Assessment of Guideline-Recommended Laboratory Screening for Obesity-Related Chronic Conditions in US Youth 10–18 Years

Objective

The 2023 American Academy of Pediatrics clinical practice guideline (CPG) recommends testing children aged ≥ 10 years with obesity for abnormalities in lipids, glucose metabolism, and liver function. We aimed to assess laboratory screening and test results for three obesity-related chronic conditions in a large cohort of US patients 10–18 years with obesity.

Methods

We used electronic health record data to estimate (1) prevalence of screening for diabetes, dyslipidemia, and nonalcoholic fatty liver disease (NAFLD), individually and in combination, and (2) prevalence of abnormal test results, by obesity severity and demographics.

Results

Among 333,110 patients with obesity, only one-quarter (26%) were screened for diabetes, dyslipidemia, or NAFLD during 2020–2022. Among those screened, complete screening (all three conditions) occurred half of the time. Screening rates were significantly higher in those with more severe obesity, yet 64% of children with class 3 obesity remained unscreened. When screening occurred, results revealed a high proportion of abnormal lipid (56%), NAFLD (44% elevated or borderline), and diabetes markers (14% prediabetes or diabetes).

Conclusions

Most youth with obesity were not screened for chronic conditions. Many who were screened had abnormal results. These findings establish baseline estimates and highlight opportunities for improvement in uptake of CPG recommendations to support evidence-based obesity pediatric care.