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Goldman VE, Espinoza JC, Vidmar AP. Inpatient medical management of severe pediatric obesity: Literature review and case reports. Front Pediatr 2023; 11:1095144. [PMID: 36861081 PMCID: PMC9970259 DOI: 10.3389/fped.2023.1095144] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 01/17/2023] [Indexed: 02/15/2023] Open
Abstract
Pediatric obesity rates continue to rise steeply with significant adverse effects on health outcomes across the lifespan. Significant obesity can affect the efficacy, side effects, and ability to use certain treatment, medication, or imaging modalities needed in the evaluation and management of acute pediatric conditions. Inpatient settings are rarely used as an opportunity for weight counseling and thus there is a paucity of clinical guidelines on how to manage severe obesity in the inpatient setting. We present a literature review and three patient cases with single-center protocol for non-surgical management of severe obesity in children admitted for other acute medical reasons. We performed a PubMed review from January 2002 to February 2022 utilizing keywords: "inpatient," "obesity," and "intervention." For our cases, we identified three patients with severe obesity acutely impacting their health while admitted for medical treatment who concurrently underwent acute, inpatient, weight loss regimens at a single children's hospital. The literature search yielded 33 articles describing inpatient weight loss treatments. Three patients met case criteria, all three of which demonstrated a decrease in their weight in excess percent of the 95th percentile after inpatient weight-management protocol implementation (% reduction BMIp95: 16%-30%). This highlights obesity acutely limits or impacts specific medical care required during inpatient admissions in pediatric patients. It also suggests that implementation of an inpatient weight-management protocol during admission may provide an opportune setting to support acute weight loss and overall improved health outcomes in this high-risk cohort.
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Affiliation(s)
- Victoria E Goldman
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Juan C Espinoza
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Keck School of Medicine of University of Southern California, Los Angeles, CA, United States
| | - Alaina P Vidmar
- Department of Pediatrics, Children's Hospital Los Angeles, Los Angeles, CA, United States.,Keck School of Medicine of University of Southern California, Los Angeles, CA, United States.,Department of Pediatrics, Endocrinology and Metabolism, Children's Hospital Los Angeles Center for Diabetes, Los Angeles, CA, United States
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2
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Kovalerchik O, Powers E, Holland ML, Sharifi M, Langhan ML. Differences in Frequency of Visits to Pediatric Primary Care Practices and Emergency Departments by Body Mass Index. Acad Pediatr 2020; 20:532-539. [PMID: 31904438 DOI: 10.1016/j.acap.2019.12.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Revised: 12/25/2019] [Accepted: 12/29/2019] [Indexed: 12/13/2022]
Abstract
OBJECTIVES To examine differences in utilization across health care settings among children by body mass index (BMI) categories to help identify opportunities for interventions. METHODS A retrospective study was conducted using 1 year of electronic health records following an index primary care visit for children 3 to 17 years old in 2016. Index visits occurred at >40 pediatric practices affiliated with a Northeastern health system. Using normal BMI as a reference group, we examined the extent to which children's BMI percentile categories were associated with primary care visits, emergency department (ED) visits, hospitalizations, and ED visit acuity. Age, sex, race/ethnicity, and insurance status were used as covariates. RESULTS Of those with biologically plausible values for height and weight (n = 30,352), the prevalences of overweight, obesity, and severe obesity were 16.3%, 12.4%, and 5.7%, respectively. Children outside of the normal BMI range made more primary care visits; however, relative patterns of ED utilization were not consistent. Children with obesity versus normal BMI were less likely to have ED visits of high acuity. Risk of hospitalization was higher among children with overweight or severe obesity. CONCLUSIONS Children's BMI categories were associated with health care utilization, specifically primary care visits, ED visits, and hospitalizations. Further investigation is needed to explore the drivers of these differences in utilization, such as the impact of stigma and perceived weight bias on care-seeking patterns, and to examine the role of settings outside of primary care in pediatric weight management.
