Arthur J Davidson1, Emily V McCormick2, L Miriam Dickinson3, Matthew A Haemer4, Shanna D Knierim5, Simon J Hambidge6. 1. Denver Public Health, Denver Health, Denver, Colo; Department of Biostatistics and Informatics, University of Colorado, Aurora, Colo; Department of Family Medicine, University of Colorado, Aurora, Colo. Electronic address: adavidson@dhha.org. 2. Denver Public Health, Denver Health, Denver, Colo. 3. Department of Biostatistics and Informatics, University of Colorado, Aurora, Colo; Department of Family Medicine, University of Colorado, Aurora, Colo. 4. Department of Pediatrics, University of Colorado, Aurora, Colo. 5. Division of General Pediatrics, Community Health Services, Denver Health, Denver, Colo. 6. Department of Pediatrics, University of Colorado, Aurora, Colo; Department of Epidemiology, University of Colorado, Aurora, Colo; Division of General Pediatrics, Community Health Services, Denver Health, Denver, Colo.
Abstract
OBJECTIVE: To determine the utility of repeated patient-level body mass index (BMI) measurements among higher-risk patients seen at safety-net clinics as a community-level monitoring tool for overweight and obesity population trends. METHODS: Data from a network of urban, federally qualified community health centers with computerized tracking of BMI at sequential outpatient visits were analyzed. We performed a longitudinal observational study over 8 years (2005-2012) with children stratified by weight status groups on the basis of BMI. Changes in BMI z-scores were used to estimate population trends among children 2 to 11 years old, with at least 2 visits (at least 1 year apart), for whom weight and height were measured. RESULTS: Among children (n = 33,542), the rate of overweight was 16% and rate of obesity was 18% at their last visit. Children were followed for an average of 3.24 ± 1.76 years to measure trends and change in weight status from earlier to later childhood. Children who were obese at first visit had increased odds (adjusted odds ratio 27.8, 95% confidence interval 25.6-30.2) of being obese by last visit. Mean change in BMI z-score per person-year of observation was 0.10 ± 0.38, with a differing rate of change based on weight status category at last visit (not overweight = 0.06 ± 0.39; overweight = 0.17 ± 0.34; obese = 0.19 ± 0.36). Change in BMI z-score per person-year decreased for 40% of obese children; however, their weight status group remained unchanged. CONCLUSIONS: Childhood obesity prevalence was high, with substantial progression to overweight and obesity from first to last visit. Clinically derived BMI z-score per person-year measures can effectively show population trends not observed using standard weight status categories.
OBJECTIVE: To determine the utility of repeated patient-level body mass index (BMI) measurements among higher-risk patients seen at safety-net clinics as a community-level monitoring tool for overweight and obesity population trends. METHODS: Data from a network of urban, federally qualified community health centers with computerized tracking of BMI at sequential outpatient visits were analyzed. We performed a longitudinal observational study over 8 years (2005-2012) with children stratified by weight status groups on the basis of BMI. Changes in BMI z-scores were used to estimate population trends among children 2 to 11 years old, with at least 2 visits (at least 1 year apart), for whom weight and height were measured. RESULTS: Among children (n = 33,542), the rate of overweight was 16% and rate of obesity was 18% at their last visit. Children were followed for an average of 3.24 ± 1.76 years to measure trends and change in weight status from earlier to later childhood. Children who were obese at first visit had increased odds (adjusted odds ratio 27.8, 95% confidence interval 25.6-30.2) of being obese by last visit. Mean change in BMI z-score per person-year of observation was 0.10 ± 0.38, with a differing rate of change based on weight status category at last visit (not overweight = 0.06 ± 0.39; overweight = 0.17 ± 0.34; obese = 0.19 ± 0.36). Change in BMI z-score per person-year decreased for 40% of obesechildren; however, their weight status group remained unchanged. CONCLUSIONS: Childhood obesity prevalence was high, with substantial progression to overweight and obesity from first to last visit. Clinically derived BMI z-score per person-year measures can effectively show population trends not observed using standard weight status categories.
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