Overweight/Obese Youth May Not Receive Needed Lab Screening

Laurie Barclay, MD

April 10, 2014

Maryland Medicaid/Children's Health Program providers are inadequately coding diagnoses of overweight and obesity in children and adolescents, according to a CDC study published in the April 11 issue of the Morbidity and Mortality Weekly Report. Furthermore, at-risk overweight and obese children and adolescents are not receiving recommended laboratory screening tests for obesity-related conditions.

"Expert Committee recommendations for the prevention, assessment, and treatment of childhood obesity were released in 2007 that update the 1998 guidelines published by the American Academy of Pediatrics," write Lee Hurt, DrPH, from the Armed Forces Health Surveillance Center in Silver Spring, Maryland, and the Maryland Department of Health and Mental Hygiene in Baltimore, and colleagues. "The recommendations included screening laboratory tests (lipid panel and fasting glucose) for children and adolescents with a body mass index (BMI) at or above the 85th percentile for age and sex, as well as dietary and physical activity assessment and screening for a family history of obesity risk factors."

Compared with children and teenagers aged 2 to 19 years in a nationally representative US sample, those enrolled in the Maryland Medicaid/Children's Health Program from 2005 to 2010 had significantly higher rates of BMI that were at or exceeding the 95th percentile. Teenagers aged 12 to 19 years and Hispanic children and teenagers had the highest prevalence of obesity.

Of the 10,882 Healthy Kids study participants, 16.5% were overweight (BMI in the 85th to 94th percentiles) and 21.4% were obese (BMI at or above the 95th percentile). Obesity prevalence increased with age, going from 16.3% in children aged 2 to 5 years, to 23.1% in those aged 6 to 11 years, to 25.6% in those aged 12 to 19 years.

Obesity prevalence was 28.1% in Hispanic participants, 21.0% in non-Hispanic whites, 20.8% in non-Hispanic blacks, and 14.5% in non-Hispanic Asians. From 2005 to 2010, there was no significant change in the prevalence of overweight and obesity.

Overweight/Obese Youth Not Receiving Sufficient Screening

Only a small proportion of children and teenagers with a BMI at or exceeding the 85th percentile underwent lipid and fasting glucose screening laboratory tests recommended to detect obesity-related conditions of hyperlipidemia and diabetes. In addition, they also had lower-than-recommended rates of documented dietary and exercise counseling.

Only 29.9% of overweight participants and 40.2% of obese participants underwent lipid panel testing. Only 10.3% of obese participants had fasting glucose testing, and only 1.5% had International Clarification of Diseases, Ninth Revision, Clinical Modification, procedure codes for taking a family history of diabetes. The most common comorbid conditions diagnosed among obese study participants were asthma in 33.5%, depression in 7.2%, and dyslipidemia in 7.9%.

"Children who are overweight or obese should be appropriately identified and screened for complications, consistent with the Expert Committee recommendations," the study authors write. "The increased obesity-related morbidity and low levels of diagnostic coding and laboratory screening identified in this study present a challenge to efforts to reduce and treat childhood obesity. Public health agencies can use this information as an opportunity to assess, understand, and reduce the barriers to implementation of the guidelines."

Limitations of this study include possible height and weight measurement or data recording errors, lack of information on duration of overweight or obesity, possible bias, patient noncompliance with recommended tests, and failure to include any screenings or tests performed more than 5 years before each participant's chart review.

"The results of this investigation were presented to the medical directors of all Maryland Medicaid HealthChoice managed-care organizations, the health officers in each Maryland jurisdiction, and pediatricians to make them aware of the need to increase obesity screening and testing for obesity-related complications among this population," the study authors conclude.

The study authors have disclosed no relevant financial relationships.

Morb Mortal Wkly Rep. 2014;63:305-308.

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