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Affiliation(s)
- Olga Kovalerchik
- Department of Emergency Medicine, Yale University School of Medicine (O Kovalerchik and ML Langhan), New Haven, Conn.
| | - Emily Powers
- Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine (E Powers and ML Langhan), New Haven, Conn; Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine (E Powers and M Sharifi), New Haven, Conn
| | | | - Mona Sharifi
- Department of Pediatrics, Section of General Pediatrics, Yale University School of Medicine (E Powers and M Sharifi), New Haven, Conn
| | - Melissa L Langhan
- Department of Emergency Medicine, Yale University School of Medicine (O Kovalerchik and ML Langhan), New Haven, Conn; Department of Pediatrics, Section of Emergency Medicine, Yale University School of Medicine (E Powers and ML Langhan), New Haven, Conn
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3
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Myers J, Werk LN, Hossain MJ, Lawless S. Quality Improvement Project to Promote Identification and Treatment of Children With Obesity Admitted to Hospital. Am J Med Qual 2020; 35:411-418. [PMID: 31941346 DOI: 10.1177/1062860619898534] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Among children hospitalized for acute problems, comorbid obesity is commonly unaddressed. The objective was to improve identification and initial management of obesity among hospitalized children. In collaboration with nurses and dietitians, pediatric hospitalists of 2 children's hospitals conducted a quality improvement project to improve body mass index (BMI) documentation, obesity diagnosis, diet, and nutrition consultation through clinician education, development of computerized clinical decision-support system tools, and workflow modifications. Participants received monthly performance feedback. Among those with elevated BMI, diagnosis rose to 70.2%; a documented obesity diagnosis was associated with being 35 times more likely (P < .001) to receive at least 1 intervention while hospitalized. Participants reported an increase in skill in (27%), comfort with (27%), and knowledge of (33%) obesity management. Improvement in health care provider recognition and management of obesity in the inpatient setting is achievable. Additional work is needed to identify how best to sustain desired practice patterns.
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Affiliation(s)
- Joseph Myers
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
| | - Lloyd N Werk
- Nemours Children's Hospital, Orlando, FL.,University of Central Florida, Orlando, FL
| | | | - Stephen Lawless
- Nemours/Alfred I. duPont Hospital for Children, Wilmington, DE
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4
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Walston JM, Foster BA, Gardner TA, Benchbani H, Noelck M, Austin JP. Sexual History and Contraception Documentation in Hospitalized Adolescents: Are Technology-Dependent Patients Overlooked? Hosp Pediatr 2019; 9:967-973. [PMID: 31685520 DOI: 10.1542/hpeds.2019-0113] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
OBJECTIVES Adolescents are at high-risk for sexually transmitted infections and pregnancy, yet many do not receive regular preventive care. Hospitalization represents an opportunity for providing sexual and contraception counseling for this high-risk population. Our aim in this study was to assess the frequency of sexual and contraception history documentation in hospitalized adolescents and identify subgroups that may benefit from more vigilant screening. METHODS A retrospective chart review of adolescent patients 11 years of age and older who were discharged from the pediatric hospitalist service at an urban, academic children's hospital from July 2017 to June 2018 was conducted. Patient and admission characteristics were analyzed for presence of sexual and contraception history documentation. Technology-dependent patients were analyzed separately. In addition, technology-dependent patients were assessed by chart review for developmental appropriateness for screening. RESULTS Twenty-five percent of patients (41 of 165) had a sexual history documented, and 8.5% (14 of 165) had a contraception history documented. Among patients with any technology dependence, 0 had a sexual history documented and only 1 had a contraception history documented, whereas 31.5% (12 of 38) were deemed developmentally appropriate for screening. Female and older patients were more likely to have sexual and contraceptive histories documented than male and younger patients. Patients transferred from the PICU had lower rates of sexual history documentation compared with direct admissions. CONCLUSIONS Hospitalized adolescents, especially those with technology dependence, did not have adequate sexual and contraception histories documented. Improving documentation of these discussions is an important step in providing adolescents with preventive medicine services while hospitalized.
