Insurance coverage is variable nationwide and difficult to secure in some locales. “In Ohio, Medicaid has been favorable toward covering these kids so far,” Dr. Michalsky said. “We have a high rate of obesity, so the state may be especially attuned [to the problem].”
Comorbidities Are Missed in Teens
Dr. Schuster said the “most striking thing” about seeing adolescents referred to her hospital's bariatric surgery clinic is how “many of them didn't have their comorbid conditions diagnosed” before their surgical evaluations.
Hypertension, sleep apnea, diabetes, and other obesity-related comorbid conditions “are underdiagnosed and undermanaged” in obese adolescents, Dr. Schuster and her colleagues said in a poster presented at the annual scientific sessions of the American Diabetes Association.
Of 46 patients who were seen at the Columbus Children's Hospital Adolescent Bariatric Surgery Clinic in 2004 and 2005, 42% received a “new diagnosis” of obstructive sleep apnea and 33% learned they were hypothyroid.
During their initial presurgical evaluation, 25% were first told they had type 2 diabetes, 13% learned they had gastroesophageal reflux disease, and 10% received a new diagnosis of hypertension. Not surprisingly, since insulin resistance is hard to diagnose in most clinical settings, 54% learned for the first time that they were insulin resistant.
The prevalence of comorbidities was similar to, or higher than, the rates recorded among morbidly obese adults presenting at other clinics at Ohio State University in Columbus, reported Dr. Schuster and her associates.