Obesity Overlooked in Hospitalized Children
CHICAGO — Not quite half of 785 hospitalized pediatric patients were overweight or obese, and psychiatric diagnoses affected almost a quarter of those children and teens, according to a chart review.
Overall, 102 (13%) children were overweight based on a body mass index percentage of 85%-95%, and another 227 (29%) were obese based on a BMI percentage greater than 95%, for a total of 42%, Dr. Marsha Medows and her associates reported in a poster at the annual meeting of the Society of Hospital Medicine.
Obesity was recognized as a diagnosis or problem in only 23% of the 227 obese children.
Failure to diagnose obesity and overweight in children represents an important missed opportunity to intervene, according to the investigators. Childhood obesity confers a substantial risk of adult obesity, lifelong health risks, and social and economic disadvantages.
Providers might not diagnose, counsel, or treat their obese patients because of concerns related to societal stigma and effectiveness of treatment, Dr. Medows of the department of pediatrics at New York University Langone Medical Center said in an interview.
“The social stigma is real, but so are the threats to health status that obesity poses,” she said. “Providers, recognizing this negative view of obesity, need to be empathic in their discussions regarding weight management.”
Psychiatric illness was significantly more common in obese/overweight children (24%), compared with those without a weight problem (7%). There were no differences in diagnoses of respiratory illness, skin and soft-tissue infections, or diabetes.
“Obese children are at significantly higher risk for experiencing poor psychological well-being,” Dr. Medows said. “Many studies have not determined if depression is a consequence of obesity or if depression predisposes to obesity. Bipolar disorder and schizophrenia are independent risk factors for obesity.”
The medical center is in the process of changing its computer system to automatically flag overweight/obese BMI and place these patients on the problem list. When obesity was recognized as a problem in the study, the primary care physician was contacted regarding referral of the patient to the obesity clinic.
The chart review included children (60% male), aged 6 months to 18 years (mean, 8.5 years), who were hospitalized during a 15-month period at an urban community hospital. Diabetes was present in 1.4% of patients, but the prevalence was not different between those with or without a weight problem.
The investigators reported no conflicts of interest.