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5
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Halvorson EE, Curley T, Wright M, Skelton JA. Weight Bias in Pediatric Inpatient Care. Acad Pediatr 2019; 19:780-786. [PMID: 30796998 PMCID: PMC6703967 DOI: 10.1016/j.acap.2019.02.005] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2018] [Revised: 02/14/2019] [Accepted: 02/18/2019] [Indexed: 11/30/2022]
Abstract
OBJECTIVE Weight bias can influence medical care but has not been studied in the pediatric inpatient setting. We will quantify implicit and explicit weight bias of pediatric inpatient providers and qualitatively explore providers' attitudes toward children with obesity and patient/family perceptions of weight bias in the hospital. METHODS We performed a mixed-methods study including semistructured key informant interviews and validated tests for implicit (Implicit Association Test) and explicit (Crandall's Anti-Fat Attitudes Questionnaire) bias with pediatric hospitalists, residents, and acute care nurses. We performed semistructured key informant interviews with pediatric inpatients aged 7 to 17 years and the patient's parent(s) or guardian(s). Interviews were coded using an inductive approach to identify recurrent themes. RESULTS We enrolled 28 pediatric providers, 12 patients, and 12 parents/guardians. In total, 71% of providers exhibited moderate or strong implicit weight bias, with generally lower scores for explicit bias. Qualitative analysis identified seven themes: the existence of weight bias, shared responsibility for a child's obesity, a potential for provider bias toward the parents of pediatric patients with obesity, possible effects of patient weight on inpatient care, importance of terminology in addressing obesity, and the possibility of addressing obesity inpatient but a preference for obesity to be addressed in the outpatient setting. CONCLUSIONS Health care providers, patients, and families in the pediatric inpatient setting identified multiple ways that obesity could impact care, including provider weight bias.
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Affiliation(s)
| | - Thomas Curley
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Mariah Wright
- Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA
| | - Joseph A Skelton
- Department of Pediatrics, Wake Forest School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, USA,Brenner FIT (Families in Training), Brenner Children’s Hospital, Medical Center Blvd, Winston-Salem, NC 27157, USA
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6
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Lee DS, Gross E. Adolescents and Their Parents: Perceptions of Addressing Obesity in the Inpatient Setting. Hosp Pediatr 2018; 8:547-553. [PMID: 30131325 DOI: 10.1542/hpeds.2017-0178] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
OBJECTIVES Extending obesity screening to the inpatient setting may increase adolescent and parent awareness of weight status. Whether this should be a priority given limited resources depends on how interventions would be received by adolescents and their parents. In this study, we aimed to further understand the perception of adolescents and their parents to addressing obesity in the inpatient setting to inform how to better address this issue. METHODS Pairs of hospitalized adolescents 13 to 18 years old on a general service and their parents were surveyed. The adolescent and parent surveys included 20 and 21 multiple choice and ordered response questions, respectively. Questions assessed perception of adolescent weight status, readiness to discuss weight status in the hospital, and preferences regarding how that should be done. Demographics were self-reported. Adolescent BMI was calculated from medical records and categorized on the basis of Centers for Disease Control and Prevention charts. RESULTS Analysis was done on 121 of 122 adolescent-parent pair responses. Of the adolescents, 34% were obese and 21% were overweight. Over two-thirds of adolescents and parents wanted to be informed during the hospitalization if the adolescent was overweight or obese, but there was concordance of both wanting to be informed in only 55% of pairs. A majority of adolescents and parents indicated that they preferred receiving information from physicians and through face-to-face discussion. CONCLUSIONS Although most adolescents and parents want to be informed of weight status in the inpatient setting, providers should be aware of potential differences in adolescent and parent receptiveness.
