Detecting overweight children in primary care: Do national data reflect the typical urban practice?
Yes, they do. We discuss the significance for 3 age brackets.
- Primary care physicians can easily identify overweight in children aged >2 years using body-mass index.
- There is no consensus on the appropriate way of identifying overweight before age 2 years. However, the primary care physician should be alert if the body-mass index of a child <2 years of age is significantly higher then those published (as a guideline) in this paper.
- Overweight is occurring early. Thus it is essential that primary care physicians focus on identifying overweight as early as preschool age.
- Primary care physicians have to pay particular attention to identifying overweight in non-Hispanic black children aged 2 to 11 years, who may have a higher prevalence of being at risk for overweight compared with 1999–2002 national data.
- Children seen for a sick-child visit may be at higher risk for overweight; thus, we recommend that height and weight measurements be obtained during these visits.
The rate of “at risk for overweight” and “overweight” in young children, starting in preschool years, is alarming.1
Primary care physicians are in the best position to identify children who are at risk for overweight or are overweight, even in preschool years. A major effort has to be put forward in achieving a consensus regarding assessment of body adiposity and overweight in the child aged younger than 2 years.
We believed it was important to collect data directly from primary care practices in western New York and reduce selection bias created by referrals to an endocrinology clinic. The aims of our study were to obtain data regarding the feasibility of detecting “risk for over-weight” and “overweight” in infants and young children seen for well-child visits based on pediatricians’ standard practice, to compare these estimates with the national data,5,6 and to compare the data obtained during well-child visits with data obtained in preschool children seen for a sick-child visit.
Results: Overweight in 3 age groups
Data from 1190 well-child visits (79.2% non-Hispanic white, 12.9 non-Hispanic black, 3.0% Hispanic, 1.3% other) and 292 sick-child visits (100% non-Hispanic white, aged 3.8 ± 1.1 years) were analyzed. TABLE 1 illustrates the subjects’ demographic data.
Subjects aged <2 years. TABLE 2 illustrates that mean body-mass index (BMI) values in subjects younger than 2 years are similar to the values reported in the National Health and Nutrition Examination Survey (NHANES) 2001 to 2002 data.
Subjects aged 2 to 5 years. The prevalence of overweight or at risk for over-weight in non-Hispanic white children aged 2 to 5 years is comparable with that reported in the 1999 to 2002 NHANES dataset (TABLE 3). In non-Hispanic black children in this group, the prevalence of at risk for overweight is similar to the NHANES sample, but the prevalence of overweight is higher (13.5 vs 8.8%).
Within the non-Hispanic white 2- to 5-year-old group, the prevalence of “at risk for overweight” is 36% in the western New York children seen for sick visits compared with 25.5% in the children seen for well visits.
Subjects aged 6 to 11 years. Like the 2-to 5-year-olds, the prevalence of over-weight or at risk for overweight in non-Hispanic white children aged 6 to 11 years is comparable with that reported in the 1999 to 2002 NHANES data. However, a sharp increase is present in the 6- to 11-year-old non-Hispanic black group with regard to “at risk for overweight” (56.0%) and overweight (42.0%) compared with NHANES data (TABLE 3).
In the 6- to 11-year-olds the prevalence of “overweight” or at “risk for overweight” in non-Hispanic black subjects is 3 (42.0 vs 13.9%) and almost 2 times (56.0% vs 29.4%) higher, respectively, than those observed in non-Hispanic white children.
TABLE 1
Demographic data (well child visits only)
| NON-HISPANIC WHITE | NON-HISPANIC BLACK | |||||
|---|---|---|---|---|---|---|
| Cohort | Age (yrs) mean ± SD | N | Sex (M/F) | Age (yrs) mean + SD | N | Sex (M/F) |
| <2 years | 1.1 ± 0.4 | 200 | 107/93 | 1.1 ± 0.5 | 97 | 61/36 |
| 2–5 years | 3.7 ± 1.1 | 451 | 233/218 | 3.7 ± 1.0 | 89 | 46/43 |
| 6–11 years | 8.8 ± 1.8 | 238 | 112/126 | 9.2 ± 1.8 | 50 | 29/21 |
TABLE 2
BMI data for patients aged <2 years (well-child visits only)
| AGE GROUP | NHANES (N) | WNY (N) | |
|---|---|---|---|
| Non-Hispanic white | 6–12 months | 17.9 ± 1.4 (88) | 18.3 ± 1.8 (75) |
| 13–18 months | 16.7 ± 1.2 (41) | 17.5 ± 1.7 (78) | |
| 19–24 months | 16.3 ± 1.3 (44) | 17.0 ± 1.3 (47) | |
| Non-Hispanic black | 6–12 months | 17.9 ± 1.8 (55) | 17.7 ± 1.8 (38) |
| 13–18 months | 17.1 ± 1.4 (35) | 18.0 ± 1.8 (33) | |
| 19–24 months | 16.6 ± 1.4 (35) | 17.5 ± 2.3 (26) |
TABLE 3
Percentage of children aged 2 to 5 years and 6 to 11 years at risk for overweight or overweight
| AGE GROUP | WESTERN NEWYORK, 2003–2005 | NHANES, 1999–2002 | |
|---|---|---|---|
| Non-Hispanic white >95th | 2–5 years | 10.0 | 8.6 |
| Non-Hispanic white >95th | 6–11 years | 13.9 | 13.5 |
| Non-Hispanic white >85th | 2–5 years | 25.5 | 20.8 |
| Non-Hispanic white >85th | 6–11 years | 29.4 | 28.6 |
| Non-Hispanic black >95th | 2–5 years | 13.5 | 8.8 |
| Non-Hispanic black >95th | 6–11 years | 42.0 | 19.8 |
| Non-Hispanic black >85th | 2–5 years | 28.1 | 23.2 |
| Non-Hispanic black >85th | 6–11 years | 56.0 | 33.7 |
