Health. 2003; 93: 1844-1850
- Childhood body mass index trajectories: modeling, characterizing, pairwise correlations and socio-demographic predictors of trajectory characteristics.BMC Med Res Methodol. 2012; 12: 1-13
US Centers for Disease Control and Prevention. A SAS Program for the CDC growth charts. Available at: http://www.cdc.gov/nccdphp/dnpao/growthcharts/resources/sas.htm. Accessed April 12, 2013.
- Hispanic and black US children’s paths to high adolescent obesity prevalence.Pediatr Obes. 2012; 7: 423-435
- Occurrence and timing of childhood overweight and mortality: findings from the Third Harvard Growth Study.J Pediatr. 2012; 160: 743-750
- Trackiong overweight and obesity in Japanese children; a six years longitudinal study.J Med Invest. 2010; 57: 114-123
- Tracking excess weight and obesity from childhood to young adulthood: a 12-year prospective cohort study in Slovenia.Public Health Nutr. 2011; 14: 49-55
- Recommended community strategies and measurements to prevent obesity in the United States.MMWR Morb Mortal Wkly Rep. 2009; 58: 1-29
- Building capacity for childhood obesity prevention and treatment in the medical community: call to action.Pediatrics. 2011; 128: S71-S77
- A systems-oriented multilevel framework for addressing obesity in the 21st century.Prev Chronic Dis. 2009; 6: A82
- Eighty-year trends in infant weight and length growth: the Fels longitudinal study.J Pediatr. 2012; 160: 762-768
- Predicting overweight and obesity in adulthood from body mass index values in childhood and adolescent.Am J Clin Nutr. 2002; 76: 653-658
US Preventive Services Task Force. Clinical summary of US preventive services task force recommendation: screening for obesity in children and adolescents. Available at: http://www.uspreventiveservicestaskforce.org/. Accessed July 15, 2014.
- Channeling Change: Making Collective Impact Work.Stanford Social Innovation Review, Stanford, Calif2012
- Systems approach to childhood and adolescent obesity prevention and treatment in a managed care organization.Int J Obes. 1999; 23: S38-S42
- Accountable Care Organization 2013 Program Analysis, Quality Performance Standards Narrative Measure Specifications.Centers for Medicare and Medicaid Services, Quality Measurement and Health Assessment Group Center for Clinical Standards and Quality, Bethesda, Md2012 (Project 0213195.000.004)
- The population health record: concepts, definition, design, and implementation.J Am Med Inform Assoc. 2010; 17: 359-366
- Decreases in community viral load are accompanied by reductions in new HIV infections in San Francisco.PLOS One. 2010; 5: e11068
- Digital Data Improvement Priorities for Continuous Learning in Health and Health Care: Workshop Summary.National Academies Press, Washington, DC2012
- The Learning Healthcare System.National Academies Press, Washington, DC2007
- Annual medical spending attributable to obesity: payer- and service-specific estimates.Health Aff. 2009; 28: w822-w831
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.
