Underdiagnosis of Pediatric Obesity and Underscreening for Fatty Liver Disease and Metabolic Syndrome by Pediatricians and Pediatric Subspecialists

Objectives

To evaluate how often general pediatricians, pediatric endocrinologists, and gastroenterologists diagnose children as overweight and how often interventions are provided, including nutritional counseling and screening for nonalcoholic fatty liver disease (NAFLD) and metabolic syndrome.

Study design

The study was a retrospective chart review of outpatient visits at 2 academic hospitals.

Results

A total of 2256 patient visits were analyzed, including 715 visits by overweight children. Of those 715 visits, 31% resulted in a diagnosis of overweight. Diagnosis of overweight and nutritional counseling were least likely to occur during gastroenterology visits (22% and 13%, respectively, P < .01). Screening for metabolic syndrome was most likely to occur during endocrinology visits (34%; P < .01). Screening for NAFLD was most likely to occur during gastroenterology visits (23%; P < .01). Children age < 5 years and those with a body mass index percentile (BMI%) of 85% to 94% were least likely to receive diagnosis and intervention for overweight.

Conclusions

The majority of overweight children were not diagnosed and did not receive relevant and recommended evaluations and interventions. Specific attention should be focused on providing diagnosis and interventions for overweight children, especially those age < 5 years and with a BMI% of 85% to 94%.

AAP, American Academy of Pediatrics, ADA, American Diabetes Association, ALT, Alanine aminotransferase, BMI%, Body mass index percentile for age, ICD-9, International Classification of Diseases, 9th revision, NAFLD, Nonalcoholic fatty liver disease, NHANES III, Third National Health and Nutrition Examination Survey, NIDDM, Non–insulin-dependent diabetes, SU, Stanford University, UCSF, University of California, San Francisco