title: Childhood obesity in secondary care: national prospective audit of Australian pediatric practice.
abstract: OBJECTIVE
  In many countries, pediatricians offer skilled secondary care for children with conditions more challenging than can readily be managed in the primary care sector, but the extent to which this sector engages with the detection and management of obesity remains largely unexplored. This study aimed to audit the prevalence, diagnosis, patient, and consultation characteristics of obesity in Australian pediatric practices.
  
  
  METHODS
  This was a national prospective patient audit in Australia. During the course of 2 weeks, members of the Australian Paediatric Research Network prospectively recorded consecutive outpatient consultations by using a brief standardized data collection form. Measures included height, weight, demographics, child and parent health ratings, diagnoses, referrals, investigations, and consultation characteristics. We compared the prevalence of pediatrician-diagnosed and measured obesity (body mass index ≥95th percentile) and top-ranked diagnoses, patient, and consultation characteristics in (a) obese and nonobese children, and (b) obese children with and without a diagnosis.
  
  
  RESULTS
  A total of 198 pediatricians recorded 5466 consultations with 2-17 year olds, with body mass index z-scores calculated for 3436 (62.9%). Of the 12.6% obese children, only one-third received an "overweight/obese" diagnosis. Obese children diagnosed as overweight/obese were heavier, older, and in poorer health than those not diagnosed and incurred more Medicare (government-funded health system) cost and referrals.
  
  
  CONCLUSIONS
  Obesity is infrequently clinically diagnosed by Australian pediatricians and measurement practices vary widely. Further research could focus on supporting and normalizing clinical obesity activities from which pediatricians and parents could see clear benefits.
authors.affiliation: Centre for Community Child Health, Royal Children's Hospital, The University of Melbourne, Parkville, Victoria, Australia.
authors.forename: Michele
authors.initials: M
authors.lastname: Campbell
authors.forename: Hannah E
authors.initials: HE
authors.lastname: Bryson
authors.forename: Anna M H
authors.initials: AM
authors.lastname: Price
authors.forename: Melissa
authors.initials: M
authors.lastname: Wake
mesh_terms: D000293:Adolescent; D001315:Australia / Q000453:epidemiology; D015992:Body Mass Index; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D008297:Male; D008485:Medical Audit; D050177:Overweight / Q000175:diagnosis / Q000453:epidemiology; D063766:Pediatric Obesity / Q000175:diagnosis* / Q000453:epidemiology; D010372:Pediatrics / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015995:Prevalence; D011446:Prospective Studies; D063127:Secondary Health Care / Q000706:statistics & numerical data*