Identification, Evaluation, and Management of Obesity in an Academic Primary Care Center

Abstract

Although the prevalence of childhood obesity has now reached epidemic proportions, it was under-recognized and under-treated by pediatric primary care providers in our study. Providers identified obesity as a problem for only one-half of the obese children examined for health supervision. The lowest rates of obesity identification occurred among children <5 years of age and those with milder degrees of obesity. Identification did not improve with additional years of pediatric training. Even for the subset of children identified as obese by their providers, evaluation and treatment often were not consistent with current recommendations. For example, more attention was given to the role of diet, compared with activity, in the evaluation of obesity. In particular, only a small number of providers (5%) recommended a decrease in television viewing to their obese patients, despite evidence linking television viewing and pediatric obesity. This finding is of concern, because obesity is known to be a multifactorial disease that responds only to significant changes in both dietary and activity behaviors. Only 13% of providers requested laboratory studies as part of their recommendations. The American Academy of Pediatrics currently recommends obtaining a lipid profile, total cholesterol level, and screening test for type 2 diabetes mellitus as part of the evaluation of obesity. The majority of clinicians who requested laboratory studies included thyroid function tests, which are not recommended by the American Academy of Pediatrics because of the very low likelihood of hypothyroidism as a cause of obesity. Although the extent of evaluation and management for children who were recognized as obese did not meet current guidelines, it was far better than that for patients who were not identified as obese by their providers. This demonstrates the importance of timely identification as the crucial initial step in the management of obesity. The results of this study are disheartening, especially as evidence mounts regarding the importance of early intervention in preventing the medical and psychosocial sequelae of obesity, as well as the persistence of obesity into adulthood. This study highlights the need for increased awareness and identification of obesity in the primary care setting, especially among younger children and those with mild obesity.

Liver acoustic radiation force impulse (ARFI) in childhood obesity: comparison and correlation with biochemical markers

“…An isolated hepatic steatosis is considered a benign condition; NASH, however, is an advanced liver disease that can lead to liver fibrosis and/or cirrhosis [1]. In children, obesity has emerged as a new chronic disease [2]. However, despite its significance and increasing prevalence, primary caregivers do not consistently diagnose childhood obesity and hence miss significant opportunities for early interventions [3,4].…”

From the Patient’s Perspective: The Impact of Training on Resident Physician’s Obesity Counseling

“…7,[14][15][16] When counseling does occur, most physicians do not discuss specific behavior change recommendations such as diet and exercise, 8 indicating that quality of counseling may be poor. Lack of training and competency in obesity management are among the reasons that physicians do not adequately counsel patients.…”

A Comprehensive School Health Program to Reduce Disparities and Risk for Type 2 Diabetes in Overweight At-Risk Youth

“…Data were analyzed under the intent-to-treat principle whereby all randomized subjects were analyzed in the group to which they were randomized [21]. The intent-to-treat analysis was performed on all 97 randomized subjects.…”