Overweight Teens Neglected as Screenings Focus on Obesity

Nancy A. Melville

July 20, 2011

July 20, 2011 — Primary care providers commonly neglect to offer appropriate weight management screening to the very adolescents who are at a high risk of becoming obese — those who are overweight — according to new research published online July 18 in Pediatrics.

Carolyn Bradner Jasik, MD, and colleagues from the Division of Adolescent Medicine, Department of Pediatrics, University of California–San Francisco, who were investigating childhood obesity prevention efforts among primary care providers, evaluated data from the 2003, 2005, and 2007 California Health Interview Surveys on 9220 adolescents, aged 12 to 17 years, who had had a checkup in the past 12 months.

The data included responses to telephone interviews in which respondents were asked about whether they received screening for nutrition, physical activity, and emotional distress at their last checkup. Their body mass index (BMI) also was calculated according to self-reported height and weight.

A pooled sample of results for all 3 years showed that obese, but not overweight, adolescents reported higher rates of screening for physical activity (odds ratio [OR], 1.4; P < .01) and nutrition (OR, 1.6; P < .01) compared with normal-weight individuals.

Stratified analysis by individual year revealed higher screening for obese compared with normal-weight adolescents for nutrition and for physical activity in 2003, as well as for all 3 topics in 2005. Overall screening rates, however, did not differ according to BMI status in the year 2007. In addition, "[o]verweight adolescents were not more likely than normal-weight adolescents to be screened for any topic in any year," the authors found.

Furthermore, the screening rates declined significantly between 2003 and 2007 for nutrition (from 75% to 59%; P < .01), physical activity (from 74% to 60%; P < .01), and emotional distress (from 31% to 24%; P < .01).

The self-reported nature of the study has limitations, particularly reliance on self-reported heights and weights. Other limitations include the use of cross-sectional, rather than longitudinal, data; the use of state-specific data, which reduces generalizability; and that data were confined to questions included in the California Health Interview Survey.

"Obese adolescents receive more preventive screening versus their normal-weight peers," the authors conclude. "Overweight adolescents do not report more screening, but standards of care dictate increased attention for this group. These results are discouraging amid a rise in pediatric obesity and new guidelines that recommend screening by BMI status."

The standards of care on the management and treatment of pediatric obesity emphasize a heightened focus on screening for adolescents classified as overweight, as part of a new commitment to early intervention.

Guidelines, including the American Medical Association 2008 Expert Committee recommendations and the 2010 US Preventive Services Task Force guidelines, recommend tailoring screening efforts uniquely for adolescents in the normal weight (0 - 84th percentile), overweight (85th - 94th percentile), and obese (95th percentile) BMI groups.

They also recommend the incorporation of mental health and psychosocial assessment in obesity screening because of higher rates of depression and anxiety among overweight youth. The authors cite previous research to explain why screening for emotional distress in obese and overweight individuals in the current study was low, stating that "lower rate of [mental health] screening among teenagers likely relates to the lack of available referral resources and provider confidence and training in this area."

The authors also speculate that several factors could explain why overweight adolescents do not receive the more focused overall screening they may need, ranging from a lack of provider inclination to a lack of resources to provide the screening.

"First, providers face barriers to screening, such as doubt that screening is effective, shorter visit times, and low reimbursement," the authors write.

"Many pediatricians also lack local resources in pediatric weight management to which they can refer patients, further reducing their inclination to address this issue in their practice."

Providers also may err by not taking the time to measure BMI to determine which patients are truly overweight and may rely solely on visual inspection to identify obese patients, the authors add.

"Subjective identification ranges from 20% to 50%, whereas rates of calculating BMI are much lower, ranging from 0.5% to 19%," they write. "Overweight patients would be less likely to be identified by inspection alone."

"Pediatricians should be screening all adolescents regardless of BMI, so inspection should not be initiating screening," the authors emphasize.

The study was supported by the Maternal and Child Health Bureau; the Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health; the Staglin Family Fund; the Young Adult and Family Center, University of California–San Francisco Department of Psychiatry; the National Institute of Nursing Research; the National Center for Research Resources, National Institutes of Health; and the University of California–San Francisco Clinical and Technical Science Institute. The study authors have disclosed no relevant financial relationships.

Pediatrics. Published online July 18, 2011. Abstract

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