Background

Underdiagnosing pediatric overweight and obesity delays treatment. Little is known about factors associated with accurate documentation and treatment of pediatric overweight and obesity in a resident clinic. The study aims to identify patient characteristics associated with physicians’ assessment and documentation of pediatric obesity.

Methods

We performed a retrospective cohort study of all patients with BMI≥85% who presented to a pediatric resident clinic for a Well-Child Visit from 7/1/16-6/30/17. We collected patient demographics, anthropometrics, and documentation of weight status (primary outcome) and any evaluation offered (secondary outcomes). Bivariate analyses used chi-square or ANOVA. Significant variables were incorporated into multivariable logistic regression models for our primary and secondary outcomes.

Results

Of 799 patients that met inclusion criteria, 31.2% had overweight, 46.1% class I obesity, 17.1% class II, 5.6% class III; 73.8% were Hispanic, and 92% had Medicaid. Correct documentation of weight status was associated with higher BMI category (Class I obesity vs overweight OR=2.4 [1.7-3.5]; Class III vs overweight OR=4.1 [2.1-7.9]). Compared to patients with overweight, patients with class III obesity were more likely to have labs ordered: lipids (OR=17.8 [7.9-40.1]), glucose (OR=10.6 [3.8-29.4]). Older patients (10-15 vs 2-4 years) were more likely to have labs ordered: lipids (OR=54.9 [7.4-405.7]), glucose (OR=10.1 [1.4-75.8]). Neither documentation nor evaluation was significantly associated with patient race or ethnicity.

Conclusions

Higher BMI was positively associated with both documentation of weight status and lab evaluation of comorbidities. No associations were found with race. This provides valuable preliminary data for designing interventions to improve physician documentation and evaluation of pediatric obesity.