Identification and counseling for obesity among children on psychotropic medications in ambulatory settings

Clinical approaches to minimize iatrogenic weight gain in children and adolescents

Clinical providers may underestimate the role of management of diseases that can occur with obesity, termed co-morbid conditions, distinct from disease that arise as a result of obesity, co-morbidities. Many of these conditions are associated with iatrogenic weight gain, and can interfere with weight loss outcomes in children and adolescents with obesity. Management of co-morbid conditions, and thoughtful selection of medications associated with weight neutrality or weight loss may increase the effectiveness of obesity treatment strategies. The aim of this commentary is to summarize the literature and discuss considerations for obesity treatment in the context of the more complicated patient, which often requires strategic management of co-morbid conditions and minimizing iatrogenic weight gain.

Developmental-Behavioral Pediatricians' Diagnosis and Coding of Overweight and Obesity in Children with Autism Spectrum Disorder

OBJECTIVE

The prevalence of obesity in autism spectrum disorder (ASD) is high, and managing obesity in children with ASD can be challenging. The study's objective was to examine developmental-behavioral pediatricians' (DBPs) coding practices for overweight/obesity in children with ASD and patient characteristics associated with coding.

METHODS

We analyzed the clinical data on children with ASD with at least 1 visit at one of 3 developmental-behavioral pediatrics network sites between January 2010 and December 2011. Weight status was calculated using body mass index z-scores. For children meeting the criteria for overweight/obesity, we assessed the frequency of weight-related ICD-9 diagnosis codes at DBP visits, used multivariable logistic regression to determine characteristics associated with the presence of these codes, and examined the prevalence of weight-related codes relative to other diagnosis codes.

RESULTS

The sample included 4542 children, ages 2 to 19 years. 15.5% of children met the criteria for overweight, 14.7% for obesity, and 6.3% for severe obesity. Of children meeting the criteria for overweight/obesity/severe obesity, 7.5% had a weight-related code documented at their visits. Children with obesity or severe obesity and older children had higher odds of having a weight-related code. Compared with not being on medications, atypical antipsychotics use was significantly associated with increased odds of having a weight-related code. Of 3802 unique ICD-9 diagnosis codes documented at any visit during the study period, only 4% were related to weight.

CONCLUSION

Few children meeting the criteria for overweight/obesity had documented weight-related codes. Weight-related coding was more likely for children with obesity, who were older, and those taking atypical antipsychotics.

Family-style dining on a child and adolescent psychiatry unit: a quality improvement project to reduce weight changes in patients

BACKGROUND

Improving nutritional standards for children has become a national health initiative. However, children who are hospitalized are often at additional risk for poor nutrition and diet. Following a change to family-style dining, nursing staff noted significant patient weight changes. We undertook a quality improvement project to address this issue and promote healthy weight maintenance.

METHODS

Nursing staff requested changes to the types of foods served and placed limits on how much patients were permitted to eat. We also developed a nutrition group to educate the patients on healthy food choices.

RESULTS

We were able to reduce weight changes in patients on our unit from a mean change of 2.5 kg (5.5 lb) to a mean change of 0.01 kg (0.027 lb).

CONCLUSIONS

Patient education, healthy food offerings, and limiting the amount of food eaten at meals had positive outcomes on patient weights during a child and adolescent psychiatry hospitalization.