What blood work evaluation is recommended for an 11-year-old with severe obesity?

Blood Work Evaluation for 11-Year-Old with Severe Obesity

For an 11-year-old with severe obesity, a comprehensive laboratory assessment should include fasting lipid panel, comprehensive metabolic panel, thyroid function tests, fasting glucose, and liver function tests to screen for obesity-related complications. 1

Core Laboratory Assessment

The American Academy of Pediatrics and American Heart Association recommend the following baseline laboratory tests for children with severe obesity (BMI ≥95th percentile):

• Fasting lipid panel 2, 1

  • Total cholesterol (abnormal >170 mg/dL)
  • LDL cholesterol (abnormal >110 mg/dL)
  • HDL cholesterol (abnormal <45 mg/dL)
  • Triglycerides (abnormal >100 mg/dL)

• Glucose metabolism assessment 2, 1

  • Fasting glucose (abnormal ≥100 mg/dL)
  • Hemoglobin A1c
  • Consider fasting insulin to assess insulin resistance

• Liver function tests 1

  • ALT (abnormal >26 U/L for boys, >22 U/L for girls)
  • AST
  • To screen for non-alcoholic fatty liver disease (NAFLD)

• Thyroid function tests 2, 1

  • TSH and free T4
  • Particularly important as TSH levels often increase with degree of hepatic steatosis 3

• Comprehensive metabolic panel 2, 1

  • Electrolytes
  • Renal function
  • Protein levels

Additional Testing Based on Clinical Findings

• High-sensitivity CRP to assess cardiovascular risk 1

• Blood pressure measurement (three separate readings)

  • Abnormal values defined as >95th percentile for age, height, and sex 1
  • Essential for cardiovascular risk assessment

• Consider sleep study if symptoms of obstructive sleep apnea are present (snoring, witnessed apneas, excessive daytime sleepiness) 1

Frequency of Testing

• If initial tests are normal, repeat laboratory assessment at minimum every 3 years 1
• If abnormalities are present, more frequent monitoring is recommended (every 6-12 months) 1
• If BMI continues to increase or family history includes early cardiovascular disease or type 2 diabetes, more frequent testing is warranted 1

Common Pitfalls to Avoid

1. Delayed screening: Studies show that clinicians often fail to request appropriate laboratory tests in obese children, with liver tests requested in only 12.5% of encounters with obese children who had NAFLD 2

2. Incomplete evaluation: Focusing only on glucose metabolism while missing other important comorbidities like dyslipidemia or NAFLD 2

3. Overlooking TSH abnormalities: TSH levels often increase with the degree of hepatic steatosis in obese children, making thyroid function testing important 3

4. Failure to repeat testing: Even if initial tests are normal, obesity-related complications may develop over time, necessitating regular monitoring 1

5. Missing psychological assessment: Laboratory evaluation should be complemented by screening for depression, bullying, and psychological distress 1

By implementing this comprehensive laboratory assessment approach, clinicians can identify obesity-related complications early and intervene appropriately to reduce morbidity and mortality in severely obese children.