P0216 - Screening and Management of Obesity by Pediatric Residents

Background: Residents serve as front-line providers and play an important role caring for and counseling pediatric patients with obesity. Identifying practice patterns related to obesity screening and counseling by residents can inform efforts to improve success of obesity management. The objective of this study was to identify pediatric obesity diagnosis, screening and management patterns by pediatric residents.

Methods: We performed a retrospective chart review of preventive visits conducted by residents at an academic continuity practice between August 2019 – October 2019. Charts of patients 2-18 years old with BMI ≥85th percentile for age and sex at the visit were reviewed. Overweight was defined as BMI 85th to < 95th percentile; obese was defined as BMI ≥95th percentile. Data collected included anthropometric measurements, diet and exercise documentation, diagnoses made, screening labs/referrals provided, and resident training level. A survey was sent to residents assessing attitudes toward obesity management. Comparisons were performed using χ2 or Fisher’s exact test and multivariable logistic regression. The study was deemed exempt by Icahn School of Medicine IRB.

Results: Of 1250 visits reviewed, 405 (32%) patients met study definition of overweight or obese. Of these, 39% were identified correctly by the provider, 53% were not identified, and 8% were identified incorrectly. 89% of these patients had diet history, 31% had physical activity, and 43% had family history documented. Patients who met criteria for obesity received physical activity documentation and counseling, portion size counseling, at least one referral, and screening labs more often than patients who were overweight (all P<0.05). They were also more likely to receive a diagnosis than those who were overweight, even after adjusting for sex, age, and resident training level (OR 10.2; 95%CI 6.03-17.25; P<0.0001). Patients with obesity who were identified correctly by the provider received counseling on physical activity (but not diet or portion size) more often than those not identified or identified incorrectly (P=0.0001). 78% of residents felt “somewhat” or “very” comfortable discussing overweight/obesity with patients and their families.

Conclusion: Although a majority of residents reported feeling comfortable discussing overweight/obesity with pediatric patients, these diagnoses were often under-recognized or incorrectly made and appropriate counseling was therefore lacking. This study highlights the need for tools to educate trainees on proper diagnosis and standardized screening and management practices for obesity and overweight.