Detecting overweight children in primary care: Do national data reflect the typical urban practice?

Discussion

Significance of the data for those aged <2 years

The earlier children begin increasing in adiposity, the greater the risk for being obese as adolescents and adults,^7,8 with 40% of infants whose weight was above the 95th percentile reported to be over-weight as adults.⁹ Our BMI data in the subjects younger than 2 years were similar to those reported in the 2001 to 2002 NHANES sample.

However, there is no agreement on the best way of assessing overweight in infants aged <2 years,¹⁰ and BMI may not represent a valid measure of adiposity in these children.¹¹ Traditionally, weight-length ratio or ponderal index have been used to define overweight in infants aged <2 years. Despite the potential limit of using BMI in infants, the use of BMI from birth on may be helpful in tracking the infant’s growth and looking at trends and risk factors associated with the years preceding the adiposity rebound.^7,10

The data presented herein are significant because they reflect the anthropometrical parameters primary care physicians obtain and should use routinely to calculate and plot BMI.^2,12

Moreover, the primary care practices sampled could have been located anywhere in the US and the data generated are similar to the national data, despite having been collected without any standardization or additional personnel training. Thus they illustrate that primary care physicians can easily identify overweight in young children without implementing any change in their current practice, as long as they do not use the paper-and-pencil methods, shown to systematically overestimate length.¹³

Significance of the data for those aged 2 to 5 years

In 2- to 5-year-old non-Hispanic white children seen for well-child visits in a typical primary care setting in western New York, the prevalence of “overweight” is similar to the national prevalence, with a trend towards a higher prevalence of “at risk for overweight” compared with the national data (western New York 25.5% vs 20.8% NHANES).⁵ These data provide alerting evidence that 25% to 30% of preschool children are at risk for over-weight at a routine well-child visit.

Significance of the data for those aged 6 to 11 years

Caution must be used in interpreting our finding of a higher prevalence of over-weight (42.0 vs 19.8%) in the 6- to 11-year-old non-Hispanic black population, given the smaller size of this sample. However, this may reflect the fact that prevalence of overweight may be worsening in minorities, and may be higher in specific areas of the US and in populations with lower socioeconomic status.

In fact Gauthier et al¹⁴ showed that 38% of males and 16% of females (aged 4 to 17 years) were obese in a predominantly rural community of Michigan with low socioeconomic status. A higher prevalence of obesity was also found by these authors in a large database from Practice Partner Research Network practices located in 24 states.¹⁵

Comorbidities and the sick child

There are several known obesity comorbidities,¹⁶ but it is unclear if the over-weight status is actually posing the affected child at higher risk for developing illnesses treated routinely by the primary care physicians, such as viral syndrome, otitis media, and others.^17-20 Our preliminary data in a sample of 2- to 5-year-old non-Hispanic white children seen for a sick visit suggest that the prevalence of at risk for overweight may be higher in children seen for a sick-child compared with well-child visit.

Since many children are only brought to medical attention when they are in need of urgent care, by omitting height and weight measurements at the time of a sick-child visit, physicians may miss the only opportunity of detecting the child who is at risk for overweight, and thus in need of preventative measures.