Little screening of kids for obesity complications

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Only a minority of obese youths are screened for diabetes, liver problems and High cholesterol, electronic medical records from an Ohio healthcare system show.

Researchers say the findings are a call for action, since such complications could be part of the reason why heavy kids appear to have shorter lives than their slimmer peers.

Other experts, however, say there is no proof that stepping up routine screening tests will improve the prospects for the more than one in six American youngsters who are obese.

The new study, published in the journal Obesity, found that among nearly 70,000 children and adolescents with data on height and weight, a quarter were obese. That means they were among the top five percent of heaviest kids, according to their body mass index, a measure of weight in relation to height.

Obesity is a risk factor for several illnesses, including liver, cholesterol and blood sugar problems, and many medical groups, though not all, recommend screening obese kids for such conditions on a routine basis.

In the Ohio study, less than a quarter of the heaviest kids were screened for all three conditions. Even among those with a diagnosis of obesity, only 30 percent had liver tests, 41 percent had their cholesterol and other lipids checked, and 52 percent had blood sugar tests.

The numbers did climb over the past decade, the researchers found, but appeared to level off around 2004 and may even be declining.

“Lack of knowledge of current guidelines likely contributes to underscreening, as guidelines have varied throughout the study period, beginning with vague recommendations in 1998 to more complete guidelines published in 2005 and 2007,” Dr. Lacey Benson, of the Denver Children’s Hospital, and her colleagues write.

“After an obese child is diagnosed with obesity, diagnosis should be followed by an assessment for obesity-related conditions that may require treatment or further intervention,” they add.

But not all guidelines agree.

The U.S. Preventive Services Task Force, a federal expert panel, recommends screening for obesity itself and suggests targeting diet and physical activity to help kids shed the extra pounds.

But according to the task force, there simply aren’t enough data to show that benefits of further screening tests outweigh the harms—or are worth the extra cost, for that matter. The drugs used to correct potential problems all have side effects, for instance, such as the muscle pain and occasional liver damage caused by the cholesterol-lowering Statins.

“There is so much uncertainty about the long-term impacts—benefits and harms—of putting kids on Statins for decades,” said Dr. David Grossman, a member of the USPSTF.

“We do know that you can have some impact on lipid levels, but whether or not that improves outcomes and quality of life, or whether or not you could wait until later to start treatment, that is unclear,” he added. “Some people are willing to make that assumption, but our standard is such that we need to prove it.”

In the meantime, Grossman said, the decision to do lab tests should be an individual one, taking into consideration each person’s symptoms as well as disease among close relatives.

SOURCE: Obesity, online December 9, 2010.

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