848 Audit on doctors’ documentation of overweight and obesity in children attending general children’s outpatient’s clinics in Malta

• Published in: Archives of disease in childhood 2021-10, Vol.106 (Suppl 1), p.A134-A134
• Main Authors: Fenech, Amanda, Dimech, Thea, Grech, Marie Claire, Montalto, Simon Attard
• Format: Article
• Language: English
• Subjects: Abstracts; Age; Body height; Body weight; Children; Children & youth; Communicable Diseases; Diabetes mellitus; Dietetics; Documentation; Drug therapy; Gastrointestinal surgery; Guidelines; Health Behavior; Hypertension; Medical Education; Obesity; Overweight; Pediatrics; Physical activity; Physicians
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2021-rcpch.232

BackgroundChildhood obesity is a global epidemic and Malta is no exception. Despite local awareness, not all children seen at the general hospital’s children’s outpatients (COP) have their height and weight measured. In the latest Health Behavior in School Children (HBSC) report, Malta has the highest percentage of overweight and obese children in 11, 13 and 15-year-old youths. Consequently, these children are likely to progress into overweight and obese adults, with an increased risk of developing non-communicable diseases such as hypertension, diabetes and other complications at a younger age.ObjectivesThe aim of clinicians is to manage children holistically and, therefore, this should include appropriate weight assessment and management. This study was designed to gauge the prevalence of doctors’ documentation of overweight and obesity with or without appropriate advice and referral, in children attending general Children’s Outpatients. The NICE guideline on Obesity: identification, assessment and management (CG189), was used as the criterion to which we compare our local practice.MethodsThe NICE guideline on obesity was used to define overweight and obesity and WHO Growth Standards for 0–5 years and the 2007 WHO child growth reference charts for 5–19 years were used. A cross-sectional study was conducted over 10 weeks between January and March 2020. Data on age, gender, weight, height, percentiles/BMI, doctor grade, presenting complaint, appointment frequency and previous anthropometric documentation were collected from clinical notes. All children attending general COP, between 2–15 years of age and free from chronic medical illnesses affecting BMI were included.ResultsIn 418 patients, weight and height were documented in 64.8% and 58.1% respectively, while percentiles were documented in 17.0%. Furthermore, BMI was documented in just 1.2% of cases, and 32% no anthropometric measurements documented whatsoever. Moreover, 29.7% of children who were previously flagged up as obese/overweight were not followed-up, and only 12% who were documented as obese, were investigated, albeit incompletely. Only 7% of known overweight children had dietary advice documented in their notes.ConclusionsCOP’s services are not attaining the standard as per current guidelines, which suggest that all children should be screened for obesity opportunistically. We recommend the distribution of a dietary guidelines leaflet to parents, with additional advice on 60 minutes of daily