title: Is severity of obesity associated with diagnosis or health education practices?
abstract: OBJECTIVE
  To assess the association of the severity of obesity with diagnosis and health education, and to identify any differences within demographic or other subgroups.
  
  
  METHODS
  Clinician visits for 2-18 year olds from the 2005-2008 National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey were combined. Descriptive, bivariate and multivariate analyses were used to compare diagnosis of obesity and health education (nutrition, exercise and weight reduction) across elevated body mass index (BMI) groups (overweight, obese and extreme or very obese, defined as >120% of the 95th percentile for age and gender), patient socio-demographic characteristics, physician specialty and type of visit (well child visits (WCV) versus non-well child visits (non-WCV).
  
  
  RESULTS
  A total of 17,808 visits had a calculated BMI, of which 5.8% were extremely obese, 13% were obese and 15.2% were overweight, with the highest percentages among older children, blacks and Hispanics. Diagnosis and weight reduction education were higher among children with an extreme BMI. Nutrition and exercise education were not correlated with severity of obesity. Race, ethnicity or gender biases were not identified. Severity of obesity was significantly associated with presentation to a non-WCV rather than a WCV.
  
  
  CONCLUSIONS
  Extremely obese children have higher, but still insufficient, rates of diagnosis and health education. Nutrition and exercise education are not prevalent throughout all age groups. Providers may be relying inconsistently and insufficiently on visual cues to drive their obesity prevention practices. Furthermore, lower rates of diagnosis and education at non-WCV may result in a missed opportunity to prevent comorbidities. This is of particular concern as overweight children are less likely to be seen at WCV than non-WCV.
authors.affiliation: Department of Pediatrics, Mount Sinai Kravis Children's Hospital, New York, NY 10029, USA. maya.leventer.roberts@gmail.com
authors.forename: M
authors.initials: M
authors.lastname: Leventer-Roberts
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: L
authors.initials: L
authors.lastname: Trasande
mesh_terms: D000293:Adolescent; D015992:Body Mass Index; D002648:Child; D015362:Child Nutrition Disorders / Q000175:diagnosis / Q000208:ethnology / Q000517:prevention & control*; D002675:Child, Preschool; D005260:Female; D006266:Health Education; D006801:Humans; D008297:Male; D009749:Nutrition Surveys; D009765:Obesity / Q000175:diagnosis* / Q000208:ethnology / Q000517:prevention & control*; D009767:Obesity, Morbid / Q000517:prevention & control; D015995:Prevalence; D040242:Risk Reduction Behavior; D012720:Severity of Illness Index; D014481:United States / Q000453:epidemiology