Article
Lack of Diagnosis and Screening for Pediatric Obesity in the Retail Health Setting: Implications for Quality Improvement Measures

https://doi.org/10.1016/j.pedhc.2019.10.002Get rights and content

Abstract

Introduction

Pediatric obesity has reached an epidemic status. The purpose of this study was to examine the prevalence of overweight and obesity in patients and how often and how accurately a diagnosis was coded. The population for this study included children aged 3–18 years. This cohort presented to retail health clinics in a large urban health system for school or sports physicals from June 1, 2017, to November 30, 2017.

Method

A retrospective chart review was conducted. Statistical analysis was performed to determine if there was a relationship between obesity and age, ethnicity, race, and sex.

Results

The study identified that 15.9% of patients were overweight and 16.5% were obese. In practice, 99% of patients lacked a formal diagnosis of overweight or obesity; in addition, appropriate screening measures reflecting nutrition and physical activity were found to be lacking in 99% of cases.

Discussion

Strategies are needed to improve efforts to diagnose and manage overweight and obesity in pediatric population in the retail health setting. Organizational recommendations for change are suggested based on guidelines for childhood obesity.

Section snippets

INTRODUCTION

Childhood obesity is a major public health concern facing the United States, and it affects children at alarming rates. Centers for Disease Control and Prevention (CDC, 2018a) reports that 13.7 million children aged 2–19 years are obese. Since the 1970s, the number of children with obesity has tripled (CDC, 2018b). Healthy People 2020 (HP2020), the national framework for a healthier population, addresses specific objectives for nutrition and weight status uniquely related to children as areas

Study Design/Sample

This study uses a secondary analysis of data collected retrospectively from electronic health records (EHRs). The data were made available from patients presenting to Chicago–area retail health clinics from June 1, 2017, to November 30, 2017. Inclusion criteria included patients aged 3–18 years at the time of their encounter and presentation to the clinic for school or sports physicals. Patients younger than 3 years and older than 18 years and those presenting for reasons other than school and

RESULTS

The 6 months of data used in our analysis included 2,570 subjects who met the inclusion criteria for the study. Of these subjects, 2.0% (n = 53) were under the 5th BMI percentile, and 62.9% (n = 1,683) were between the 5th and 84th BMI percentile (see Table 1). The remaining 31% (n = 834) of subjects had a BMI of ≥85%, with overweight (n = 409) and obese (n = 425) subjects being nearly equal, 15.3% and 15.9%, respectively.

Over half of the subjects whose data were included here were male

DISCUSSION

The purpose of this study was to better understand the behaviors of nurse practitioners in screening and diagnosing overweight or obesity in children undergoing school and sports physicals. Key findings indicated that despite a high rate of BMI percentile documented in the EHR (96.1% of all subjects), 99% of subjects did not receive a formal obesity diagnosis, and 99% were missing screening measures. In addition, the rate of obesity in the study sample was 15.9%, which is higher than the HP2020

CONCLUSION

Childhood obesity rates continue to trend upward, despite the call to action in HP2020. In this study, the EHR autopopulated the BMI percentile for each patient, yet there was a significant lack of nutrition and physical activity screening noted in the EHR. There was also a critical deficiency in diagnosis for overweight and obese children. To meet the overarching goal of reducing the prevalence of overweight and obesity, it is imperative to find out why the diagnosis and management of at-risk

Jodie N. Guardi, Family Nurse Practitioner, Advocate Health Care, Aurora, IL.

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Jodie N. Guardi, Family Nurse Practitioner, Advocate Health Care, Aurora, IL.

Elizabeth Aquino, Assistant Professor and Director of the Masters Entry to Nursing Practice Program, School of Nursing, College of Science and Health, DePaul University, Chicago, IL.

Karen Larimer, Adjunct Professor, School of Nursing, College of Science and Health, DePaul University, Chicago, IL.

Jessica Bishop-Royse, Senior Research Methodologist, DePaul Faculty Scholarship Support Center, College of Liberal Arts and Social Sciences, DePaul University, Chicago, IL.

Shannon D. Simonovich, Assistant Professor, School of Nursing, College of Science and Health, DePaul University, Chicago, IL.

Conflicts of interest: None to report.

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