Pediatric obesity in a community health clinic population

Context: Over the past twenty five years the number of overweight or obese children has tripled. Childhood obesity can result in numerous chronic conditions in adulthood and the metabolic precursors may be evident in childhood. Research is this area is limited especially for Latino children who are disproportionately affected. Objectives: Two main research questions were explored. What is the biometric profile of overweight/obese Latino children and does this profile change over time? What is the parents' perception about the medical assistance they received in dealing with this issue? Methodology: This is a retrospective, descriptive study of Latino children identified as overweight or obese and receiving care from a Community Health Center in La Habra between July 1, 2008 and December 31, 2010. All demographic and physiological data were abstracted from the health center's electronic medical record system. Parents' perspective on clinic assistance was elicited via parent focus groups that were subsequently transcribed and analyzed for major themes. Results: Overall, 54 percent of children ages two to 12 years of age and having a well-child visit during the study period had BMIs placing them in the category of overweight or obese. Male gender, Hispanic ethnicity, Spanish language preference, asthma, family history of diabetes, and Medicaid insurance were associated with obesity. Over the study period, 23.5 percent of these children receiving usual care improved their weight classification. The most significant predictors of BMI Percentile reduction were total time in the study, younger age, and first BMI Percentile. Among children classified as overweight or obese only one third had any testing for metabolic disease (A1c or lipid panel); having any metabolic screening test was a significant negative predictor of weight loss. Parents expressed that providers failed to identify their child's weight as an issue until it had become serious. All of the parents wanted more written information about appropriate portion sizes and specific guidelines on a healthy diet. The subset of Spanish language parents reported satisfaction with the support received from providers. They discussed that the problems rested with the community and the schools. Conclusions/Policy Implications: A small percentage of overweight/obese Latino children receiving usual care in a community health clinic over a two-year period normalized their BMI Percentile. There is a need for ongoing research and grant funding to develop, implement, and evaluate effective interventions for Latino children, especially those receiving care in a community health clinic.