Evaluating Pediatric Obesity Comorbidity Screening in Primary Care Clinics

Background: Screening for comorbidities, including diabetes, non-alcoholic fatty liver disease, and dyslipidemia, is recommended for children identified as obese, as well as frequent follow-up to discuss lifestyle change. Fewer than 25% of parents recall a discussion with their provider about their child’s overweight or obese status and a majority of those children do not receive the recommended evaluations and interventions. General pediatricians diagnose overweight and obesity frequently but do not consistently perform subsequent screening tests. This study aimed to evaluate the baseline of pediatric patients >/= 10 years old with a BMI >/= 95th percentile who completed at least one obesity screening lab (lipids, AST, ALT, and fasting glucose) amongst seven different outpatient pediatric clinics.

Methods: This was a retrospective cohort study of 2,240 children 10-18 years old with a BMI >/= 95th percentile seen in seven outpatient pediatric clinics in a single health system from January 2014 to December 2019. Demographics, insurance status, location of primary care clinic, and lab information were collected from the electronic medical record. Log-binomial regression was used to determine whether the proportion of patients ever having a lab test ordered differed among the seven clinics.

Results: Of the 11,498 outpatient pediatric patients >/= 2 years old, approximately one-fifth were 10-18 years old with a BMI >/= 95th percentile. Their mean age was 13.2 years and almost two-thirds were male. Notably, a third of the children were enrolled in Medicaid (Table 1). Two clinics (20 S. Park & East Clinic) cared for 40% of patients with a BMI >/= 95th percentile and performed significantly lower screening than the group mean in almost all labs. Two other clinics (Stoughton & University Station) with the lower percentage of obese patients performed at or above the mean in all lab screening. Overall, clinics had higher rates of cholesterol and HDL screening than other screening labs (Figure 1).

Conclusion: Low rates of lab completion to screen for obesity associated comorbidities were observed, even in clinics with high percentages of obesity. Dyslipidemia screening may have been higher due to universal lipid screening recommendations. Next steps include interventions using quality improvement methodology and enhancement of electronic health record tools to improve lab screening rates in this population.