Weight, Overweight, Obesity Risk Factors

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Hospital physicians fail to identify, address weight / obesity  issues

Physicians and physician trainees fail to identify or address overweight / obesity in over 90 percent of hospitalized children.

Study author Marta King, M.D M.Ed., assistant professor of pediatrics at Saint Louis University School of Medicine, says this represents a missed opportunity for both patient care and physician trainee education.

"Overweight/obesity is the most common chronic pediatric disease in the United States," said King, who is also a SLUCare Physician Group pediatrician. "Physicians who recognize overweight/obesity can provide healthy weight counseling, inpatient consultations and outpatient referrals and thereby have the opportunity to improve outcomes for children with this severe and potentially life-threatening disease."

According to the Centers for Disease Control and Prevention, overweight is defined as a BMI at or above the 85th percentile and below the 95th percentile for children and teens of the same age and sex. Obesity is defined as a BMI at or above the 95th percentile.

"The children were hospitalized on the general medical service for a variety of reasons," King said. "Common diagnoses included asthma, pneumonia and cellulitis."

The study found physicians and physician trainees identified overweight/obesity in 8.3 percent of the overweight patients and addressed it in 4 percent. Attending physicians were most likely to document weight issues in physical exam or assessment, while medical students were least likely to document such issues.

"We were very liberal in our definition of identifying and addressing overweight/obesity," King said. "Physicians received credit for identifying overweight/obesity risk factors if they documented any questions about a child's diet, physical activity, screen time or family history of overweight/obesity. That meant if a single member of the physician team asked a single question about the number of soft drinks a child drinks, frequency of eating meals out or any sports the child might be involved in, it would be counted as identifying overweight/obesity risk factors."

"At least a third of parents do not acknowledge their child is overweight or obese, making recognition by health providers essential," King said.

"Like most patients admitted to a teaching hospital, patients in our study were cared for by numerous physicians and physician trainees," King said. "The fact that none of them identified or addressed weight as a problem might easily provide false reassurance to patients and family. 'Since none of a crowd of doctors caring for my child during the hospitalization mentioned weight, it must mean it is not a problem.'"

"Although we currently have limited information about patient and family wishes, the assumption patients and families are not interested is likely false. Prior studies show parents of hospitalized children wish to be told if their child is found to have overweight or obesity, that they believe action should be taken, and that the majority identify the inpatient physician as the person who should address weight concerns."

A set of guidelines for pediatric hospitals, including follow-up directives with a child's primary care physician, is one way to address the issue.

Other authors include Flory L. Nkoy, M.D. MS, MPH; Christopher G. Maloney, M.D., Ph.D., and Nicole L. Mihalopoulos, M.D., MPH of the University of Utah, Pediatrics. Saint Louis University. The Journal of Pediatrics

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Weight, Overweight, Obesity Risk Factors

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