Use of electronic medical records may result in better tracking of childhood obesity rates, new study finds

As childhood obesity continues to be a major public health issue in Canada and around the world, emphasis is typically placed on obesity interventions and prevention programs in early childhood. With limited data available on obesity rates in young children, it is suspected that the actual prevalence of this issue may be higher in Canada than has been previously documented.

In an effort to explore alternate forms of data collection in this field, an Ontario research team led by The Hospital for Sick Children (SickKids) and the Institute for Clinical Evaluative Sciences (ICES) examined the use of electronic medical records to track rates of overweight and obesity in children. They found that nearly 85 per cent of family physicians in Ontario whose practices contribute to the Electronic Medical Record Administrative data Linked Database (EMRALD) documented height and weight at well-child visits. The findings suggest this approach to obesity surveillance may be feasible on a larger scale, and may eventually be used to determine which children may benefit from interventions. The research is published in the Feb. 16 online edition of the journal Canadian Family Physician.

“We know prevention and early intervention are important in addressing the problems of overweight and obesity in children, and as health-care providers we routinely collect this important data, but we need to have a better understanding of how to use this clinical data to ensure that evidence-based interventions reach children, and how to monitor our progress overall,” says the study’s lead author, Dr. Catherine Birken, paediatrician with the SickKids Team Obesity Management Program (STOMP), staff paediatrician and scientist at SickKids. “Electronic medical record surveillance using valid and reliable data from primary health-care visits makes good sense, as young children see their primary care provider frequently during the early years of life.”

Ontario children typically have nine well-child visits with their primary care provider in the first 24 months of life, followed by annual visits until age 19. National and international child health organizations already recommend the standardized measurement of height and weight at primary care visits using the World Health Organization (WHO)’s 2014 Growth Charts for Canada.

In this cross-sectional study, the research team used the EMRALD database (housed at ICES) for Ontario children from birth to age 19 who had at least one well-child visit between January 2010 and December 2011. Using height and weight measurements from their most recent well-child visits, the researchers classified them as overweight or obese using body mass index (BMI) and the WHO’s growth reference standards. Results were compared by age group, sex and visit type.

The findings include:

• Of the more than 28,000 well-child visits during the study period, nearly 85 per cent had both height and weight documented across most age groups;
• Obesity rates were significantly higher in:
  • one- to four-year-olds compared with those under age one;
  • 10- to 14-year-olds compared with five- to nine-year-olds
• Boys aged one to four and 10 to 14 had higher obesity rates compared with girls in the same age groups.

The researchers tracked rates of overweight and obesity in Ontario children and found:

• In children five to nine years old, 9 per cent were classified as obese, and 23.7 per cent as overweight;
• In 10- to14-year-olds, 12 per cent were classified as obese, and 31.8 per cent as overweight;
• In 15- to 19-year-olds, 9.4 per cent were classified as obese, and 28.7 per cent as overweight.
• In children under one, 2.3 per cent were classified as obese, 12.1 per cent as overweight;
• In children one to four years old, 6.1 per cent were classified as obese and 26.1 per cent as overweight.

“Accessing data through electronic medical records appears to be a useful tool to improve population-based surveillance practices in monitoring overweight and obesity rates in children,” says the study’s senior author, Dr. Astrid Guttmann, staff paediatrician and associate senior scientist at SickKids, and chief science officer and senior scientist at ICES. “To make this tracking method more comprehensive, standards should be developed to include other relevant data, including health- and weight-related behaviours.”

Future research would study the validity and reliability of using electronic medical records to conduct population-based surveillance and to evaluate interventions with a larger sample size of primary-care practices, including paediatric practices, in Ontario and Canada.

Birken is also associate professor of Paediatrics and Health Policy, Management and Evaluation at the University of Toronto.

Guttmann is also associate professor of Paediatrics and Health Policy, Management and Evaluation at the University of Toronto.

The study is funded by ICES and SickKids Foundation.

This project is an example of how SickKids and ICES are contributing to making Ontario Healthier, Wealthier and Smarter www.healthierwealthiersmarter.ca.

About The Hospital for Sick Children

The Hospital for Sick Children (SickKids) is recognized as one of the world’s foremost paediatric health-care institutions and is Canada’s leading centre dedicated to advancing children’s health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada’s most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized child and family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision for Healthier Children. A Better World. For more information, please visit www.sickkids.ca. Follow us on Twitter (@SickKidsNews) and Instagram (@SickKidsToronto).

The Institute for Clinical Evaluative Sciences (ICES) is an independent, non-profit organization that uses population-based health information to produce knowledge on a broad range of healthcare issues. Our unbiased evidence provides measures of health system performance, a clearer understanding of the shifting healthcare needs of Ontarians, and a stimulus for discussion of practical solutions to optimize scarce resources. ICES knowledge is highly regarded in Canada and abroad, and is widely used by government, hospitals, planners, and practitioners to make decisions about care delivery and to develop policy. For the latest ICES news, follow us on Twitter: @ICESOntario

For more information:

Suzanne Gold
The Hospital for Sick Children (SickKids)
[email protected]
416-813-7654, ext. 202059

Deborah Creatura
Media Advisor, ICES
(o) 416-480-4780 or (c) 647-406-5996
[email protected]