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Affiliation(s)
- Diana S Lee
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York; and .,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
| | - Elissa Gross
- Department of Pediatrics, Children's Hospital at Montefiore, Bronx, New York; and.,Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York
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7
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VanFrank BK, Park S, Foltz JL, McGuire LC, Harris DM. Physician Characteristics Associated With Sugar-Sweetened Beverage Counseling Practices. Am J Health Promot 2018; 32:1365-1374. [PMID: 27956472 PMCID: PMC5612916 DOI: 10.1177/0890117116680472] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
PURPOSE Frequent sugar-sweetened beverage (SSB) consumption is associated with chronic disease. Although physician counseling can positively affect patient behavior, physicians' personal characteristics may influence counseling practices. We explored SSB-related topics physicians discuss when counseling overweight/obese patients and examined associations between physicians' SSB-related counseling practices and their personal and medical practice characteristics. DESIGN Cross-sectional survey. SETTING DocStyles survey, 2014. PARTICIPANTS A total of 1510 practicing US physicians. MEASURES Physician's SSB counseling on calories, added sugars, obesity/weight gain, health effects, consumption frequency, water substitution, and referral. ANALYSIS Adjusted odds ratios (aORs) were calculated with multivariable logistic regression, adjusting for physician's personal and medical practice characteristics. RESULTS Most physicians (98.5%) reported SSB-related counseling. The most reported topic was obesity/weight gain (81.4%); the least reported were added sugars (53.1%) and referral (35.0%). Physicians in adult-focused specialties had lower odds than pediatricians of counseling on several topics (aOR range: 0.26-0.64). Outpatient physicians had higher odds than inpatient physicians of counseling on consumption frequency and water substitution (aOR range: 1.60-2.01). Physicians consuming SSBs ≥1 time/day (15.7%) had lower odds than nonconsumers of counseling on most topics (aOR range: 0.58-0.68). CONCLUSION Most physicians reported SSB-related counseling; obesity/weight gain was discussed most frequently. Counseling opportunities remain in other topic areas. Opportunities also exist to strengthen SSB counseling practices in adult-focused specialties, inpatient settings, and among physicians who consume SSBs daily.
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Affiliation(s)
- Brenna K. VanFrank
- Epidemic Intelligence Service, Office of Surveillance, Epidemiology, and Laboratory Services, Centers for Disease Control and Prevention, Atlanta, GA, USA
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Sohyun Park
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Jennifer L. Foltz
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
- US Public Health Service Commissioned Corps, USA
| | - Lisa C. McGuire
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
| | - Diane M. Harris
- Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA, USA
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8
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Katzow M, Homel P, Rhee K. Factors Associated With Documentation of Obesity in the Inpatient Setting. Hosp Pediatr 2017; 7:731-738. [PMID: 29183918 PMCID: PMC5703768 DOI: 10.1542/hpeds.2017-0100] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Childhood obesity is rarely identified in hospitalized pediatric patients despite the high prevalence of obesity and potential for associated morbidity. The purpose of this study was to identify specific patient characteristics associated with the documentation of obesity and related weight management recommendations in the inpatient setting. METHODS Retrospective chart review was conducted on all pediatric patients ages 2 to 18 years old and discharged between January 1, 2012, and December 31, 2014, to determine the following: (1) if obesity was noted in the clinical documentation of those with a BMI ≥95th percentile; and (2) if those with documented obesity had evidence of an obesity-specific management plan. Using χ2 and multivariable logistic regression, we determined patient characteristics associated with the documentation of obesity and presence of a management plan. RESULTS Only 26% (214 of 809) of inpatients with obesity had documentation of weight status. The odds of obesity documentation were higher in patients with comorbid cholelithiasis, severe obesity, and older age. Of those with obesity documentation, 23% (49 of 214) had an obesity management plan. Comorbid sleep apnea and admission to a surgical service with a pediatric hospital medicine consult were significantly associated with the presence of an obesity management plan. CONCLUSIONS Increased efforts are necessary to improve obesity diagnosis and management in younger children who have not yet developed comorbidities. Additionally, the role of pediatric hospitalists as consultants for surgical patients should be further explored as a tool for addressing obesity during inpatient hospitalization.
