Using body mass index to identify overweight children: barriers and facilitators in primary care

Overweight is an increasingly prevalent pediatric health problem but is underdiagnosed. Despite recommendations endorsing the use of body mass index (BMI) to identify overweight children, clinicians seldom use BMI. Barriers to the use of BMI in pediatric primary care have not previously been described. We used qualitative data to determine providers' familiarity with and attitudes toward recommendations for identifying overweight children and the perceived barriers and facilitators to use of BMI.

We conducted 6 focus groups involving a total of 38 providers (pediatricians, family physicians, physician assistants, and nurse practitioners) in private practices (n = 3), academic medical centers (n = 2), and a community health center (n = 1).

Providers described lack of familiarity and agreement with BMI screening recommendations and skepticism about treatment effectiveness. Reported practice-level barriers to BMI use included lack of access to BMI charts and accurate height/weight data. In one practice, providers used an electronic medical record (EMR) system that automatically included BMI and described this EMR as a facilitator of BMI use.

Practice-level changes such as incorporating BMI into office systems and EMRs may be needed to support pediatric primary care providers in using BMI routinely. To increase use of BMI and early identification of overweight, educational interventions that address individual providers' concerns about screening recommendations and treatment effectiveness may also be necessary.