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BMI registries eyed as promising tool for fighting childhood obesity

Michigan's statewide system could prove to be a model for physician-reported registries.

By — Posted June 8, 2009

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Data have been collected to show the rise in childhood obesity -- to 16% of children between the ages of 2 and 19 in recent years, up from 5% for the period of 1971 to 1974.

Now a growing number of public health officials see data being useful not just to measure the obesity rate, but as a means to lower it.

Body mass index registries are emerging nationwide as the newest tool in the fight against childhood obesity. The latest attempt -- and the most ambitious -- is in Michigan, where doctors are expected to begin submitting height and weight information on children to the state's health department. Once funding is secured as expected by year's end, a date will be set for doctors to begin reporting.

BMI traditionally has been measured in schools, using the Centers for Disease Control and Prevention's statewide Nutrition, Physical Activity and Obesity Program, a system registry backers find to be somewhat inefficient.

Lag time prevents the CDC from getting the most up-to-date data. It also can't use the data to pinpoint trends in small geographic areas.

Public health officials hope physician-reported registries will solve these inefficiencies.

They say their goal is twofold. First, registries will help public health researchers identify societal and environmental issues contributing to childhood obesity, and help them evaluate existing programs aimed at reducing the numbers -- right down to the individual physician practice. Second, registries can help physicians keep the problem front and center by using an objective measure to prompt what can sometimes be a difficult conversation with the parents of an overweight child.

"We have done heights and weights for years and years and years. What we have not done, and still are probably not doing well, is also calculating BMIs," said Karen Mitchell, MD, past president of the Michigan Academy of Family Physicians and the program director for Providence Family Medicine Residency in Southfield, Mich.

"We do need to raise physician awareness of the importance of BMIs, and so [the registry] can become that tool to calculate BMI," she said.

The registry in Michigan, where the CDC says 12% of high school kids were obese in 2007, will be an expansion of the state's immunization tracking, a registry that includes 4.7 million children.

When physicians in Michigan enter immunization records for patients older than 2, the database will prompt them to enter height and weight, as well. The system, when it is up and running, will calculate BMI rates, assess the child's risk level, and link to information the physician can use as discussion points with the parents or print out for them to take home.

The registry's ability to automatically calculate risk levels is one way of prompting doctors to address the issue of obesity head-on at the point of care, said David Share, MD, MPH, who sits on the board of the Michigan State Medical Society and is the medical director of the Corner Health Center, a clinic for teens and the children of teens, in Ypsilanti, Mich.

Dr. Share said because there are many issues physicians need to address in the short time span of a typical clinical visit, talking to overweight patients or their parents about risk levels doesn't always happen.

Arkansas, San Diego County track data

Other states, counties and school districts across the country have created registry programs.

Arkansas started a statewide BMI surveillance program in 2003. It was the first statewide program in the country, but it is facilitated through schools rather than physicians.

Matt Longjohn, MD, MPH, executive director of the Consortium to Lower Obesity in Chicago Children and a consultant to the Michigan Dept. of Community Health, which is heading the state's BMI registry, said until Michigan's program is up and running, Arkansas is the best example of how a statewide program can work.

Even though obesity rates have not declined in Arkansas, Dr. Longjohn said the program is important because it demonstrated that statewide data on obesity trends could be collected in real time in a cost-effective way.

San Diego County, where CDC data show that 12% of high school kids were obese in 2007, added height and weight fields to its immunization registry to begin BMI surveillance in 2006. Cheryl Moder, director of the San Diego County Childhood Obesity Initiative, said her organization's goal is to have physicians look at this data, recognize there is an epidemic, and look for changes they can spearhead in their practices and their communities.

San Diego's immediate goal, said Anne Cordon, manager of the San Diego Regional Immunization Registry, was to create a connected system that would act as a central repository for obesity data. But the challenge has been getting physicians to use the registry, she said.

California does not require physicians to report to the immunization registry, so success will be found when a more simple system for doctors is created, said Philip R. Nader, MD, emeritus professor of pediatrics at the University of California, San Diego, who helped create the registry there.

"Making it easier for physicians is really critical," Dr. Nader said.

Ethan Berke, MD, MPH, assistant professor of community and family health at Dartmouth Medical School in New Hampshire, said registries have the power to measurably improve the population.

"With good, objective measurements, looking at outcomes, seeing how different interventions work, identifying particular parts of your state or your community that require more help, finding out what is working well so you can emulate it elsewhere -- then you can really start to effect change."

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