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Affiliation(s)
- Michelle Katzow
- Department of Pediatrics, New York University School of Medicine, New York, New York;
- Department of Pediatrics, Maimonides Infants & Children's Hospital, Brooklyn, New York
| | - Peter Homel
- Office of Research Administration, Maimonides Medical Center, Brooklyn, New York; and
| | - Kyung Rhee
- University of California, San Diego, San Diego, California
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9
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Harvey KC, McDermott H, Coles W, Elliott S, McMullan N, Anandaram A, Ismail S, Webb E, Kirk J. Tackling the childhood obesity crisis: acute paediatricians are not playing their part. Arch Dis Child 2017; 102:875-876. [PMID: 28611070 DOI: 10.1136/archdischild-2017-313005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/09/2017] [Indexed: 11/03/2022]
Affiliation(s)
- Kate Christina Harvey
- Department of Community Paediatrics, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Helen McDermott
- Department of Paediatrics, Sandwell and West Birmingham Hospitals NHS Trust, Birmingham, UK
| | - William Coles
- Department of Paediatrics, The Royal Wolverhampton NHS Trust, Wolverhampton, UK
| | - Susanne Elliott
- Department of Paediatrics, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
| | - Nicola McMullan
- Department of Community Paediatrics, Birmingham Community Healthcare NHS Foundation Trust, Birmingham, UK
| | - Archana Anandaram
- Department of Paediatrics, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Sanaa Ismail
- Department of Paediatrics, Heart of England NHS Foundation Trust, Birmingham, UK
| | - Emma Webb
- Department of Endocrinology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
| | - Jeremy Kirk
- Department of Endocrinology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, UK
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10
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Hainsworth KR, Jastrowski Mano KE, Stoner AM, Anderson Khan K, Ladwig RJ, Davies WH, Defenderfer EK, Weisman SJ. "What Does Weight Have to Do with It?" Parent Perceptions of Weight and Pain in a Pediatric Chronic Pain Population. CHILDREN-BASEL 2016; 3:children3040029. [PMID: 27854245 PMCID: PMC5184804 DOI: 10.3390/children3040029] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/26/2016] [Accepted: 11/07/2016] [Indexed: 01/15/2023]
Abstract
Tailored pain management strategies are urgently needed for youth with co-occurring chronic pain and obesity; however, prior to developing such strategies, we need to understand parent perspectives on weight in the context of pediatric chronic pain. Participants in this study included 233 parents of patients presenting to a multidisciplinary pediatric chronic pain clinic. Parents completed a brief survey prior to their child’s initial appointment; questions addressed parents’ perceptions of their child’s weight, and their perceptions of multiple aspects of the relationship between their child’s weight and chronic pain. The majority (64%) of parents of youth with obesity accurately rated their child’s weight; this group of parents was also more concerned (p < 0.05) about their child’s weight than parents of youth with a healthy weight. However, the majority of parents of youth with obesity did not think their child’s weight contributed to his/her pain, or that weight was relevant to their child’s pain or pain treatment. Overall, only half of all parents saw discussions of weight, nutrition, and physical activity as important to treating their child’s pain. Results support the need for addressing parents’ perceptions of their child’s weight status, and educating parents about the relationship between excessive weight and chronic pain.
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Affiliation(s)
- Keri R Hainsworth
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
| | | | - Alison M Stoner
- Department of Psychiatry, University of Massachusetts Medical School, Worcester, MA 01655; USA.
| | - Kim Anderson Khan
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
- Jane B. Pettit Pain and Headache Center, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
| | - Renee J Ladwig
- Jane B. Pettit Pain and Headache Center, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
| | - W Hobart Davies
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA.
| | - Ellen K Defenderfer
- Department of Psychology, University of Wisconsin-Milwaukee, Milwaukee, WI 53201, USA.
| | - Steven J Weisman
- Department of Anesthesiology, Medical College of Wisconsin, Milwaukee, WI 53226, USA.
- Jane B. Pettit Pain and Headache Center, Children's Hospital of Wisconsin, Milwaukee, WI 53226, USA.
