Trends and Correlates of Health Care Provider Identification of Overweight in Children Ages 2-15 in the U.S., 2001-2010.

Research Objective: Although screening children for overweight and obesity by health care providers (HCPs) has been recommended for several years, prevalence and trends related to child overweight identification by HCPs in rural/urban areas have not been assessed nationally. This study examined (1) whether rates of HCP identification of overweight and obesity have increased over time using a nationally representative sample of U.S. children and (2) explored contextual and individual correlates of HCP identification (e.g. rural/urban designation and child characteristics).
Study Design: Secondary analysis of data from the 2001-2008 National Health and Nutrition Examination Survey (NHANES). Age and sex-specific body mass index (BMI) percentiles were calculated according to the 2000 CDC growth charts. A caregiver reported whether a HCP had ever told them that their child was overweight. Other covariates included year, age, sex, race/ethnicity, and income-to-poverty ratio. The ERS Rural-Urban Continuum Codes were used to define rurality. Multivariate logistic regressions were used to examine whether the proportion of overweight and obese children identified by a HCP increased over time and rural/urban differences in likelihood of overweight identification by HCPs. Stata 12SE survey commands and appropriate sampling weights were used to account for the complex sampling design of NHANES.
Population Studied: The study population consisted of 12,255 children, ages 2-15 years. Approximately 59% of the sample was non-Hispanic White, 15% was non- Hispanic Black, 13% was Mexican-American, and 13% identified as other. About 18% of children were overweight (BMI % 85-94.9) and 11% were obese (BMI % 95+).
Principal Findings: Among overweight children, the proportion identified by a HCP did not change significantly in 2001-2006. The proportion identified in 2007-2008 (17%, SE: 1.8) was significantly higher than the proportion identified in 2001-2002 (8%, SE: 1.8). Using 2001-2002 as a reference point, the estimated adjusted odds of identification by a HCP were 2.3 times (95% CI: 1.3-3.9) higher in 2007-2008 (p
Conclusions: Although the proportion of overweight children identified by a HCP increased from 2001-2008, there is much room for improvement, particularly in the identification of overweight among younger children.
Implications for Policy, Delivery, or Practice: Identification of pediatric overweight is a necessary step toward prevention and treatment. As obesity is difficult to reverse, it is critical to identify children at risk and intervene at the earliest stages: (1) when children are very young, and (2) when children are in the pre-obesity category (i.e., overweight). Improved adherence to existing screening guidelines could help shift at-risk children toward a healthier weight trajectory.