Case-Based Review

Adolescent Obesity and Its Risks: How to Screen and When to Refer

Journal of Clinical Outcomes Management. 2014 February;21(2)

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Case Conclusion

The patient was referred to a multidisciplinary obesity clinic where he and his family met with dietician, exercise physiologist, health psychologist, and endocrinologist. Healthy lifestyle modifications with specific goals were instituted, including elimination of all calorie-containing beverages (except daily recommended intake of fat-free milk) and initiation of physical activity for 30 minutes a day 5 days per week. He was started on metformin due to glucose intolerance and increased risk for diabetes. Follow-up occurred at monthly intervals for the first 3 months. Additional goals and lifestyle interventions were implemented at each follow-up. At 6 months’ follow-up, the patient’s height was 164 cm, weight was stable at 58.4 kg and BMI was 21.7 (79th percentile). Blood pressure was slightly improved at 123/80 mm Hg. Repeat labs showed mild but consistent improvement in all areas. Specifically, fasting glucose 100 mg/dL, fasting insulin 40 uIU/mL, HgA1C 5.6%, total cholesterol 162 mg/dL, HDL cholesterol 40 mg/dL, LDL cholesterol 105 mg/dL, triglycerides 140 mg/dL, and ALT 38 u/L. The patient continues to be monitored closely with goal to improve metabolic health and long-term health outcomes.

Summary

Childhood obesity is a major public health concern. The health impact of obesity on children is broad and profound. Since treatment of obesity is often unsuccessful, prevention of obesity or early detection of its health consequences are crucial responsibilities and opportunities for primary care clinicians. While clinical guidelines can be instructive, application of clinical guidelines must be tailored to individual adolescent patients according to accompanying risk factors. This review aims to help clinicians stratify risk based on susceptibility to development of insulin resistance and other morbidities associated with adolescent obesity. While the enormity of the obesity epidemic can appear overwhelming to primary care providers, they remain in the best position to initiate early intervention strategies. Coordinating care between primary care providers and specialty clinics will continue to be an important partnership for the care of those experiencing health-threatening effects of adolescent obesity.

Corresponding author: Aaron L Carrel, MD, University of Wisconsin, 600 Highland Ave, H4-436, Madison, WI 53792.

Financial disclosures: Drs. Seibert and Carrel have received fellowship grants from Genentech.