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11
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Borgmeyer A, Ercole PM, Niesen A, Strunk RC. Lack of Recognition, Diagnosis, and Treatment of Overweight/Obesity in Children Hospitalized for Asthma. Hosp Pediatr 2016; 6:667-676. [PMID: 27733428 DOI: 10.1542/hpeds.2015-0242] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Information is lacking regarding recognition and treatment of overweight and obesity in children hospitalized for asthma. The study objectives were to determine the current practice of recognition, diagnosis, and treatment of overweight and obesity for children hospitalized for asthma and to describe demographic, asthma, and weight characteristics for these patients. METHODS A retrospective record review was conducted for children admitted to the hospital with asthma in 2012. Charts were reviewed for evidence of recognition, diagnosis, and treatment of overweight and obesity. Subjects were classified into age-adjusted Centers for Disease Control and Prevention weight categories based on BMI percentile and chronic asthma severity categories according to National Asthma Education and Prevention Program guidelines. RESULTS A total of 510 subjects aged 3 to 17 years were studied. Obesity was present in 19.6% and overweight in 13.3% of subjects. BMI percentile was recorded in only 3.3% of all charts, in only 11% of subjects with obesity, and in 0% of subjects with overweight. BMI percentile was documented more often in subjects with severe obesity (P = .013) and with moderate to severe persistent asthma (P = .035). Only 9 of 168 subjects who were overweight or obese (5.6%) were given a discharge diagnosis indicating overweight or obesity, and 14 (8.3%) received treatment. Chronic asthma severity differed by BMI weight category (P < .001), with a significant relationship between obesity status and chronic asthma severity in older subjects (P = .033). There were no differences in severity of acute episodes based on weight group. CONCLUSIONS Overweight and obesity were underrecognized, underdiagnosed, and undertreated in children hospitalized for asthma.
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Affiliation(s)
| | | | | | - Robert C Strunk
- Division of Allergy, Immunology, and Pulmonary Medicine, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
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12
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Lee DS, Gross E, Rinke ML. Physician Perspectives on Obesity Screening in Hospitalized Children. Clin Pediatr (Phila) 2016; 55:983-5. [PMID: 26603582 DOI: 10.1177/0009922815617976] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Nearly one-third of the children in the United States are obese or overweight and face associated physical and mental health issues.(1,2) Parents often misperceive and underreport their child's weight status.(3-5) This misperception is a major barrier to increasing healthy lifestyle choices, such as limiting screen time, increasing physical activity, improving diet, and participating in prevention programs.(6-8) Increasing parental awareness of children's weight status is an important initial step in addressing the obesity epidemic.
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Affiliation(s)
- Diana S Lee
- Children's Hospital at Montefiore, Bronx, NY, USA Albert Einstein College of Medicine, Bronx, NY, USA
| | - Elissa Gross
- Children's Hospital at Montefiore, Bronx, NY, USA Albert Einstein College of Medicine, Bronx, NY, USA
| | - Michael L Rinke
- Children's Hospital at Montefiore, Bronx, NY, USA Albert Einstein College of Medicine, Bronx, NY, USA
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13
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King MA, Nkoy FL, Maloney CG, Mihalopoulos NL. Physicians and Physician Trainees Rarely Identify or Address Overweight/Obesity in Hospitalized Children. J Pediatr 2015; 167:816-820.e1. [PMID: 26254834 PMCID: PMC4607260 DOI: 10.1016/j.jpeds.2015.06.040] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2015] [Revised: 05/06/2015] [Accepted: 06/23/2015] [Indexed: 10/23/2022]
Abstract
OBJECTIVES To determine how frequently physicians identify and address overweight/obesity in hospitalized children and to compare physician documentation across training level (medical student, intern, resident, attending). STUDY DESIGN We conducted a retrospective chart review. Using an administrative database, Centers for Disease Control and Prevention body mass index calculator, and random sampling technique, we identified a study population of 300 children aged 2-18 years with overweight/obesity hospitalized on the general medical service of a tertiary care pediatric hospital. We reviewed admission, progress, and discharge notes to determine how frequently physicians and physician trainees identified (documented in history, physical exam, or assessment) and addressed (documented in hospital or discharge plan) overweight/obesity. RESULTS Physicians and physician trainees identified overweight/obesity in 8.3% (n = 25) and addressed it in 4% (n = 12) of 300 hospitalized children with overweight/obesity. Interns were most likely to document overweight/obesity in history (8.3% of the 266 patients they followed). Attendings were most likely to document overweight/obesity in physical examination (8.3%), assessment (4%), and plan (4%) of the 300 patients they followed. Medical students were least likely to document overweight/obesity including it in the assessment (0.4%) and plan (0.4%) of the 244 hospitalized children with overweight/obesity they followed. CONCLUSIONS Physicians and physician trainees rarely identify or address overweight/obesity in hospitalized children. This represents a missed opportunity for both patient care and physician trainee education.
