Identification, evaluation, and management of obesity in an academic primary care center.

Abstract

Timely identification of obesity by pediatric health care providers remains the crucial initial step in the management of obesity. Direct assessment of pediatric cliniciansﾒ performance in identifying and managing obesity in clinical practice has not been conducted to date. The objective of this study was to determine rates of identification of obesity by pediatric residents, nurse practitioners, and faculty members in an academic primary care setting and to describe the actions taken by these providers in their evaluation and management of obesity. A retrospective medical record review of all health supervision visits for children 3 months to 16 years of age, examined between December 1, 2001, and February 28, 2002, was performed. The study was set in a large, primary care practice located in a tertiary-care, academic, pediatric hospital, which serves a predominantly urban, minority (70% African American), Medical Assistance-insured (90%) population. Participants were primary care providers, including pediatric residents, nurse practitioners, and faculty physicians. Of the 2515 visits reviewed, a total of 244 patients met the study definition of obesity, yielding an estimated prevalence of obesity visits of 9.7% among health supervision visits for children 3 months to 16 years of age. This prevalence of obesity visits cannot be used to estimate the population prevalence of obesity, given the skewed distribution of visits toward very young children. For all children who met the study definition of obesity, providers documented obesity in their assessments in only 53% of the reviewed visits. Although the majority of charts (69%) contained an adequate dietary history, only 15% included a description of the childﾒs activity level or television viewing.