A Comprehensive Analysis of Overweight, Obesity, and Failure to Thrive in Pediatric Inpatients: Prevalence, Diagnostic Practices, and Management Approaches at a Tertiary Hospital in Riyadh, Saudi Arabia

Objective: This study aimed to assess the prevalence, diagnostic accuracy, and inpatient management of pediatric weight abnormalities at a tertiary children's hospital in Riyadh, Saudi Arabia, using a retrospective cohort design. Methods: The study analyzed medical records of pediatric inpatients aged 2–14 years admitted to King Abdullah Specialized Children's Hospital (KASCH) in 2023. Data collected included anthropometrics, dietary history, physical activity, diagnostic workup, and treatment plans. Overweight and obesity were classified using BMI percentiles, while FTT was identified via weight-for-age and growth percentile criteria. Descriptive statistics were used to analyze diagnostic accuracy and factors influencing missed diagnoses. Results: Of 7,771 admissions, 760 patients (9.6%) had weight abnormalities: 60.3% with FTT, 24.2% obese, and 15.5% overweight. FTT was more accurately diagnosed (38%) than obesity (28%) or overweight (13%). Documentation of dietary intake was detailed in only 9.6% of cases; physical activity and screen time were universally undocumented. Obese children more frequently underwent metabolic testing and were referred to endocrinology, while FTT patients often received high-calorie formulas and follow-up with dietitians. Logistic regression revealed age group and dietary history documentation were significantly associated with diagnostic accuracy (p < 0.05). Conclusion: The study highlights underdiagnosis of overweight and obesity, suboptimal documentation practices, and inconsistent inpatient management of pediatric weight disorders. Despite standard anthropometric measurements, weight abnormalities are often overlooked during acute hospital care. FTT receives comparatively more clinical attention, while overweight and obesity remain underrecognized.