Research Article: Identifying obesity/overweight status in children and adolescents; A cross-sectional medical record review of physicians’ weight screening practice in outpatient clinics, Saudi Arabia

Date Published: April 25, 2019

Publisher: Public Library of Science

Author(s): Maliha Nasim, Mohammed Aldamry, Aamir Omair, Fadia AlBuhairan, Kathleen E. Bethin.


BMI is a feasible and recommended measure for overweight and obesity screening in children and adolescents. The study aimed to determine how often physicians correctly identified obesity/ overweight status in children and adolescents by using BMI percentile charts.

This retrospective cross-sectional study reviewed the paper medical records of children and adolescents (6–14 years) who visited family medicine and pediatric outpatient clinics (Jan-June 2012) in a medical city in Riyadh. Investigators calculated BMI percentiles (using height, weight, age and gender data retrieved from the records) in order to identify patient weight status. Physician documentation of obesity/overweight diagnoses in patient problem lists were cross checked against their BMI percentile to assess the accuracy of physicians’ identification of weight status. The recommended management plan for identified patients was also recorded.

A total of 481 charts were reviewed, 213 (44%) children were seen by family medicine physicians and 268 (56%) by pediatricians. The sample was equally distributed by gender. Height was undocumented for 13% (71) of visiting patients. Eighteen percent of patients (86) were classified as overweight (35)/obese (51) according to age and sex adjusted BMI percentile. Physicians’ correctly identified and documented weight status in 20% of overweight/obese patients: 17 out of 86 subjects. Weight status identification was higher among pediatricians—25% as compared to family medicine physicians—10% [p = 0.08]. Dietary referral was the most common management plan for the identified children. Physicians were more likely to identify obese children {≥95th} compared to overweight {≥85th – 95th} children. Subjects whose BMI for age classified them into the highest BMI percentile category {≥95th} were more likely to be correctly identified (29%) compared to those classified within {≥85th – 95th} category—6% [p = 0.007].

Physician identification of obesity/ overweight status for children and adolescents was low, irrespective of their specialty, and despite the condition being prevalent in the sample. Future research that concentrates on interventions that may improve documentation of obesity/overweight diagnoses and parameters needed for BMI indices would be beneficial.

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Overweight and obesity levels in childhood and adolescence is a global public health concern.[1, 2] Worldwide prevalence rates of overweight/obesity have risen considerably in children and adolescents in both developed and developing countries.[3] Curtailing the rise in obesity is prioritized in the WHO’s global action plan on prevention and control of NCDs 2013–2020 and in a recent position paper for the society of adolescent health addressing prevention and treatment of adolescent obesity.[4, 5] There is overwhelming evidence that overweight/obese children and adolescents face social, psychological and physical problems as a consequence of their weight. Obese/overweight children are more likely to suffer from anxiety and depression, be bullied, face discrimination, and report low self-esteem compared to healthy weight counterparts.[6, 7] Furthermore, overweight and obesity has been linked to poor health outcomes and negatively impacts quality of life. It also contributes to populations’ burden of disease by impacting all cause morbidity, mortality, and health related quality of life.[3, 8] Obese children and adolescents are more likely to be obese adults and have more severe disease risk factors than individuals of healthy weight in their youth.[9, 10]

Early identification and referral by physicians to behavioral interventions that improve weight status has been recommended as a critical step in the pathway to curtailing the rise in overweight and obesity in children and adolescents. Physician documentation of overweight or obese status in the medical records of children and adolescents through use of BMI screening is essential to identifying cases who are affected or at high risk of being affected by obesity. Furthermore, documentation of overweight/obese status on patients’ problem lists has been shown to increase the rate at which health providers address obesity in future patient visits.[29] The current study showed that physicians are poor at identifying/documenting cases of children and adolescents who are overweight/ obese. Furthermore, children and adolescents with BMIs ≥95th percentile were more likely to be identified by their physicians as compared to patients who fell into the overweight category.

The outpatient physician clinic consultation is often the first step in parent/child healthcare seeking behavior. This clinical encounter provides an excellent opportunity to screen for physicians to routinely monitor BMI and identify children and adolescents at risk of/ affected by obesity. By doing so, timely appropriate preventative and treatment interventions can be initiated early resulting in better short and long term health outcomes for those affected. The low rates of overweight/obesity diagnosis documentation by physicians (hospital pediatricians and family medicine physicians) in our study indicate that an opportunity for early identification of obesity among this vulnerable population is being missed. Further research that concentrates on looking at factors that may influence physicians’ documentation of obesity and overweight status in patient problem lists are recommended to support efforts to curtail the rising obesity epidemic in this group.




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