719204
research-article2017
GPHXXX10.1177/2333794X17719204Global Pediatric HealthGohil et al
Brief Report
Clinical Versus Objective Assessment of Overweight and Obese Children Among Primary Care Physicians
Global Pediatric Health Volume 4: 1–4 © The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav https://doi.org/10.1177/2333794X17719204 DOI: 10.1177/2333794X17719204 journals.sagepub.com/home/gph
Anisha Gohil, DO1, Shannon James, MD1, and Samar Rahhal, MD1 Received April 16, 2017. Accepted for publication May 30, 2017.
Introduction In the past few decades, pediatric obesity has become a major issue in the care of children.1 The prevalence of overweight and obese children ages 2 to 19 years in 2011 to 2012 was 31.8% according to an original investigation done by JAMA.2 When solely examining obesity in the same group, prevalence was 16.9%. According to the American Academy of Pediatrics (AAP) Clinical Report from July 2015, pediatricians should identify children at risk for developing obesity at every health visit using the recommended growth charts. The World Health Organization’s weight-for-age and weight-for-length normative growth chart is recommended for birth through 23 months of age. The Centers for Disease Control and Prevention (CDC) body mass index (BMI) growth charts should be used for age 2 years and older.3 A study published in Pediatrics in 2010 showed that of 677 primary care clinicians surveyed, 97% reported visually assessing children for weight status. For children older than age 2 years, only 52% reported assessing the BMI percentile.4 Another study published in Public Health Reports in 2009 was conducted in an urban academic pediatric practice and reviewed 397 medical records of children ages 5 to 11 years. Results showed that 59.7% of records contained a CDC BMI growth chart, 5.5% of physicians documented BMI, and 4.3% of physicians plotted BMI.5 Several articles have provided evidence that visual assessment of BMI alone does not correctly identify overweight and obese patients.4-10 Additionally, some of these studies demonstrate that physicians tend to underestimate a patient’s weight versus BMI.4,7-10 This could be due to a higher prevalence of overweight and obese patients changing perceptions of what is the norm.10 The current literature suggests a disconnect between clinical and objective assessment of weight. The purpose of this study was to assess physician visual interpretation of BMI within our hospital system. The primary goal was
to see how well physicians in our hospital system clinically estimated weight versus an objective assessment tool (BMI). Another goal was to raise awareness within our own hospital system of the importance of addressing BMI at all health visits.
Methods Data was gathered via online surveys collected from physicians at St. Vincent Hospital, a community hospital in Indianapolis, Indiana, from March through April of 2016. The 5 groups of physicians surveyed included pediatric outpatient physicians, family medicine outpatient physicians, pediatric hospitalists, pediatric residents, and family medicine residents. Surveys were created via SurveyMonkey and distributed via email. Three surveys were created (Survey A, Survey B, and Survey C), and each included one photograph of a child with a known BMI. Photographs used were obtained from the CDC’s “Visual Assessment Versus Calculation of BMI” growth chart training website.11 Each contacted physician received one copy of the survey. Survey A had a photograph of an overweight child, Survey B had a photograph of a normal weight child, and Survey C had a photograph of an obese child. BMI definitions used were normal weight 5th to
research-article2017
GPHXXX10.1177/2333794X17719204Global Pediatric HealthGohil et al
Brief Report
Clinical Versus Objective Assessment of Overweight and Obese Children Among Primary Care Physicians
Global Pediatric Health Volume 4: 1–4 © The Author(s) 2017 Reprints and permissions: sagepub.com/journalsPermissions.nav https://doi.org/10.1177/2333794X17719204 DOI: 10.1177/2333794X17719204 journals.sagepub.com/home/gph
Anisha Gohil, DO1, Shannon James, MD1, and Samar Rahhal, MD1 Received April 16, 2017. Accepted for publication May 30, 2017.
Introduction In the past few decades, pediatric obesity has become a major issue in the care of children.1 The prevalence of overweight and obese children ages 2 to 19 years in 2011 to 2012 was 31.8% according to an original investigation done by JAMA.2 When solely examining obesity in the same group, prevalence was 16.9%. According to the American Academy of Pediatrics (AAP) Clinical Report from July 2015, pediatricians should identify children at risk for developing obesity at every health visit using the recommended growth charts. The World Health Organization’s weight-for-age and weight-for-length normative growth chart is recommended for birth through 23 months of age. The Centers for Disease Control and Prevention (CDC) body mass index (BMI) growth charts should be used for age 2 years and older.3 A study published in Pediatrics in 2010 showed that of 677 primary care clinicians surveyed, 97% reported visually assessing children for weight status. For children older than age 2 years, only 52% reported assessing the BMI percentile.4 Another study published in Public Health Reports in 2009 was conducted in an urban academic pediatric practice and reviewed 397 medical records of children ages 5 to 11 years. Results showed that 59.7% of records contained a CDC BMI growth chart, 5.5% of physicians documented BMI, and 4.3% of physicians plotted BMI.5 Several articles have provided evidence that visual assessment of BMI alone does not correctly identify overweight and obese patients.4-10 Additionally, some of these studies demonstrate that physicians tend to underestimate a patient’s weight versus BMI.4,7-10 This could be due to a higher prevalence of overweight and obese patients changing perceptions of what is the norm.10 The current literature suggests a disconnect between clinical and objective assessment of weight. The purpose of this study was to assess physician visual interpretation of BMI within our hospital system. The primary goal was
to see how well physicians in our hospital system clinically estimated weight versus an objective assessment tool (BMI). Another goal was to raise awareness within our own hospital system of the importance of addressing BMI at all health visits.
Methods Data was gathered via online surveys collected from physicians at St. Vincent Hospital, a community hospital in Indianapolis, Indiana, from March through April of 2016. The 5 groups of physicians surveyed included pediatric outpatient physicians, family medicine outpatient physicians, pediatric hospitalists, pediatric residents, and family medicine residents. Surveys were created via SurveyMonkey and distributed via email. Three surveys were created (Survey A, Survey B, and Survey C), and each included one photograph of a child with a known BMI. Photographs used were obtained from the CDC’s “Visual Assessment Versus Calculation of BMI” growth chart training website.11 Each contacted physician received one copy of the survey. Survey A had a photograph of an overweight child, Survey B had a photograph of a normal weight child, and Survey C had a photograph of an obese child. BMI definitions used were normal weight 5th to