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Affiliation(s)
- Marta A. King
- Department of Pediatrics Saint Louis University, St. Louis, MO
| | - Flory L. Nkoy
- Department of Pediatrics, University of Utah, Salt lake City, UT
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14
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Guss CE, Wunsch CA, McCulloh R, Donaldson A, Alverson BK. Using the hospital as a venue for reproductive health interventions: a survey of hospitalized adolescents. Hosp Pediatr 2015; 5:67-73. [PMID: 25646198 DOI: 10.1542/hpeds.2014-0043] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND AND OBJECTIVES Less than one-half of sexually active adolescents have received counseling regarding contraception and sexually transmitted disease (STD) from their health care provider. We hypothesized that hospitalized adolescents would be interested in receiving reproductive health education and/or STD testing. In addition, we assessed the opinion of female adolescents on initiation of contraception during hospitalization. METHODS A convenience sample of 13- to 18-year-old male and female adolescent patients hospitalized at a tertiary pediatric hospital were approached for inclusion. Consenting patients completed a self-administered anonymous questionnaire. RESULTS Questionnaires from 49 female adolescents and from 51 male adolescents were collected. Based on their answers, 37% of female adolescents and 44% of male adolescents want to learn more about contraception and/or abstinence in the hospital independent of sexual activity. Thirty percent of respondents reported a desire for STD testing in the hospital. Fifty-seven percent of female subjects answered that adolescents should be offered contraception while in the hospital. CONCLUSIONS Among hospitalized adolescents in this study, there was an interest in reproductive health education and contraception even among those with a primary care provider and without sexual experience. Thus, hospital-based pediatricians can play a pivotal role in expanding critical sexual health services by discussing and offering sexual health care to hospitalized adolescents. We recommend that hospitals make a brochure available to all admitted adolescents, with opportunity for follow-up discussions with their hospitalist.
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Affiliation(s)
- Carly E Guss
- Boston Children's Hospital, Boston, Massachusetts
| | - Caroline A Wunsch
- Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island; and
| | | | - Abigail Donaldson
- Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island; and
| | - Brian K Alverson
- Department of Pediatrics, Rhode Island Hospital, Providence, Rhode Island; and
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Azhdam DB, Reyhan I, Grant-Guimaraes J, Feinstein R. Prevalence and documentation of overweight and obesity in hospitalized children and adolescents. Hosp Pediatr 2014; 4:377-381. [PMID: 25362080 DOI: 10.1542/hpeds.2014-0040] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
OBJECTIVE Overweight and obesity (OAO) are major problems among children and adolescents. Hospitalization of pediatric patients provides an opportunity for physicians to initiate point-of-care services related to weight status. Our goal was to determine the prevalence of OAO among hospitalized pediatric patients and to assess the extent of documentation of OAO in their medical records. METHODS We conducted a retrospective chart review of 8- to 18-year-olds admitted to an inpatient pediatric unit during 6 months in 2012. Age, gender, height, weight, BMI, discharge diagnosis, and admitting specialty were extracted from electronic medical records. BMI percentile was calculated from Centers for Disease Control and Prevention growth charts. Prevalence of OAO was determined for medical and surgical subspecialties, and charts were queried for documentation of weight status. RESULTS The study included 603 patients. Approximately one-third (36.5%) of patients were either overweight or obese, and nearly one-fifth (19.7%) were obese. The prevalence of overweight was similar between medical and surgical specialties. Obesity prevalence differed slightly, at 20.8% and 17.3% (P > .05), respectively. Only 0.9% of overweight and obese patients had documented discharge diagnoses of overweight or obesity, and only 13.2% had documentation of weight status noted anywhere in their medical record. CONCLUSIONS We identified a significant number of hospitalized OAO patients, an overwhelming percentage of whom never had weight status documented during their admission. Hospitalization offers health providers a window of opportunity to identify obesity, communicate risks, and initiate weight management interventions.
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Affiliation(s)
| | | | - Jamilah Grant-Guimaraes
- Departments of Pediatrics, and Department of Pediatrics, Hofstra North Shore-LIJ School of Medicine, New Hyde Park, NY
| | - Ronald Feinstein
- Adolescent Medicine, Cohen Children's Medical Center, New Hyde Park, New York; and
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