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physicians fail to identify, address weight /
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
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