Background The prevalence of overweight children in the United States is increasing. Barriers to obesity diagnosis and treatment are multifactorial. As with other chronic conditions, timely follow-up is an essential component of treatment. The purpose of this study was to determine the compliance with follow-up of children diagnosed as overweight.
Hypothesis Appropriate diagnosis and counseling of overweight children will lead to better compliance with follow-up.
Methods A chart review was conducted on 2- to 17-year-old children who presented for well-child visits between 7/31 and 8/16/03 at an inner-city university-affiliated clinic. Diagnosis of overweight, BMI, comorbid conditions, demographic data, and follow-up appointment were recorded. A year later, a second chart review was done on those identified as overweight and their BMI, diagnosis, management, and compliance with follow-up were recorded.
Results We reviewed 278 charts: 88% were African American, 56% male, and 94% on Medicaid. Fifty-eight children (21%) were overweight, but only 40 were correctly identified, including 16 with comorbid conditions, while 18 overweight were not diagnosed. Of the 40 children correctly diagnosed, 93% received dietary counseling, 85% exercise advice, and 60% were told to decrease their sedentary activities. Referral to a nutritionist was made for 16 children but only two kept their appointments. Follow-up appointments were made for 31 of 40 (78%) overweight: 18 in 4 weeks, 13 in 6 to 12 weeks. Only 3 children returned at the appointed time, but none mentioned overweight as a reason for the visit among the complaints presented. The physician also failed to discuss the overweight diagnosis of the previous visit.
Conclusion Majority of children diagnosed as overweight received appropriate counseling and follow-up appointment. The majority (93%) failed to return, and those who returned did so for reasons other than the weight issue. The physician likewise failed to address the problem. Barriers to compliance by both patient and physician need to be explored if we are to solve the problem of obesity.
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