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Recognition of overweight-obesity in children – are paediatricians missing the opportunity in outpatient clinics?
  1. V Gali1,
  2. V Krishna Venkatesh1,
  3. V Ganesan2
  1. 1Paediatric specialty trainee, City Hospital, Birmingham, UK
  2. 2Consultant Paediatrician, City Hospital, Birmingham, UK

Abstract

Aims Overweight-obesity is an emerging major health issue in children in the UK. Success of any initiative to address this and mitigate its potential health burden during adulthood relies on proactive engagement of children, parents and professionals. Paediatricians will naturally be at the forefront of such interventions. This study explores if opportunities available in children's outpatient clinics are utilised effectively.

Methods This retrospective study looked at 1000 data-sets (routine height and weight) of 2–16 year-old children who attended clinics in the paediatric outpatient department of an inner-city District General Hospital between April 2008 and March 2009. We calculated body mass index (BMI) to identify overweight or obesity as described in the NICE guideline (UK 1990 BMI growth reference chart). Clinic letters from our electronic database were checked to answer three specific questions – Was overweight-obesity recognised? Was it discussed with the parent? Was any action initiated to address this issue?

Results In this cohort of 1000 children, 231 (23%) were under-five; 483 (48%) were 5–11 year-old and 286 (29%) were over-11 to 16 year-old. 583 (58%) were boys. BMI plots revealed that 152 (15%) were obese and 121 (12%) were overweight. 106 (25%) girls and 167 (29%) boys were overweight-obese. Prevalence of overweight-obesity -27.3%- and its distribution among boys (29%) in this cohort correlate with a recent UK-wide survey (2008). Information extracted from clinic letters suggested that only 4 out of 10 overweight-obese children (38%; n=104) were recognised – better if obese (56%; n=84) than overweight (17%; n=20). Documentation of discussion was even less frequent. Specific action was initiated only in 43% of obese (n=65) and 10% of overweight (n=12) children.

Conclusion This study with a large sample size (n=1000) highlights that a significant proportion of overweight (83%) and obese (44%) children attending clinics in paediatric outpatient department may remain unrecognised, despite routine availability of height and weight data required to calculate BMI. This message should alert all paediatricians in the UK to audit their practice to clarify if opportunities in their clinics are used effectively to recognise overweight-obesity, raise awareness and initiate action.

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