Patient Population

This retrospective review of medical records was conducted in a community health clinic in the Southwest Region of Los Angeles County, and was approved by the Institutional Review Board of Human Investigations. The median household income for the region was approximately $29,501 (1995 LAC/DHS Data Collection and Analysis). The ethnic distribution of this geographic area was 59.7% Hispanic, 23.3% African American, 11.5% White non-Hispanic, and 5.4% other.

The medical records of 231 consecutive subjects attending clinic for well-child care or routine physical examination, between January and March 1998, were reviewed for this study. During the study period, a traditional attending-resident physician management model existed where 17 pediatric residents, under the supervision of three of the same attending pediatric physicians, provided direct patient care. Twenty-three medical records were excluded from the study due to lack of height or weight data, or both in 21, and chronic illness significantly affecting weight or stature in 2. In subjects who had more than one appointment during the study period, the most recent visit was used for extracting height and weight data. The total records of 208 subjects (123 males and 85 females) between the ages of two weeks and 17 years of age (mean 5.5 years) were used in this study. In each eligible patient record, current and all previous clinic visits were reviewed for recorded information reflecting provider recog­nition and/or documentation of obesity, overweight, and/or intervention for obesity. viagra soft

Data Collection

In the clinic, the standard protocol was to measure height or length to the nearest 0.1 cm, using a measuring board for recumbent length in children < 24 months; and standing height without shoes having heels, buttocks, and head against upright scale in children > 24 months. Weight (kg) was measured to the nearest 0.1 kg using a pediatric scale (Seca model 727), or beam balance scale (Detecto). These scales were calibrated daily with standard weights. All children were weighed in light clothing or paper gowns without shoes. Each of these devices for height and weight measurements was available for use during the total time of the study. Blood pressures were measured in the supine position using a mercury manometer with a pneumatic cuff covering at least two-thirds of the subjects arm for recording the muffling or disappearance of the Korotkoff sounds. The resident physician level was the only provider characteristic recorded for analysis in this study. The patient’s demographics, laboratory values, and prescribed therapy or documented intervention were also recorded.

Data Analyses

The Body Mass Index (BMI) classification was calculated for all patients using height and weight data from each visit. Since both the 85th and 95th percentiles are levels recommended for evaluation and/or treatment, we defined overweight in children > 2 years of age as having a BMI > 90th percentile for age and sex. Children, < 2 years of age with BMI or weight to height ratio at or above the 90th percentile, were considered at high-risk for childhood overweight. Patients who had a chart recording of overweight or obesity, an appropriate type of intervention, and/or appropriate referral appointments made or given a follow-up appointment because of body weight were considered to have a documented record of overweight. The review for presence of documented intervention consisted of notations of nutrition counseling, nutrition consult, exercise, psychosocial counseling or referral, and any documentation of weight loss goals. The differences of age, race, and gender, as well as the mean values for cholesterol and blood pressure between the overweight and normal weight subjects were analyzed.

Statistical Analyses

The software package SPSS for Windows was utilized for statistical analyses. All categorical variables were analyzed with the Pearson chi-square test, or Fisher’s exact test when sample size was less than 20. All continuous variables were analyzed with the student f-test for equality of means. Inferences were made at the 0.05 level of significance. canadian pharmacy cialis