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Assessment of Child Anthropometry in a Large Epidemiologic Study
Published on: February 2, 2017
Pediatricians and screening for obesity with body mass index: does level of training matter?
Jennifer B Hillman1, Sarah D Corathers, Stephen E Wilson
1Division of Adolescent Medicine, Cincinnati Children's Hospital Medical Center and University of Cincinnati School of Medicine, Cincinnati, OH 45236, USA. Jennifer.Hillman@cchmc.org
Insights
Pediatricians rarely screen children for obesity using body mass index (BMI) charts. Resident physicians were more likely than attending physicians to document and plot BMI, indicating a need for improved childhood obesity screening practices.
Area of Science:
- Pediatrics
- Public Health
- Preventive Medicine
Background:
- Childhood obesity is a growing epidemic in industrialized nations.
- Annual screening using body mass index (BMI) is recommended for all children.
- Adherence to BMI screening recommendations by pediatricians is not well-documented.
Purpose of the Study:
- To determine the proportion of children screened for obesity using BMI.
- To compare the likelihood of BMI documentation and plotting between attending and resident physicians.
Main Methods:
- Systematic review of medical records from an urban academic pediatric practice.
- Inclusion of children aged 5–11 years who presented for healthcare in 2004.
- Logistic regression analysis to identify factors associated with BMI documentation.
Main Results:
- Only 5.5% of records documented BMI, and 4.3% plotted BMI.
- Resident physicians were significantly more likely to document (13.0% vs. 3.0%) and plot (9.0% vs. 2.7%) BMI compared to attending physicians.
- Children with BMI ≥95th percentile were more likely to have their BMI documented and plotted.
Conclusions:
- The utilization of BMI for childhood obesity screening in this academic pediatric practice was found to be very poor.
- Resident physicians demonstrated higher rates of BMI documentation and plotting than attending physicians.
- There is a critical need to improve adherence to childhood obesity screening guidelines in pediatric settings.
Objectives:
Pediatric obesity is increasing at epidemic rates in industrialized nations. It is recommended that pediatricians screen all children annually with the use of body mass index (BMI). However, it is unclear whether this recommendation is followed. This study sought to (1) determine the proportion of children screened for obesity with BMI, and (2) test whether attending physicians are more likely than resident physicians to document and plot BMI.
Methods:
We conducted a systematic review of medical records in an urban academic pediatric practice. Participants were children aged 5 to 11 years presenting for health care in 2004. We measured the proportion of subjects with documented and plotted BMI and compared results for attending and resident physicians. We used logistic regression analysis to determine factors associated with documentation of BMI.
Results:
Of 397 medical records reviewed, 59.7% contained the 2000 Centers for Disease Control and Prevention growth curve with BMI for age; 5.5% documented BMI, and 4.3% plotted BMI. Resident physicians were more likely to document (13.0% vs. 3.0%, p = 0.0008) and plot (9.0% vs. 2.7%, p = 0.0260) BMI compared with attending physicians. Children with a BMI--95% for age were more likely to have their BMI documented (odds ratio [OR] = 10.7, 95% confidence interval [CI] 3.7, 31.5) and plotted (OR = 7.1, 95% CI 2.3, 21.6).
Conclusion:
We found the use of BMI to screen for childhood obesity very poor in this academic pediatric practice. Resident physicians were more likely to document and plot BMI than attending physicians.
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