Characterizing Obesity Risk in Children Receiving Healthcare in an Emergency Department

Background: Level of adiposity needs to be characterized in children for prevention and treatment of overweight/obesity. This thesis aimed to characterize obesity risk in children, comparing across indirect measures of adiposity, and between perceived body size versus measured adiposity in children and their parents. Methods: Enrolled was a convenience sample of 925 children receiving health care at a large, urban pediatric emergency department. Child-parent dyads were created and anthropometric and demographic data collected. Age and sex-specific percentiles were determined for body mass index (BMI; measured height/weight) and waist circumference (WC). BMI Z-score was calculated based on age and sex. The sample ranged in age from 5-18 years, was gender balanced (50.1% male) and racially/ethnically diverse (38.6% white, 14.4% African American, 37.2% Hispanic), and 57% on public health insurance. Results: By BMI percentile, the sample showed risk of elevated adiposity (2.1% underweight, 60.2% normal weight, 16.4% overweight, 13.7% obese, 7.6% extremely obese), which is similar to U.S. national prevalence. BMI percentile distribution was skewed to the 100th percentile (16% of children at the 100th percentile). BMI and WC percentiles were highly correlated, yet WC percentile didn’t show the skew toward 100th percentile. The BMI Z-score trended toward normal distribution. All measures revealed demographic differences in adiposity—overweight/obesity frequencies were highest among non-white and publicly insured children. More parents and children failed to recognize measured overweight/obesity in the child; highest discrepancy between measured and perceived overweight/obesity was among non-white and publically insured parent/child dyads. Conclusion: This sample of ethnically/racially diverse sample of children with high percentage of economic disadvantage had risk of overweight/obesity equal to that seen across the U.S. Neither parent nor child correctly identified excessive adiposity. The indirect measures of adiposity, despite difference in distribution, performed equally well at delineating risk of overweight/obesity and misperception of overweight/adiposity across demographic groups