title: Clinician identification of youth abusing over-the-counter products for weight control in a large U.S. integrated health system.
abstract: BACKGROUND
  Abuse of over-the-counter (OTC) products, such as diet pills and laxatives, for weight control by adolescents is well-documented and can precipitate serious medical conditions. Yet only a small percentage of youth with disordered weight control behaviors receive treatment. The objective of this study was to examine how often clinicians communicate with youth with symptoms consistent with abuse of OTC products for weight control about possible use of these products. We used electronic medical records and administrative claims for services for 53,229 12 to 17 year old patients receiving care from an integrated health system in the U.S. Northwest from August 2007 to December 2010. We examined electronic text of clinical notes to identify encounters in which the clinician noted one of 10 metabolic conditions potentially associated with abuse of OTC products (diet pills, laxatives, diuretics, ipecac, orlistat, and alli®) for weight control and then assessed whether clinicians noted communication with adolescent patients about possible use of OTC products for weight control.
  
  
  RESULTS
  We identified 130 (0.2% of sample) patients with clinical notes indicating one or more of the metabolic conditions. In clinical notes for only four (3.1%) of these patients did clinicians document suspicion or communication about possible abuse of the OTC products. All four had a previous eating disorder diagnosis. In the 12 months subsequent to the clinical encounter in which a metabolic disturbance was identified, medical notes for only three (2.3%) of the 130 patients indicated clinician suspicion or communication about possible abuse of these products or an eating disorder.
  
  
  CONCLUSIONS
  Clinicians are missing a critical window of opportunity to query adolescents when presenting with suspicious metabolic disturbances about possible abuse of OTC products for weight control. Clinicians may need more training to detect OTC product abuse, and electronic medical records should prompt more thorough enquiry.
authors.affiliation: Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 333 Longwood Ave., #634, Boston, MA 02115, USA ; Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA.
authors.forename: S Bryn
authors.initials: SB
authors.lastname: Austin
authors.affiliation: Group Health Research Institute, Seattle, WA, USA ; Department of Health Services Research, University of Washington, School of Public Health, Seattle, WA, USA.
authors.forename: Robert B
authors.initials: RB
authors.lastname: Penfold
authors.affiliation: Group Health Research Institute, Seattle, WA, USA.
authors.forename: Ron L
authors.initials: RL
authors.lastname: Johnson
authors.affiliation: Department of Family Relations and Applied Nutrition, University of Guelph, Guelph, Canada.
authors.forename: Jess
authors.initials: J
authors.lastname: Haines
authors.affiliation: Division of Adolescent and Young Adult Medicine, Boston Children's Hospital, 333 Longwood Ave., #634, Boston, MA 02115, USA.
authors.forename: Sara
authors.initials: S
authors.lastname: Forman
keywords: Adolescence; Diet pills; Diuretics; Eating disorder; Electronic medical record; Laxatives