Identifying obesity/overweight status in children and adolescents; A cross-sectional medical record review of physicians’ weight screening practice in outpatient clinics, Saudi Arabia

BACKGROUND: BMI is a feasible and recommended measure for overweight and obesity screening in children and adolescents. The study aimed to determine how often physicians correctly identified obesity/ overweight status in children and adolescents by using BMI percentile charts. METHODS: This retrospective cross-sectional study reviewed the paper medical records of children and adolescents (6–14 years) who visited family medicine and pediatric outpatient clinics (Jan-June 2012) in a medical city in Riyadh. Investigators calculated BMI percentiles (using height, weight, age and gender data retrieved from the records) in order to identify patient weight status. Physician documentation of obesity/overweight diagnoses in patient problem lists were cross checked against their BMI percentile to assess the accuracy of physicians’ identification of weight status. The recommended management plan for identified patients was also recorded. RESULTS: A total of 481 charts were reviewed, 213 (44%) children were seen by family medicine physicians and 268 (56%) by pediatricians. The sample was equally distributed by gender. Height was undocumented for 13% (71) of visiting patients. Eighteen percent of patients (86) were classified as overweight (35)/obese (51) according to age and sex adjusted BMI percentile. Physicians’ correctly identified and documented weight status in 20% of overweight/obese patients: 17 out of 86 subjects. Weight status identification was higher among pediatricians—25% as compared to family medicine physicians—10% [p = 0.08]. Dietary referral was the most common management plan for the identified children. Physicians were more likely to identify obese children {≥95(th)} compared to overweight {≥85(th) - 95(th)} children. Subjects whose BMI for age classified them into the highest BMI percentile category {≥95(th)} were more likely to be correctly identified (29%) compared to those classified within {≥85(th) - 95(th)} category—6% [p = 0.007]. CONCLUSION: Physician identification of obesity/ overweight status for children and adolescents was low, irrespective of their specialty, and despite the condition being prevalent in the sample. Future research that concentrates on interventions that may improve documentation of obesity/overweight diagnoses and parameters needed for BMI indices would be beneficial.