Missed Opportunities: Documentation and Referral Rates Among Children and Adults with Obesity

Abstract

Introduction: Our study reports rates of obesity documentation on the problem list (PL) and numbers of referrals to obesity medicine specialists and dietitians among pediatric and adult patients with obesity. Methods: All pediatric and adult patients with obesity seen at 14 primary care clinics between 7/1/2017 and 6/30/2019 were evaluated for inclusion of obesity on the PL and referrals to obesity medicine specialists or dietitians. Results: For children with BMI >95% for age, obesity was documented in 31.2%, and 12.5% received a referral. For adults with BMI >30, obesity was documented in 54.2%, and 8.4% received a referral. Significantly more subjects received referrals when obesity was on the PL (both age-groups) compared to those without (children: 20.2% vs 9.0%; adults: 12.12% vs 3.9%, p values < 0.0001). Higher BMI and more comorbidities were also associated with higher referral rates (children: 26.6% vs 8.6% for those with a BMI ≥ 99 percentile; adults: 19.9% vs 5.8% for those with a BMI ≥ 40; children: 20.2% vs 10.7% for ≥ 1 comorbidity vs 1 or fewer; adults: 22.7% vs 5.1% with ≥ 3 comorbidities compared to 0 comorbidities). Discussion: The low rates of documentation of obesity and low rates of referral raise concern that providers may be missing opportunities to identify and manage their patients affected by obesity. Conclusions: Children and adults with obesity are more likely to be referred to a dietitian or obesity medicine specialist if obesity is on the PL, they have a higher BMI, and they have more medical comorbidities.