Obesity screening for children falls short of recommended guidelines

Children and adolescents who have been diagnosed as obese may not be receiving the recommended laboratory screening tests for obesity-related complications, including diabetes and liver and lipid abnormalities, from their primary care physicians.

A retrospective cohort study of electronic medical records for 69,900 patients aged 2 to 18 years between June 1999 and December 2008 from a tertiary academic healthcare system in Northeast Ohio demonstrated that among 18,232 obesity-diagnosed patients (body mass index [BMI] in the 95th percentile), only 22% (2,042 patients) were screened for all 3 conditions: diabetes, liver abnormalities, and dyslipidemias. Of the tests ordered for diabetes screening among diagnosed obese patients, 41% were the basic metabolic panel. For liver abnormalities, 81% of the tests ordered were for hepatic function panel, and for dyslipidemia, more than 50% were for the full lipid profile.

Males were less likely than females to be screened, and Hispanic patients were more likely to be screened than non-Hispanic, nonwhite patients. Increasing BMI and age were associated with minimally higher rates of screening; however, screening for all 3 obesity-related conditions peaked in 2004, then declined significantly by 2008.

The current study sought to explore patterns of screening for obesity-related complications among obese pediatric patients in order to determine additional treatment and intervention, as recommended by the 2007 revised expert committee guidelines. The study confirmed the low level of recommended screenings for these patients by their pediatric primary care providers, even after a diagnosis of obesity.

Researchers note that many children who are obese may not be screened for obesity-related conditions because their health care provider does not recognize that the child is obese and does not know the current expert committee guidelines for obese patients or recognize the increased risk of comorbid conditions. Additionally, providers may perceive that identifying and discussing weight problems in children and adolescents is futile and that treating obesity can be “very frustrating.” Last, providers may believe that screening all obese children over the age of 10 years is “low yield and not cost effective” because they may be identifying higher-risk patients and screening only those individuals.

Benson LJ, Baer HJ, Kaelber DC. Screening for obesity-related complications among obese children and adolescents: 1999-2008. Obesity (Silver Spring). 2010. Epub ahead of print.