Diagnosis and Screening for Obesity-Related Conditions Among Children and Teens Receiving Medicaid – Maryland, 2005-2010
By Armed Forces Health Surveillance Center | |
Proquest LLC |
The prevalence of obesity among children and adolescents in
Approximately 383,000 children and teens aged 2-19 years received
The data were linked to
Of the 10,882 Healthy Kids study participants, 16.5% were classified as overweight (BMI in the 85th-94th percentiles), and 21.4% were classified as obese (BMI at or above the 95th percentile) (Table 1). The prevalence of obesity increased progressively, from 16.3% in children aged 2-5 years, to 23.1% among children aged 6-11 years, to 25-6% among children and teens aged 12-19 years. No significant difference was observed in obesity prevalence by sex. Hispanic participants had a significantly higher prevalence of obesity (28.1%) compared with their non-Hispanic white (21.0%), non-Hispanic black (20.8%), and non-Hispanic Asian (14.5%) counterparts. No significant change was observed in the prevalence of overweight and obesity during the period 2005-2010.
The rate of screening laboratory tests was lower than expected, based on the recommendations by the Expert Committee for children with elevated BMI (7). The Expert Committee recommends that all children and adolescents with a BMI at or above the 85th percentile for age and sex undergo lipid panel testing, beginning at age 10 years (or if they have other risk factors for comorbid conditions), but only 29.9% of study participants in the overweight category (in the 85th-94th percentiles) were tested, and only 40.2% of participants in the obese category were tested (Table 2). The Expert Committee also recommends that all children and adolescents with a BMI at or above the 95th percentile undergo a fasting glucose test beginning at age 10 years (or if they have other risk factors for comorbid conditions with a BMI in the 85th-94th percentiles); however, only 10.3% of obese study participants underwent this test.
The Expert Committee also recommends that clinicians assess for a family history of overweight and related complications (/)* This study found that 1.5% of obese study participants had ICD-9-CM procedure codes for taking a family history of diabetes (Table 2). A similar number were coded for being screened for a family history of lipid disorders. A similar lack of coding occurred for indicating dietary or exercise counseling was provided to obese participants (<2.0%). The records of few children and teens with a BMI in the 85th-94th percentiles included a diagnosis code of overweight (0.9%). The records of a higher percentage of children and teens with a BMI at or above the 95th percentile included a diagnosis code of obesity (22.3%); however, this is still below the number that met the criteria for obesity based on BMI percentile (7).
Diagnoses of medical conditions associated with overweight and obesity were observed to increase significantly across the three BMI groups (Table 2). Asthma, depression, and dyslipidemia were the most common comorbid conditions diagnosed among obese study participants (33.5%, 7-2%, and 7-9%, respectively).
When the data were analyzed to identify emergency department (ED) visits with a primary or secondary diagnosis of an obesity-related complication, the prevalence of these ED visits increased significantly with increasing BMI (Table 2).
Discussion
This study demonstrates that the prevalence of obesity is higher among
This study also indicates these at-risk children and teens are not being adequately coded for overweight and obesity by their
The findings in this study are subject to at least six limitations. First, although the height and weight of each study participant was directly measured by a clinician during a well-child visit, measurement errors or data recording errors might have occurred, resulting in misclassification. Second, because the height and weight were abstracted from a single well-child visit, it is not possible to know when individual participants became overweight or obese or for how long they had been overweight. Third, bias might have resulted because some of the participants were followed for different periods because they were too young to have 5 years of encounter data or because they were enrolled inconsistently in
The results of this investigation were presented to the medical directors of all Maryland Medicaid HealthChoice managed-care organizations, the health officers in each
Acknowledgments
What is already known on this topic?
Expert Committee recommendations for the prevention, assessment, and treatment of childhood obesity were released in 2007 that update the 1998 guidelines published by the
What is added by this report?
Among Maryland Medicaid or Maryland Children's Health Program enrollees, the percentage of children and teens aged 2-19 years with a BMI at or above the 95th percentile is higher than in a nationally representative sample of the U.S. population. Despite recommendations for laboratory screening of children and adolescents with a BMI at or above the 85th percentile, the rates of lipid and fasting glucose screening among Maryland Medicaid or Maryland Children's Health Program enrollees were below what is recommended. Similarly, rates of documented dietary and exercise counseling also were below what is recommended.
What are the implications for public health practice?
Children who are overweight or obese should be appropriately identified and screened for complications, consistent with the Expert Committee recommendations. The increased obesity-related morbidity and low levels of diagnostic coding and laboratory screening identified in this study present a challenge to efforts to reduce and treat childhood obesity. Public health agencies can use this information as an opportunity to assess, understand, and reduce the barriers to implementation of the gu idelines.
* Obesity-related conditions included asthma, depression, dyslipidemia, sleep apnea, diabetes, hypertension, tibia vara, acanthosis nigricans, steatohepatitis, dysmetabolic syndrome, and hyperinsulinemia.
References
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3. Assadi F. The growing epidemic of hypertension among children and adolescents: a challenging road ahead. Pediatr Cardiol 2012;33:1013-20.
4. CDC. Prevalence of abnormal lipid levels among youths-
5. Copeland KC, Silverstein J, Moore KR, et al. Management of newly diagnosed type 2 diabetes mellitus (T2DM) in children and adolescents. Pediatrics 2013; 131:364-82.
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7. Barlow SE. Expert committee recommendations regarding the prevention, assessment, and treatment of child and adolescent overweight and obesity: summary report. Pediatrics 2007;120(Suppl 4):S 164-92.
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9. CDC. A SAS program for the 2000 CDC growth charts (ages 0 to <20 y).
1Armed Forces Health Surveillance Center; 1 2Maryland
Copyright: | (c) 2014 U.S. Center for Disease Control |
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