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Pediatricians recognize most overweight or obese children without using proportional weight curves

One in six school-aged children in the United States is obese. Pediatricians "know obesity when they see it" if a child's body mass index (BMI) is above the 95th percentile. However, pediatricians may overlook excess weight in children with a BMI at the 85th to 94th percentile, suggests a new study. In the study, pediatricians identified overweight and obesity in 86 percent of children with a BMI at or above the 95th percentile but only in 27 percent of children with a BMI at the 85th to 94th percentile.

Less keen identification of mildly overweight children may be due to competing demands of the medical visit or because these children now seem fairly normal, explains Sarah E. Barlow, M.D., M.P.H., of Saint Louis University. Doctors tended to more often identify obese adolescents than younger children, but identification was not associated with patient sex or race, practice setting, insurance type, or visit length.

Only 41 percent of growth charts were current, and only 6.1 percent had the BMI plotted. BMI plotting was associated with identification of overweight and obesity when the BMI was at the 85th to 94th percentile, but not when the BMI was at or above the 95th percentile. Thus, BMI plotting on children's charts may increase recognition in mildly overweight children.

After controlling for BMI percentile, patients identified as overweight or obese were 7.5 and 5.6 times respectively more likely to receive diet and exercise counseling. These findings were based on analysis of identification of overweight and obese children among pediatricians in diverse public and private practices in St. Louis, who participated in a study of the care of chronic conditions during health supervision visits.

The researchers analyzed visit notes, growth charts, and a one-page questionnaire about patient demographics and visit content from 30 visits of children (age 6 to 17 years) per pediatrician. The study was supported by the Agency for Healthcare Research and quality (HS13901).

See "Recognition of childhood overweight during health supervision visits: Does BMI help pediatricians?" by Dr. Barlow, Sonal R. Bobra, M.P.H., Michael B. Elliott, Ph.D., and others, in the January 2007 Obesity 15(1), pp. 225-232.

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