Documentation Of Obesity On The Problem List And Referral Rates Among Obese Children And Adults

Abstract

Obesity is a serious public health concern that is overwhelming primary care providers. Studies have shown that simply documenting obesity on the problem list promotes action about obesity. PURPOSE: To determine the rate of obesity documentation on the problem list and referrals to obesity medicine specialists and dietitians among obese adult and pediatric patients at 14 primary care offices in a regional health network in Southern Maine. METHODS: All patients with BMI > 30 (adults) or BMI > 95%ile for age (pediatrics) between 5 - 100 years old, who were seen at one of 14 primary care clinics in Maine between July 1, 2017 and June 30, 2019 were included for retrospective review. Variables requested included age, BMI, inclusion of obesity on the problem list, various comorbidities, and any referrals to dietitian or obesity medicine specialists. The percentage rate of inclusion of obesity on the problem list and rate of referrals were calculated for both pediatric and adult patients. RESULTS: We obtained records for 20,461 patients, 2,780 under 18 and 17,681 over 18. Obese children had obesity on the problem list in 31.2% of cases, and recieved any referral 12.5%. Obese adults had obesity on the problem list 54.2% of the time, and a referral in 8.4% of cases. For both children and adults, more referrals were made for patients with obesity on the problem list compared to those without this problem listed (in children: 20.2% vs 9.0%; for adults: 12.12% vs 3.9%, p values < 0.0001). Similarly, a statistically significant higher proportion of referrals were made for those with higher BMI (in children: 26.6% vs 8.6% for those with a BMI ≥ 99 percentile; adults: 19.88% vs 5.75% for those with a BMI ≥ 40, p values < 0.0001), and for those with a greater number of comorbidities on the problem list (referrals in 20.2% vs 10.7% for children with ≥ 1 comorbidity vs 1 or fewer, and in 22.68% vs 5.13% of adults with ≥ 3 comorbidities compared to 0 comorbidities, p values < 0.0001). CONCLUSIONS: The inclusion rate of obesity on the problem list for obese children and adults was found to be low overall, but inclusion was associated with higher proportion of referrals to obesity medicine specialists and dietitians. There was also more likely to be a referral among patients with higher BMI and multiple comorbidities.