Marta A. King,,St. Louis,MO,Flory . Nkoy,,Salt Lake City,UTAH,Chris . Maloney,,Salt Lake City,UTAH,Nikki . Mihalopoulos,,Salt Lake City,UTAH
There is limited information about identification and management overweight/obesity in hospitalized children. No studies have addressed physician documentation of overweight/obesity in history, physical exam, assessment, and plan or documentation variation associated with physician training level.
The primary purpose of the study was to determine how frequently physicians identify and address overweight/obesity in hospitalized children. The secondary purpose was to compare physician documentation across training level (medical student, intern, resident, attending).
We conducted a retrospective chart review. Using an administrative database, Center for Disease Control and Prevention BMI calculator, and random sampling technique, we identified our study population of 300 overweight/obese children 2-18 years hospitalized on the general pediatric service of tertiary care pediatric hospital. We reviewed admission, progress, and discharge notes to determine how frequently medical students and physicians identified (documented in history, physical exam, or assessment) and addressed (documented in hospital or discharge plan) overweight/obesity. Chi-square and Fisher’s exact tests were performed to compare documentation across physician training level.
Physicians and physician trainees identified overweight/obesity in 8.3% (n=25) and addressed it in 4% (n=12) of 300 hospitalized overweight/obese children. There were significant differences in the documentation associated with level of training. (Table) Medical students were least likely to identify and address overweight/obesity documenting overweight/obesity in history (1.2%, n=3), physical exam (2.9%, n=7), assessment (0.4% n=1), and hospital or discharge plan (0.4%, n=1) of the 244 overweight/obese hospitalized children they followed.
Medical students and physicians rarely identify or address overweight/obesity in hospitalized children. The low frequency of overweight/obesity documentation by medical students is especially worrisome as future physicians may feel overweight/obesity is not a problem they need to address. In preparation for designing educational interventions and inpatient specific guidelines, future studies should focus on exploring medical student and physician knowledge and attitudes about pediatric overweight/obesity and on identifying barriers to identification and management.