title: Underdiagnosis of pediatric obesity during outpatient preventive care visits.
abstract: OBJECTIVE
  To examine obesity diagnosis, obesity-related counseling, and laboratory testing rates among obese pediatric patients seen in US preventive outpatient visits and to determine patient, provider, and practice-level factors that are associated with obesity diagnosis.
  
  
  METHODS
  By using 2005-2007 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data, outpatient preventive visits made by obese (body mass index ≥95%) 2- to 18-year-old patients were examined for frequencies of obesity diagnosis, diet, exercise, or weight reduction counseling, and glucose or cholesterol testing. Multivariable logistic regression was used to examine whether patient-level (gender, age, race/ethnicity, insurance type) and provider/practice-level (geographic region, provider specialty, and practice setting) factors were associated with physician obesity diagnosis.
  
  
  RESULTS
  Physicians documented an obesity diagnosis in 18% (95% confidence interval, 13-23) of visits made by 2- to 18-year-old patients with a body mass index ≥95%. Documentation of an obesity diagnosis was more likely for non-white patients (odds ratio 2.87; 95% confidence interval, 1.3-6.3). Physicians were more likely to provide obesity-related counseling (51% of visits) than to conduct laboratory testing (10% of visits) for obese pediatric patients.
  
  
  CONCLUSIONS
  Rates of documented obesity diagnosis, obesity-related counseling, and laboratory testing for comorbid conditions among obese pediatric patients seen in US outpatient preventive visits are suboptimal. Efforts should target enhanced obesity diagnosis as a first step toward improving pediatric obesity management.
authors.affiliation: Department of Pediatrics, University of California, San Francisco, Calif 94118, USA. Patela@peds.ucsf.edu
authors.forename: Anisha I
authors.initials: AI
authors.lastname: Patel
authors.forename: Kristine A
authors.initials: KA
authors.lastname: Madsen
authors.forename: Judith H
authors.initials: JH
authors.lastname: Maselli
authors.forename: Michael D
authors.initials: MD
authors.lastname: Cabana
authors.forename: Randall S
authors.initials: RS
authors.lastname: Stafford
authors.forename: Adam L
authors.initials: AL
authors.lastname: Hersh
mesh_terms: D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D003951:Diagnostic Errors; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening; D024821:Metabolic Syndrome / Q000517:prevention & control; D015999:Multivariate Analysis; D009765:Obesity / Q000175:diagnosis / Q000517:prevention & control*; D010353:Patient Education as Topic; D010818:Practice Patterns, Physicians'; D011320:Primary Health Care; D014481:United States