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

Abstract

Background: Childhood 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. An audit was carried out on the documentation of overweight and obesity in children, along with any advice given in this regard.

Methods: The NICE guideline on obesity was used to define overweight and obesity. 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.

Results: In 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.

Conclusion: COP'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, continuous medical education for doctors, giving sustainable advice during follow ups and the introduction of a child obesity clinic.