Childhood Obesity Under-Diagnosed

A Michigan State University study has found that despite the increased attention being paid to childhood obesity issues, very few physicians and other health care providers are identifying obesity, and its myriad complications, in their young patients.

In a paper presented at the annual meeting of the Pediatric Academic Societies in Seattle, MSU physician Ihuoma U. Eneli and colleagues reported that between 1997 and 2000, obesity was identified in less than 1 percent of children who visited a doctor's office or urgent care facility.

This is despite the fact that in the United States around 15 percent of children aged 6 to 19 and nearly 11 percent of preschool children are considered obese.

"In addition, a little more than 7 percent of all kids who were obese actually did get a diagnosis of obesity," said Eneli, an assistant professor in MSU's Department of Pediatrics and Human Development. "That's awfully low."

Childhood obesity is defined as any child whose body mass index (BMI) is at the 95th percentile or above.

Because childhood obesity can result in a variety of both short- and long-term health problems, it's important that it be diagnosed as early as possible, Eneli said.

"There are complications with obesity and we are seeing these complications a little more frequently with children," she said. "Type-2 diabetes is a good example. Identifying obesity is an important initial step in guiding evaluation and treatment."

According to Eneli and colleagues, the main reason physicians and other providers tended to under-diagnose obesity in children: time, or the lack of it.

"To address obesity in the office setting takes a little more time," she said. "In addition, we also found that if a child was obese, the visit took longer than if the child was not."

In addition, Eneli said, many physicians don't believe they are adequately trained in behavior modification and are reluctant to treat obese children.

The study also found that nearly 20 percent of those children diagnosed as obese were under the age of five.

"I thought this was particularly striking," Eneli said. "It raises a lot of questions and further emphasizes the seriousness and urgency of the visits to health care providers."

What's needed, she said, is a good, effective program that can be used within the office setting.

"A lot of obesity programs involve a clinic in which a child goes for any number of sessions," Eneli said. "The office setting does not allow for that."

When discussing interventions with obese or overweight children, diet is not a word commonly used. Eneli said children should not be put on diets.

"Unless it's a life-threatening situation, you normally don't want to do that," she said. "In most cases you can look at the family dynamics, in how they relate to food and you can look at the child's eating habits. These are all things that can be modified."

Children who are overweight or obese tend to grow into adults who are overweight or obese, Eneli said.

"That risk increases tremendously with the age of the child," she said. "For example, an obese 18-year-old has an 18-fold chance of continuing to be obese as an adult."

To obtain their results, Eneli and her MSU colleagues examined more than 45,000 ambulatory care visits by children aged 17 and under between 1997 and 2000. The data was provided by the National Center for Health Statistics.

Other researchers were Debra R. Keast of the MSU Department of Food Science and Human Nutrition; Pramod K. Pathak of the MSU Department of Epidemiology; and Marsha D. Rappley of the MSU Department of Pediatrics and Human Development.

The research was funded by a grant from the Blue Cross Blue Shield Foundation of Michigan.