Glucose and Cholesterol Screening for Pediatric Obesity

A Training for CHDP Providers

Prepared by: The CHDP Nutrition Subcommittee

Goal

To ensure that children and adolescents with BMI ≥ 85th percentile, as well as those who are at risk but not overweight, are screened for the most common medical conditions associated with childhood overweight

Agenda

Review the medical conditions associated with pediatric overweight/obesity

Summarize the risk factors for complications of pediatric overweight/obesity that need to be identified as part of a health assessment

Clarify the guidelines as described in CHDP Provider Information Notices 05-16 and 05-22

Overweight & Obese Children California children ages 2 to <5

2009

16.4 14.9 13.1 14.6 15.9

18.413.7 13.4 13.2

17

0

10

20

30

40

Hispanic White Asian Black All Groups

Per

cent

age

Overweight: 85 - <95%BMI Obese: > or = 95% BMI

2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report

Overweight & Obese Children California children ages 5 to <20 years

2009

19.1 17.2 13.8 17.6 18.4

24.519.9

13.3

21.2 23.1

0

10

20

30

40

50

Hispanic White Asian Black All Groups

Per

cent

age

Overweight: 85 - <95%BMI Obese: > or = 95% BMI2009 CDC Pediatric Nutrition Surveillance System growth statistics from CHDP PM160 report

Accurate Weight & Stature

BMI Percentile

Select the appropriate growth chart

Record the data

Calculate BMI

Plot measurements

Interpret plotted measurements

Boys: 2 to 20 years

BMI BMI

BMI BMI

> 99th % Severely obese

> 95th % Obese

85th to < 95th % Overweight

< 5th % Underweight

BMI % Growth Chart

Obese

Overweight

Normal*

Underweight

Lab Tests(cholesterol &

glucose)

In-depthMedical

Assessment

Note in chart:“Counsel & Follow-up”

Measurements

• Weight• Height• Age• Plot

Assessment Algorithm

+

-

*Further tests may be warranted depending

on family history

Conditions Associated with Childhood Overweight

Cardiovascular Conditions• High Blood Cholesterol• Lipid Disorders• Hypertension (HTN)

Endocrine Conditions• Type 2 Diabetes• Insulin Resistance• Impaired Glucose Tolerance• Menstrual Irregularities• Polycystic Ovarian

Syndrome

Gastrointestinal Conditions• Non-Alcoholic Fatty Liver

Disease (NAFLD)• Gallstones

Orthopedic Conditions• Accelerated Growth• Hip Disorders

Psychological Conditions• Depression/Self-Esteem• Substance Abuse• Disordered Eating• Discrimination

Pulmonary Conditions• Asthma• Sleep Apnea

Recommended Screening for Children ≥ 5 Years of Age

Screen for both cholesterol & glucose* if BMI ≥ 85th % AND two of the following risk factors (may be repeated as medically necessary):

BMI ≥ 95th % Family history of diabetes Black, Hispanic, American Indian, Asian, Pacific

Islander, Native Alaskan One of the following: acanthosis nigricans, HTN,

dyslipidemia or polycystic ovarian syndrome Less than 30 minutes activity/day or consistently

unbalanced diet*This training is not intended to cover all aspects of type 1 or type 2 diabetes

Recommended Screening for Children ≥ 5 Years of Age

Screen for cholesterol if one of the following risk factors is present (may be repeated as medically necessary):

One parent or grandparent had heart/vascular disease, heart attack, heart death, heart surgery or stroke at ≤ 55 years of age*

One parent has a cholesterol level ≥ 240 mg/dl*

*Family history may not be available for all children

Referral & Care Managementfor Abnormal Test Results

Fasting glucose ≥ 126 mg/dl (elevated): counsel & repeat test, endocrinology referral and/or CCS referral*

Cholesterol > 170 - < 200 mg/dl (borderline): counsel & repeat test in one year*

Cholesterol ≥ 200 mg/dl (elevated): cardiac referral and/or CCS referral*

*Clinical judgment should be used

Screening Guide

Billing Instructions

Description Code Age Reimbursement

Blood glucose – collection & analysis, or collection & handling

25 5 years through 20 years 11 months

$4.34

Blood/serum cholesterol – collection & analysis or collection & handling

26 5 years through 20 years 11 months

$4.03

Completing the PM160

25

26

Blood glucose

Use Code 25 and/or 26 ONLY if collecting the sample.

Otherwise, denote: “Sent for glucose and/or cholesterol lab.”

LaboratoriesBlood Glucose – Code 25Cholesterol – Code 26

Blood/Serum Cholesterol

Resources

For the AMA 2007 Expert Committee Recommendations, go to:

www.ama-assn.org/ama/pub/category/11759.html

For the AAP policy on lipid screening and heart health in children, go to:

www.aap.org/advocacy/releases/july08lipidscreening.htm

American Diabetes Association: Type 2 Diabetes in Children and Adolescents. Pediatrics 105:671-680, 2000

Summary

Lab screening is necessary to provide quality care for children who are overweight/obese

Glucose and cholesterol screening facilitates early identification of children who are at risk for diabetes and cardiovascular disease

Abnormal lab results can help guide providers to

initiate early intervention and/or referral to treatment