BOSTON — Overweight and obese adolescents are not being sufficiently screened for weight-related comorbid conditions, and the failure to do so can have enduring health implications, Dr. Margaret Stager said at the annual meeting of the Society for Adolescent Medicine.
Despite the implementation of a screening protocol in the pediatric department of an urban medical center, approximately one-third of patients seen during a 2.5-year period who were identified as being overweight (body mass index between the 85th and 94th percentile) or obese (95th percentile or higher) did not have the recommended laboratory screening tests ordered, reported Dr. Stager of the MetroHealth Medical Center in Cleveland. The recommended laboratory studies for this population according to the protocol include a full lipid profile, liver function tests, and insulin and glucose levels.
A chart review of 362 overweight and obese adolescent patients seen in the adolescent medicine division of the medical center between October 2002 and May 2005 showed that 113 patients did not have the recommended screening tests ordered, Dr. Stager reported in a poster presentation. Eighty-one of the patients had tests ordered but not completed, and 168 patients completed the lab testing.
The study population—69% of whom were female—was 46% African American, 36% white, and 18% Hispanic. The mean body mass index was 33 kg/m
There were no significant differences in either racial background or age with respect to overweight or obese status, but males were more likely to be obese than overweight, Dr. Stager pointed out.
Among the patients who underwent the recommended fasting laboratory tests, abnormal test results were found in both the overweight and obese groups, but no significant differences between the two groups were seen in mean values for total cholesterol, low-density lipoprotein, alanine aminotransferase, aspartate aminotransferase, glucose, and insulin levels.
“There were significantly more abnormal test results in the obese vs. the overweight group for high-density lipoproteins and triglycerides,” Dr. Stager said. The mean HDL levels were 49 mg/dL for the overweight group and 42 mg/dL for the obese group, and the respective mean triglyceride levels were 71 mg/dL and 97 mg/dL. Additionally, in each group, “there were two patients with impaired glucose tolerance,” she noted.
The findings suggest “a missed opportunity” for identifying patients at risk for comorbid conditions related to being overweight or obese such as cardiovascular disease or diabetes and providing supportive interventions to help minimize the health damage, said Dr. Stager.