1. Abstract In children, overweight is defined as BMI > 85th percentile (Body Mass Index) but 95 th percentile by age and gender. Children who are morbidly obese have BMI > 97% for age. Obesity is now the most prevalent nutritional disease of children and adolescents in the United States. In 2007, 32 percent of Texas high-school students were estimated to be overweight or obese. The nationwide prevalence of childhood obesity was greater in Texas overall compared to other states in the U.S due to predominance of Hispanic population. Obesity comes with significant and more frequent co- morbidities. It is also costly: it has been associated with an inpatient cost four times higher, and a LOS double than the non-obese children. In recent times, there has been a movement to address obesity at all levels of healthcare, even in the inpatient setting. Several studies have shown that many hospitals do not have policies that address obesity. There is an absence of healthy lifestyle options. Further, the diagnosis of the condition, or related workup is missing from the patients’ management plans. This study was initially a Quality Improvement (QI) Project, and this research has recently completed our pilot study. We reviewed electronic charts of Floor Admissions from January to April of the year 2013. BMI was calculated using the CDC application. The group was segregated into those with above-normal BMI (>/= 85%ile) and those with BMI below 85%ile. Initial data show that the incidence of obesity in our inpatient population (15%) is similar to national statistics (17%). There was poor compliance with the guidelines for obesity screening. Only 7% had a correct diagnosis associated with elevated BMI. Labs and Nutrition consults were underutilized. However, contrary to literature, we found that length of stay (LOS) between the two BMI groups did not differ. A review of the rest of the year’s charts is currently in order. Addressing the Issue of Obesity in a University-Based Hospital: A Pilot Study in a Border-Town Children’s Hospital Allan Damian, MD 1 ; Lynn Hernan, MD 2 ; Davina Menezes, MD 1 ; Marvi Montano, MD 1 ; Diba Farah, MD 1 ; Indu Pathak, MD 3 1 PGY-3, Department of Pediatrics, Texas Tech University Health Sciences Center PLF-SOM 2 Director of Medical Quality and Pediatric Safety, El Paso Children’s Hospital 3 Medical Director of Pediatric Hospitalist Division, El Paso Children’s Hospital Objectives To determine the extent to which pediatric residents and hospitalists in a university-based, border-town hospital identify and intervene upon obese patients in an inpatient setting Review of Literature Howe, 2010: Hospitalists: Under-addressing obesity in inpatient population; Believe that: it is a non acute issue they lack the time Young, 2011: 63% of the responding children’s hospitals did not have a policy in place to identify or treat obese pediatric patients once identified. Expert Committee Recommendations on Obesity: BMI should be calculated and plotted at least annually classification should be integrated with other risk factors growth pattern familial obesity medical risks Recommendations for Prevention both specific eating and physical activity behaviors use of patient-centered counseling techniques Assessment methods to screen for current medical conditions and for future risks assess diet and physical activity Treatment - 4 stages of obesity care Recommendations  Re-education of all our staff: nurses, residents and hospitalists regarding the importance of labeling an elevated BMI appropriately.  Adherence to screening guidelines  Proper documentation  Proper treatment and follow-up.  Installing alerts on our EMR for elevated BMI. Texas Pediatric Society Electronic Poster Contest [1] Barlow S (2007) Expert Committee Recommendations on the Prevention, Assessment and Treatment of Child and Adolescent Obesity. Pediatrics. 1 0.1542/peds.2007-2329C [2] Hamdy (2010). Obesity – who is responsible?. South Med J. 103(6): 493. [3] Howe EE, et al (2010) Addressing obesity in the hospitalized patient: a needs assessment. South Med J. 103(6):500-4. [4] Young KL, et al (2011) Identification and treatment of obesity as a standard of care for all patients in children’s hospitals. Pediatrics. 