Radiology reports fail to mention pediatric obesity

Radiologists underreport the incidence of pediatric obesity, despite an increase in public awareness of the condition and increasing recognition of obesity-related disease, according to a study in the March issue of the American Journal of Roentgenology.

Dr. Janet L. Strife and colleagues at Cincinnati Children's Hospital analyzed more than one million reports from their database spanning the years 1994 to 2002. Keywords used to mine the database were obesity, obese, excessive soft tissue(s), heavy, overweight, abnormal body habitus, and excessive fat.

The number of reports containing a keyword ranged from 131 to 456 per year. For each year, documentation of obesity occurred in less than 0.4% of all reports. During that same time, the national prevalence of pediatric obesity ranged from 6% to 16%.

An analysis of a subset of records from 1999 and 2000 showed that even if the reports mentioned obesity, it was usually not listed in the diagnostic impression.

Radiologists may be missing an opportunity to play a role in disease prevention and early recognition. Documenting findings of obesity could bring them to the attention of referring physicians, the authors said.

They suggested that the lack of standard measurements for imaging obesity could be behind radiologists' underreporting of the disease. But they noted that radiologists are often expected to report subjective findings such as osteoporosis and heart size and stated that obesity should be no different.

Obesity's negative social connotation could also deter some radiologists from documenting it in a report.

The study acknowledged that many radiologists self-report their primary reason for not documenting obesity as its obviousness on physical examination. This does not mean that obesity is being addressed, however, according to the authors.

"The obese adolescent patient who presents to the emergency department with knee or hip pain should not be told that the radiographs are normal, especially if there are inches of soft-tissue fat," they said. "There is a well-known association between slipped capital femoral epiphysis and the immature skeleton and obesity. It is the radiologist's responsibility to try to prevent further disease by reminding the clinical care providers of the morbidity and potential risk associated with obesity in that patient."

Twenty-five years ago, the prevalence of childhood obesity (defined as a body mass index of 30 or higher) was approximately 5% to 6%. In 2002, data showed percentages over 16%, according to the National Health and Nutrition Examination Surveys.

Studies have shown that one-third of obese preschool childhood were obese as adults, and about half of obese school-age children were obese as adults.

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