Registration and management of children with overweight by general practitioners in The Netherlands.

European Journal of General Practice 2024, VOL. 30, NO. 1, 2425186 https://doi.org/10.1080/13814788.2024.2425186 Research Article Registration and management of children with overweight by general practitioners in The Netherlands Hevy Hassan, Jacoline van den Driest, Angeline Bosman, Bart Willem Koes, Patrick Jan Eugène Bindels and Marienke van Middelkoop Department of General Practice, Erasmus MC University Medical Center, Rotterdam, The Netherlands KEY MESSAGES • Children rarely visit general practitioners for weight-related issues. • GPs recognise children with overweight but document and refer them less frequently than children who visit the GP for a weight-related issue. • Addressing overweight/obesity at the point of visit is an opportunity to improve weight control in children. ABSTRACT Background: General practitioners (GPs) form the gateway to healthcare in numerous European countries. Their role in addressing and managing overweight/obesity in children is crucial. In Dutch guidelines, GPs are encouraged to proactively address weight-related issues during patient consultations, regardless of the initial reason of the visit. Objective(s): To examine the frequency, management and follow-up of GP visits of children for overweight/obesity and the identification by GPs of these children presenting with other complaints. Methods: A retrospective cohort study. Health records from 2012–2021 in the Rijnmond Primary Care Database (RPCD) of children aged 2–18 with overweight/obesity who visited the GP were analysed. Children were categorised into two groups: those visiting for weight-related issues (group 1) and those visiting for other complaints but identified as overweight or obese by GPs (group 2). Data on patient demographics, reasons for contact, and management strategies were extracted. Results: From the 120,991 children, 3035 children with documented overweight or obesity were identified, 208 were excluded. The study population comprised 2827 individuals: 55% belonging to group 1, 45% to group 2. The frequency of first visits remained stable at approximately 0.5% visits per total person-years each year. Group 1 received more referrals (74%) and follow-up consultations (45.5%) than group 2 with 17% referrals and 19.7% follow-up consultations. Conclusion: This study highlights a concerning difference in the management of the two groups. Strategies for effective management of overweight in children and the GP’s role, warrant further investigation. Especially when overweight is not the primary reason for visit. Introduction In many European countries, general practitioners (GPs) are the initial healthcare providers to address patients’ health problems, including overweight [1]. National and international guidelines on childhood obesity are available and consistent with growth monitoring, healthy weight, and overweight management [2,3]. Dutch guidelines for GPs recommend addressing ARTICLE HISTORY Received 8 April 2024 Revised 21 October 2024 Accepted 28 October 2024 KEYWORDS Childhood obesity; general practitioners; primary care; overweight; weight management overweight, regardless of the reason for the consultation. GPs should also provide advice on healthy lifestyles to reduce obesity and improve children’s health [4]. Typically, children under 18 visit a GP on average twice a year [5], and those with overweight tend to have more yearly visits than those with normal weight [6]. Only few children visit the GP for a weight related problem [7]. If a weight problem is not the main CONTACT Hevy Hassan Department of General Practice, Erasmus MC University Medical Center, Room Na-1923, PO Box 2040, 3000 CA, Rotterdam, The Netherlands Supplemental data for this article can be accessed online at https://doi.org/10.1080/13814788.2024.2425186. © 2024 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The terms on which this article has been published allow the posting of the Accepted Manuscript in a repository by the author(s) or with their consent. 2 H. HASSAN ET AL. reason of consultation, discussions between child, parent and the GP on weight management may be hindered due to factors as time constraints, visual assessments to estimate the child’s weight, or discomfort discussing weight due to social stigma [8–10] Earlier research shows that only 0.6% of children’s GP visits were weight-related [11]. However, it remains unclear how many children initially visit for this reason or have their weight noted during visits for other issues. This study will use electronic health records (EHRs) to outline how GPs register, manage, and follow up children with overweight in daily practice. It is hypothesised that children rarely visit their GP with concerns about their weight, and GPs rarely address overweight during consultations when the child consults for reasons other than their weight. Therefore, the objective of this study was twofold. Firstly, we aimed to gain more insight into the frequency at which GPs record children aged 2–18 years with overweight and obesity, as well as to explore the differences between children who initially visited their GP for weight-related issues and those who visited for other complaints but were identified as overweight or obese by their GP. Secondly, we aimed to provide insight into the management and follow-up strategies of GPs in consultations with children with overweight or obesity. Methods Study design This retrospective cohort study used the Rijnmond Primary Care Database (RPCD), which is a derivative of the integrated Primary Care Information (IPCI) [12,13] focused on the greater Rotterdam area in the Netherlands. The RPCD includes data from approximately 120 GPs and contains pseudonymised information from the medical records of up to 500,000 primary care patients [14]. In the Netherlands, the GP is the first point of care for patients. GP files consist of medical notes, diagnostic codes, laboratory results, prescriptions, referrals and letters from secondary care, dietitians, physiotherapist and youth doctors (YD). This study was exempt from patient consent requirements due to the use of anonymised data and a waiver from the RPCD Governance Board. Study cohort The study population consisted of children with overweight/obesity aged between 2 and 18 who visited their GP between 2012 and 2021. Two groups were differentiated based on the reason of consultation: those who initially (i.e. mainly/primarily) visited for weight-related issues (further referred to as group 1) and those who visited for other complaints but were also identified as overweight or obese by their GP (further referred to as group 2). To identify child (...truncated)