128: S47. References The big question is, “Why do hospitalists have to care?” Isn’t this for the PCP to address? As mentioned in the study by Young, and the editorial by Hamdy, the issue of obesity is an epidemic that has to be dealt with at all levels. It is more cost-effective to prevent rather than treat. And we all know obesity leads to many other complications. Labeling an elevated BMI as either overweight or obese later on, allows us to treat and manage effectively and ensures there is follow up. Our data show that the incidence of obesity in the inpatient population in El Paso is 15%, similar to the 17% overall national prevalence. There was equal distribution among males and females. However, contrary to the CDC data, we found no predilection for age, where older age groups tended to have higher BMIs in the CDC data. Perhaps this could be due to the small sample size. Also, the LOS for the high-BMI group and the non-overweight/ obese groups were similar. Data collected was from the first four months of the year during which most admissions were for shorter-stay respiratory symptoms. Also, we did not separate the low-BMI (e.g., failure to thrive/ malnourished) patients from the healthy BMI patients. The former group tended to have longer stays. Overall, our recognition and compliance to the screening guidelines were very poor. Only 7% had a diagnosis of either “overweight” or “obese.” Appropriate laboratories were either underutilized or not at all. Zero FPGs were done. Though the numbers for liver enzymes were higher, these are part of the routine CMP usually requested for other conditions. Nutrition consult was obtained in only 11% of patients. Discussion Results Summarized in the flowchart below: Methods Study Design: retrospective chart review Request made to IT for electronic chart/ data download: All admissions to EPCH from Jan 1, 2013 to Dec 31, 2013. Inclusion criteria: Age: ≥ 2 years – 18 years old Admitted to the Pediatric Ward of EPCH, Admission date from Jan. 1, 2013 to Dec 31, 2013 Exclusion criteria: 18 years old, Transferred to the Pediatric Ward Incomplete anthropometric data in EMR unable to calculate BMI BMI percentile <85 th percentile BMI and BMI percentile calculated using the CDC application. Patient encounters meeting entry criteria were tabulated on an Excel sheet. Data analysis using simple statistics. Definitions National Statistics 2013 AHA Update: >23.9 million children (2-19 years old) are overweight or obese - 33% of boys - 30% of girls CDC Data: >Childhood obesity rate: 17% (2003-2004) Approximately 12.5 million children >Racial disparities Hispanics - 22.4% Non-Hispanic black youth - 20.2% N Non-Hispanic white youth - 14.1% Non-Hispanic Asian youth - 8.6% >In 2011-2012: age disparity 2 – 5 year olds - 8.4% 6 – 11 year olds - 17.7% 12 – 19 year olds - 20.5% Economic Burden: Obese children have double the hospital LOS (Cost is 42% more/day) In 2013 obesity cost $254 billion Projected cost in 2030 - $957 billion by 2030 (18% of total US budget) Hypothesis We are failing to diagnose the overweight/obesity in the medical records and therefore not implementing the interventions needed. 2000 Encounters downloaded 374 Charts screened Incomplete anthropometrics (29) BMI calculated (345) Met entry criteria: 90 Overweight: 38 (10%) Obese: 43 (11%) Morbidly Obese: 9 (2%) BMI ClassRecommendations Recommended Labs Obtained Overweight (85-94%ile) N = 38 Fasting lipid panel0 Fasting glucose0 AST/ ALT11% (n = 10)* Obese (95-99%ile) N = 43 Fasting lipid panel2% (n = 2)* Fasting glucose0 AST/ ALT23% (n = 21) * Morbidly Obese >99%ile N = 9 Fasting lipid panel1% (n = 1)* Fasting glucose0 AST/ ALT6% (n = 5)* Equal Distribution of males and females above; No age predilection on graph on right. Table showing rate of compliance with Expert Committee Recommendations below: BMI < 85%ile BMI ≥ 85%ile Mean1.81.6 Median2.82.1 SD6.11.7 BMI ClassNumber Primary Diagnosis (discharge) Overweight1Acute cholecystitis Obese5 Pancreatitis SCFE Head trauma Acute cholecystitis Acute appy s/p lap Morbidly Obese0 Total6~ 7% diagnosis LOS did not differ for the two groups (below); while the percent compliance to inpatient lab testing was low (right). What Lies Ahead…  Data analysis for the rest of the year (2013) to gain a larger sample size.  Looking beyond EMR and also into our paper charts (we were not fully electronic during the year 2013).  Segregating data for ethnicity.  Comparing the rate of compliance to the guidelines at the inpatient and outpatient settings.