title: Sensitivity and specificity of obesity diagnosis in pediatric ambulatory care in the United States.
abstract: OBJECTIVE
  We examined the sensitivity and specificity of an obesity diagnosis in a nationally representative sample of pediatric outpatient visits.
  
  
  METHODS
  We used the 2005 to 2009 National Ambulatory Medical Care and National Hospital Ambulatory Medical Care surveys. We included visits with children 2 to 18 years, yielding a sample of 48 145 database visits. We determined 3 methods of identifying obesity: documented body mass index (BMI) ≥95th percentile; International Classification of Diseases, Ninth Revision (ICD-9) code; and positive answer to the question, "Does the patient now have obesity?" Using BMI as the gold standard, we calculated the sensitivity and specificity of a clinical obesity diagnosis.
  
  
  RESULTS
  Among the 19.5% of children who were obese by BMI, 7.0% had an ICD-9 code and 15.2% had a positive response to questioning. The sensitivity of an obesity diagnosis was 15.4%, and the specificity was 99.2%.
  
  
  CONCLUSIONS
  The sensitivity of the obesity diagnosis in pediatric ambulatory visits is low. Efforts are needed to increase identification of obese children.
authors.affiliation: Boston Medical Center/Boston Children's Hospital, Boston, MA, USA.
authors.forename: Carolyn O
authors.initials: CO
authors.lastname: Walsh
authors.forename: Carly E
authors.initials: CE
authors.lastname: Milliren
authors.forename: Henry A
authors.initials: HA
authors.lastname: Feldman
authors.forename: Elsie M
authors.initials: EM
authors.lastname: Taveras
mesh_terms: D000293:Adolescent; D000553:Ambulatory Care / Q000592:standards*; D015992:Body Mass Index; D002648:Child; D002675:Child, Preschool; D005260:Female; D019538:Health Care Surveys / Q000379:methods* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D009765:Obesity / Q000175:diagnosis*; D010372:Pediatrics / Q000592:standards*; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D014481:United States
keywords: diagnosis; health care surveys; pediatric obesity; sensitivity and specificity